Background

Although emerging data during the SARS-CoV-2 pandemic have demonstrated robust messenger RNA vaccine–induced immunogenicity across populations, including pregnant and lactating individuals, the rapid waning of vaccine-induced immunity and the emergence of variants of concern motivated the use of messenger RNA vaccine booster doses. Whether all populations, including pregnant and lactating individuals, will mount a comparable response to a booster dose is not known.

Objective

This study aimed to profile the humoral immune response to a COVID-19 messenger RNA booster dose in a cohort of pregnant, lactating, and nonpregnant age-matched women.

Study Design

This study characterized the antibody response against ancestral Spike and Omicron in a cohort of 31 pregnant, 12 lactating, and 20 nonpregnant age-matched controls who received a BNT162b2 or messenger RNA-1273 booster dose after primary COVID-19 vaccination. In addition, this study examined the vaccine-induced antibody profiles of 15 maternal-to-cord dyads at delivery.

Results

Receiving a booster dose during pregnancy resulted in increased immunoglobulin G1 levels against Omicron Spike (postprimary vaccination vs postbooster dose; P=.03). Pregnant and lactating individuals exhibited equivalent Spike-specific total immunoglobulin G1, immunoglobulin M, and immunoglobulin A levels and neutralizing titers against Omicron compared with nonpregnant women. Subtle differences in Fc receptor binding and antibody subclass profiles were observed in the immune response to a booster dose in pregnant vs nonpregnant individuals. The analysis of maternal and cord antibody profiles at delivery demonstrated equivalent total Spike-specific immunoglobulin G1 in maternal and cord blood, yet higher Spike-specific FcγR3a-binding antibodies in the cord relative to maternal blood (P=.002), consistent with the preferential transfer of highly functional immunoglobulin. Spike-specific immunoglobulin G1 levels in the cord were positively correlated with the time elapsed since receiving the booster dose (Spearman R, .574; P=.035).

Conclusion

Study data suggested that receiving a booster dose during pregnancy induces a robust Spike-specific humoral immune response, including against Omicron. If boosting occurs in the third trimester of pregnancy, higher Spike-specific cord immunoglobulin G1 levels are achieved with greater time elapsed between receiving the booster and delivery. Receiving a booster dose has the potential to augment maternal and neonatal immunity.

中文翻译：

---

COVID-19 加强剂量可在孕妇、哺乳期和非孕妇中诱导强烈的抗体反应

背景

尽管 SARS-CoV-2 大流行期间的新数据表明，信使 RNA 疫苗在人群（包括孕妇和哺乳期个体）中诱导的免疫原性很强，但疫苗诱导的免疫力的迅速减弱和令人担忧的变体的出现促使人们使用信使 RNA疫苗加强剂量。目前尚不清楚是否所有人群（包括孕妇和哺乳期个体）都会对加强剂量产生类似的反应。

客观的

本研究旨在分析一组孕妇、哺乳期和非孕妇年龄匹配的女性对 COVID-19 信使 RNA 加强剂量的体液免疫反应。

学习规划

这项研究在 31 名孕妇、12 名哺乳期和 20 名年龄匹配的非怀孕对照者中表征了针对祖先 Spike 和 Omicron 的抗体反应，这些对照者在初次 COVID-19 疫苗接种后接受了 BNT162b2 或信使 RNA-1273 加强剂量。此外，这项研究还检查了 15 名母体与脐带双体在分娩时疫苗诱导的抗体谱。

结果

怀孕期间接受加强剂量会导致针对 Omicron Spike 的免疫球蛋白 G1 水平升高（初次疫苗接种后与加强剂量后比较；P = 0.03）。与非孕妇相比，孕妇和哺乳期个体表现出相同的 Spike 特异性总免疫球蛋白 G1、免疫球蛋白 M 和免疫球蛋白 A 水平以及针对 Omicron 的中和滴度。在怀孕与非怀孕个体对加强剂量的免疫反应中观察到 Fc 受体结合和抗体亚类谱的细微差异。对分娩时母体和脐带抗体谱的分析表明，母体和脐带血中的总 Spike 特异性免疫球蛋白 G1 相当，但脐带中的 Spike 特异性 FcγR3a 结合抗体相对于母体血液更高 (P = .002)，这与高功能免疫球蛋白的优先转移。脊髓中的尖峰特异性免疫球蛋白 G1 水平与接受加强剂量后经过的时间呈正相关（Spearman R，.574；P =.035）。

结论

研究数据表明，怀孕期间接受加强剂量会诱导强烈的尖峰特异性体液免疫反应，包括针对 Omicron 的免疫反应。如果在妊娠晚期进行加强免疫，则在接受加强免疫和分娩之间的时间间隔更长时，可以达到更高的 Spike 特异性脐带免疫球蛋白 G1 水平。接受加强剂量有可能增强孕产妇和新生儿的免疫力。