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Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy.
JAMA Netw Open. 2023 Jul 03; 6(7):e2323405.JN

Abstract

Importance

Longitudinal data on COVID-19 messenger RNA (mRNA) vaccine reactogenicity and immunogenicity in pregnancy and for the mother-infant dyad are needed.

Objective

To examine COVID-19 mRNA vaccine reactogenicity and immunogenicity in pregnancy and observe longitudinal maternal and infant outcomes.

Design, Setting, and Participants

This prospective cohort study of pregnant individuals enrolled in the COVID-19 Vaccination in Pregnancy and Lactation study from December 1, 2020, through December 31, 2021, with follow-up through March 31, 2022, was conducted at a large academic medical center in an urban metropolitan area in California. Pregnant individuals receiving COVID-19 mRNA vaccines (mRNA-1273 [Moderna] and BNT162b2 [Pfizer-BioNTech]) were eligible. Of 81 participants enrolled, 5 were excluded after enrollment: 1 terminated pregnancy, 1 received the third vaccine dose prior to delivery, and 3 delivered prior to completing the initial vaccine series.

Exposure

COVID-19 mRNA vaccination at any time during pregnancy.

Main Outcomes and Measures

The primary outcomes were vaccine response as measured by blood Immunoglobulin G (IgG) titers after each vaccine dose and self-reported postvaccination symptoms. Patients' IgG titers were measured in cord blood and in infant blood at intervals up to 1 year of life; IgG and IgA titers were measured in maternal milk. Clinical outcomes were collected from medical records.

Results

Of 76 pregnant individuals included in final analyses (median [IQR] maternal age, 35 [29-41] years; 51 [67.1%] White; 28 [36.8%] primigravid; 37 [48.7%] nulliparous), 42 (55.3%) received BNT162b2 and 34 (44.7%) received mRNA-1237. There were no significant differences in maternal characteristics between the 2 vaccine groups. Systemic symptoms were more common after receipt of the second vaccine dose than after the first dose (42 of 59 [71.2%] vs 26 of 59 [44.1%]; P = .007) and after mRNA-1237 than after BNT162b2 (25 of 27 [92.6%] vs 17 of 32 53.1%; P = .001). Systemic symptoms were associated with 65.6% higher median IgG titers than no symptoms after the second vaccine dose (median [IQR], 2596 [1840-4455] vs 1568 [1114-4518] RFU; P = .007); mean cord titers in individuals with local or systemic symptoms were 6.3-fold higher than in individuals without symptoms. Vaccination in all trimesters elicited a robust maternal IgG response. The IgG transfer ratio was highest among individuals vaccinated in the second trimester. Anti-SARS-CoV-2 IgG was detectable in cord blood regardless of vaccination trimester. In milk, IgG and IgA titers remained above the positive cutoff for at least 5-6 months after birth, and infants of mothers vaccinated in the second and third trimesters had positive IgG titers for at least 5 to 6 months of life. There were no vaccine-attributable adverse perinatal outcomes.

Conclusions and Relevance

The findings of this cohort study suggest that mRNA COVID-19 vaccination in pregnancy provokes a robust IgG response for the mother-infant dyad for approximately 6 months after birth. Postvaccination symptoms may indicate a more robust immune response, without adverse maternal, fetal, or neonatal outcomes.

Links

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Authors+Show Affiliations

Cassidy AG
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Li L
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Golan Y
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco. Institute for Human Genetics, University of California, San Francisco.
Gay C
Department of Family Health Care Nursing, University of California, San Francisco.
Lin CY
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Jigmeddagva U
Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Chidboy MA
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Ilala M
Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California. Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco.
Buarpung S
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Gonzalez VJ
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Basilio E
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Duck M
UCSF Benioff Children's Hospital, University of California, San Francisco.
Murtha AP
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.
Wu AHB
Department of Laboratory Medicine, University of California, San Francisco.
Lynch KL
Department of Laboratory Medicine, University of California, San Francisco.
Asiodu IV
Department of Family Health Care Nursing, University of California, San Francisco.
Prahl MK
Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco.
Gaw SL
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco.

MeSH

FemaleInfant, NewbornPregnancyInfantHumansAdultCOVID-19 VaccinesBNT162 VaccineMothersCohort StudiesProspective StudiesCOVID-19VaccinationImmunoglobulin AImmunoglobulin G

Pub Type(s)

