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

• Published in: JAMA network open 2023-07, Vol.6 (7), p.e2323405
• Main Authors: Cassidy, Arianna G, Li, Lin, Golan, Yarden, Gay, Caryl, Lin, Christine Y, Jigmeddagva, Unurzul, Chidboy, Megan A, Ilala, Mikias, Buarpung, Sirirak, Gonzalez, Veronica J, Basilio, Emilia, Duck, Meghan, Murtha, Amy P, Wu, Alan H B, Lynch, Kara L, Asiodu, Ifeyinwa V, Prahl, Mary K, Gaw, Stephanie L
• Format: Article
• Language: English
• Subjects: Adult; BNT162 Vaccine; Cohort analysis; Cohort Studies; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - adverse effects; Drug dosages; Female; Humans; Immunoglobulin A; Immunoglobulin G; Infant; Infant, Newborn; Mothers; Obstetrics and Gynecology; Online Only; Original Investigation; Pregnancy; Prospective Studies; Vaccination - adverse effects
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2023.23405

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 remaine