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Pregnant women with COVID-19 are at risk for worse outcomes than nonpregnant women. To better understand the interaction between pregnancy, the fetus, and SARS-CoV-2 infection, investigators in Boston enrolled 127 pregnant women (64 with virologically confirmed SARS-CoV-2 and 63 without such infection). Women with COVID-19 were more likely to be Latinx, have higher body-mass index, and have public health insurance. About one third were asymptomatic, one third had mild disease and one third had moderate or severe disease.
No newborns or placentas tested positive for SARS-CoV-2. Most women with SARS-CoV-2 infection had detectable antibodies against the coronavirus spike protein and the nucleocapsid antigen, and most cord blood samples also had antibodies. However, the level of antibody to SARS-CoV-2 in cord blood was lower than in maternal blood. By contrast, the amount of antibody to influenza was enriched in cord blood relative to maternal blood.
Edlow AG et al. Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic. JAMA Netw Open 2020 Dec 22; 3:e2030455. (https://doi.org/10.1001/jamanetworkopen.2020.30455)
Comment
This carefully executed study confirms that newborns are rarely affected directly by SARS-CoV-2 infection despite even severe disease in their mothers. I am surprised by the finding of inefficient transfer of antibodies to the neonate, which contrasts with the robust transfer of antibodies to influenza. As the authors point out, infants born to SARS-CoV-2–infected women remain at risk and further studies are needed — particularly to examine the transfer of vaccine-induced antibodies from mothers to neonates.