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CME / CE

Do Maternal Antibodies Against COVID-19 Protect the Newborn?

  • Authors: MDEdge News Author: Jake Remaly; CME Author: Laurie Barclay, MD
  • CME / CE Released: 11/12/2021
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 11/12/2022
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Target Audience and Goal Statement

This activity is intended for family medicine/primary care practitioners, nurses, obstetricians/gynecologists, pediatricians, pharmacists, and other members of the healthcare team for pregnant women and their offspring.

The goal of this activity is to describe transplacental antibody transmission and levels of detectable antibodies in cord blood in women vaccinated against COVID-19 during pregnancy, according to a prospective study of pregnant women who received at least 1 dose of either messenger RNA (mRNA) COVID-19 vaccine (Pfizer-BioNTech or Moderna) from time of FDA Emergency Use Authorization to June 4.

Upon completion of this activity, participants will:

  • Describe transplacental antibody transmission and levels of detectable antibodies in cord blood in women vaccinated against COVID-19 during pregnancy, according to a prospective study
  • Identify clinical implications of transplacental antibody transmission and levels of detectable antibodies in cord blood in women vaccinated against COVID-19 during pregnancy, according to a prospective study
  • Outline implications for the healthcare team


Disclosures

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Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


MDEdge News Author

  • Jake Remaly

    Disclosures

    Disclosure: Jake Remaly has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

CE Reviewer

  • Esther Nyarko, PharmD

    Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.


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  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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CME / CE

Do Maternal Antibodies Against COVID-19 Protect the Newborn?

Authors: MDEdge News Author: Jake Remaly; CME Author: Laurie Barclay, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / CE Released: 11/12/2021

Valid for credit through: 11/12/2022

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Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

The primary goal of vaccinations administered during pregnancy is to protect the mother from serious illness. Transplacental antibody transfer could also protect newborns, but some women have unfounded concerns regarding the safety of the COVID-19 vaccine during pregnancy.

Study Synopsis and Perspective

Women who receive COVID-19 vaccines during pregnancy pass antibodies to their babies, which could protect newborns from the disease, research has shown.

In a new study that examines umbilical cord blood from 36 deliveries, researchers provide additional evidence that vaccines -- and not COVID-19 -- elicited the antibodies detected in this cohort.

Researchers with New York University (NYU) Langone Health conducted a study that included pregnant women who had received at least 1 dose of a messenger RNA (mRNA) COVID-19 vaccine (Pfizer-BioNTech or Moderna) by June 4.

All neonates had antibodies to the spike protein at high titers, the researchers found.

Unlike similar prior studies, the researchers also looked for antibodies to the nucleocapsid protein, which would have indicated the presence of antibodies from natural COVID-19. They did not detect antibodies to the nucleocapsid protein, and the lack of these antibodies suggests that the antibodies to the spike protein resulted from vaccination and not from prior infection, the researchers said.

The participants had a median time from completion of the vaccine series to delivery of 13 weeks. The study was published online in the American Journal of Obstetrics & Gynecology MFM.[1]

"The presence of these anti-spike antibodies in the cord blood should, at least in theory, offer these newborns some degree of protection," said study investigator Ashley S. Roman, MD, director of the division of maternal-fetal medicine at NYU Langone Health. "While the primary rationale for vaccination during pregnancy is to keep moms healthy and keep moms out of the hospital, the outstanding question to us was whether there is any fetal or neonatal benefit conferred by receiving the vaccine during pregnancy."

Questions remain about the degree and durability of protection for newborns from these antibodies. An ongoing study, MOMI-VAX,[2] aims to systematically measure antibody levels in mothers who receive COVID-19 vaccines during pregnancy and in their babies over time.

The present study contributes welcome preliminary evidence suggesting a benefit to infants, said Emily Adhikari, MD, of The University of Texas Southwestern Medical Center in Dallas, Texas, who was not involved in the study.

Still, "the main concern and our priority as obstetricians is to vaccinate pregnant women to protect them from severe or critical illness," she said.

Although most individuals infected with SARS-CoV-2 recover, a significant portion of pregnant women get seriously sick, Adhikari said. "With this recent Delta surge, we are seeing more pregnant patients who are sicker," said Adhikari, who has published research from one hospital describing this trend.[3]

When weighing whether patients should receive COVID-19 vaccines in pregnancy, the risks from infection have outweighed any risk from vaccination to such an extent that there is "not a comparison to make," Adhikari said. "The risks of the infection are so much higher.

