Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy.

Publication date: Jul 03, 2023

Longitudinal data on COVID-19 messenger RNA (mRNA) vaccine reactogenicity and immunogenicity in pregnancy and for the mother-infant dyad are needed. To examine COVID-19 mRNA vaccine reactogenicity and immunogenicity in pregnancy and observe longitudinal maternal and infant outcomes. 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. COVID-19 mRNA vaccination at any time during pregnancy. 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. 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. 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.

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Concepts Keywords
Biontech Adverse
California Blood
Neonatal Covid


Type Source Name
disease MESH COVID-19
disease VO vaccination
disease VO vaccine
disease VO vaccine dose
disease VO time
disease IDO blood
disease VO dose
disease VO vaccinated
disease IDO immune response
drug DRUGBANK Methylphenidate
disease MESH pregnancy complications
disease MESH preeclampsia
disease MESH gestational hypertension
disease MESH gestational diabetes
disease MESH chorioamnionitis
disease MESH infections
drug DRUGBANK Edetic Acid
drug DRUGBANK Etoperidone
disease IDO assay
disease VO protocol
disease VO efficiency
disease VO titer
drug DRUGBANK Sodium lauryl sulfate
disease IDO symptom
disease IDO infection
disease VO population
disease MESH fetal anomaly
disease MESH breakthrough infections
disease VO injection
disease IDO site
disease MESH erythema
disease VO antibody titer

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