Journal Article

Language

eng

PubMed ID

37450302

Citation

Cassidy, Arianna G., et al. "Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy." JAMA Network Open, vol. 6, no. 7, 2023, pp. e2323405.
Cassidy AG, Li L, Golan Y, et al. Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy. JAMA Netw Open. 2023;6(7):e2323405.
Cassidy, A. G., Li, L., Golan, Y., Gay, C., Lin, C. Y., Jigmeddagva, U., Chidboy, M. A., Ilala, M., Buarpung, S., Gonzalez, V. J., Basilio, E., Duck, M., Murtha, A. P., Wu, A. H. B., Lynch, K. L., Asiodu, I. V., Prahl, M. K., & Gaw, S. L. (2023). Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy. JAMA Network Open, 6(7), e2323405. https://doi.org/10.1001/jamanetworkopen.2023.23405
Cassidy AG, et al. Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy. JAMA Netw Open. 2023 Jul 3;6(7):e2323405. PubMed PMID: 37450302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy. AU - Cassidy,Arianna G, AU - Li,Lin, AU - Golan,Yarden, AU - Gay,Caryl, AU - Lin,Christine Y, AU - Jigmeddagva,Unurzul, AU - Chidboy,Megan A, AU - Ilala,Mikias, AU - Buarpung,Sirirak, AU - Gonzalez,Veronica J, AU - Basilio,Emilia, AU - Duck,Meghan, AU - Murtha,Amy P, AU - Wu,Alan H B, AU - Lynch,Kara L, AU - Asiodu,Ifeyinwa V, AU - Prahl,Mary K, AU - Gaw,Stephanie L, Y1 - 2023/07/03/ PY - 2023/7/17/medline PY - 2023/7/14/pubmed PY - 2023/7/14/entrez SP - e2323405 EP - e2323405 JF - JAMA network open JO - JAMA Netw Open VL - 6 IS - 7 N2 - Importance: Longitudinal data on COVID-19 messenger RNA (mRNA) vaccine reactogenicity and immunogenicity in pregnancy and for the mother-infant dyad are needed. Objective: To examine COVID-19 mRNA vaccine reactogenicity and immunogenicity in pregnancy and observe longitudinal maternal and infant outcomes. Design, Setting, and Participants: This prospective cohort study of pregnant individuals enrolled in the COVID-19 Vaccination in Pregnancy and Lactation study from December 1, 2020, through December 31, 2021, with follow-up through March 31, 2022, was conducted at a large academic medical center in an urban metropolitan area in California. Pregnant individuals receiving COVID-19 mRNA vaccines (mRNA-1273 [Moderna] and BNT162b2 [Pfizer-BioNTech]) were eligible. Of 81 participants enrolled, 5 were excluded after enrollment: 1 terminated pregnancy, 1 received the third vaccine dose prior to delivery, and 3 delivered prior to completing the initial vaccine series. Exposure: COVID-19 mRNA vaccination at any time during pregnancy. Main Outcomes and Measures: The primary outcomes were vaccine response as measured by blood Immunoglobulin G (IgG) titers after each vaccine dose and self-reported postvaccination symptoms. Patients' IgG titers were measured in cord blood and in infant blood at intervals up to 1 year of life; IgG and IgA titers were measured in maternal milk. Clinical outcomes were collected from medical records. Results: Of 76 pregnant individuals included in final analyses (median [IQR] maternal age, 35 [29-41] years; 51 [67.1%] White; 28 [36.8%] primigravid; 37 [48.7%] nulliparous), 42 (55.3%) received BNT162b2 and 34 (44.7%) received mRNA-1237. There were no significant differences in maternal characteristics between the 2 vaccine groups. Systemic symptoms were more common after receipt of the second vaccine dose than after the first dose (42 of 59 [71.2%] vs 26 of 59 [44.1%]; P = .007) and after mRNA-1237 than after BNT162b2 (25 of 27 [92.6%] vs 17 of 32 53.1%; P = .001). Systemic symptoms were associated with 65.6% higher median IgG titers than no symptoms after the second vaccine dose (median [IQR], 2596 [1840-4455] vs 1568 [1114-4518] RFU; P = .007); mean cord titers in individuals with local or systemic symptoms were 6.3-fold higher than in individuals without symptoms. Vaccination in all trimesters elicited a robust maternal IgG response. The IgG transfer ratio was highest among individuals vaccinated in the second trimester. Anti-SARS-CoV-2 IgG was detectable in cord blood regardless of vaccination trimester. In milk, IgG and IgA titers remained above the positive cutoff for at least 5-6 months after birth, and infants of mothers vaccinated in the second and third trimesters had positive IgG titers for at least 5 to 6 months of life. There were no vaccine-attributable adverse perinatal outcomes. Conclusions and Relevance: The findings of this cohort study suggest that mRNA COVID-19 vaccination in pregnancy provokes a robust IgG response for the mother-infant dyad for approximately 6 months after birth. Postvaccination symptoms may indicate a more robust immune response, without adverse maternal, fetal, or neonatal outcomes. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/37450302/Assessment_of_Adverse_Reactions_Antibody_Patterns_and_12_month_Outcomes_in_the_Mother_Infant_Dyad_After_COVID_19_mRNA_Vaccination_in_Pregnancy_ DB - PRIME DP - Unbound Medicine ER -