"For me, it is a matter of making sure that my patient understands that we have really good safety data on these vaccines and there is no reason to think that a pregnant person would be harmed by them. On the contrary, the benefit is to protect and maybe even save your life," Adhikari said, "[a]nd now we have more evidence that the fetus may also benefit."

The rationale for vaccinations during pregnancy can vary, Roman said. Flu shots in pregnancy are intended to protect the mother, although they confer protection for newborns as well. With the whooping cough vaccine given in the third trimester, however, the primary aim is to protect the baby from whooping cough in the first months of life, Roman said.

"I think it is really important for pregnant women to understand that antibodies crossing the placenta is a good thing," she added.

As patients who already have received COVID-19 vaccines become pregnant and may become eligible for a booster dose, Adhikari will offer it, she said, though she has confidence in the protection provided by the initial immune response.

Roman and Adhikari had no disclosures.

Study Highlights

  • In this prospective study, pregnant women identified from electronic medical record search and recruited by email received ≥ 1 dose of either mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) from time of FDA Emergency Use Authorization to June 4.
  • Investigators analyzed umbilical cord blood collected at delivery from 36 deliveries for both anti-N and anti-S IgG.
  • All 36 (100%) neonates were positive for anti-S IgG at high titers: 34 with a titer > 250 U/mL and 2 with titers of 201 U/mL and 249 U/mL.
  • Median interval from vaccine series completion to delivery was 13 (range, 5.9-24.9) weeks.
  • Both mothers of infants with cord blood titers < 250 U/mL received their second vaccine dose > 20 weeks before delivery.
  • 3 additional women had a > 20-week interval from vaccination to delivery, but their infants had anti-S IgG titers > 250 U/mL.
  • Researchers also tested 31 of the 36 samples for anti-N IgG, and all were negative.
  • 35 of the 36 women received both vaccine doses before delivery.
  • The infant whose mother received only 1 dose was still positive for anti-S IgG at a titer > 250 U/mL.
  • The investigators concluded that their findings indicate transplacental antibody transfer from mRNA COVID-19 vaccination during pregnancy, with high levels of anti-S IgG in all cord blood specimens.
  • In light of positive anti-S IgG and negative anti-N IgG, the neonatal antibodies reflect vertical transfer of antibodies from maternal vaccination rather than natural infection.
  • This is a novel finding, differentiating passive immunity from natural infection and conferred immunity from mRNA vaccination.
  • Only moderately high anti-S IgG titers in 2 women with longer latency between vaccination and delivery suggests that cord blood antibody level may correlate with time interval from vaccine receipt to delivery.
  • The investigators recommend further research to determine if vaccination in the second half of pregnancy provides higher levels of antibody transfer than vaccination earlier in pregnancy.
  • Other studies have shown that high anti-S IgG levels correlate with immune protection against SARS-CoV-2.
  • High anti-S IgG levels in cord blood suggest infant protection, at least during the neonatal period.
  • This is important as it suggests the potential for protection of infants exposed to family members or caretakers who have not COVID-19 vaccination, such as siblings too young to be vaccinated.
  • Study limitations include lack of maternal blood analysis to correlate maternal and neonatal antibody levels.
  • Despite evidence of prenatal vaccine safety, recent data suggest that only 16.3% of pregnant women have been vaccinated.
  • Although most recommendations on the importance of vaccination during pregnancy reflect concern for pregnancy as a risk factor for severe COVID-19 illness in the mother, these findings add novel support for vaccinating pregnant women, including neonatal benefit and potential protection from COVID-19 illness in the first days of life.
  • Future research should examine vertical antibody transmission in a larger population and durability of antibody detection during infancy.

Clinical Implications

  • mRNA COVID-19 vaccination during pregnancy results in transplacental antibody transfer.
  • Positive anti-S IgG and negative anti-N IgG in cord blood reflect vertical transfer of antibodies from maternal vaccination rather than natural infection.
  • Implications for the Healthcare Team: These study findings add novel support for providing education to and vaccinating pregnant women, including neonatal benefit and potential protection from COVID-19 illness in the first days of life.

 

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