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- Title
COVID-19 mRNA vaccines drive differential antibody Fc-functional profiles in pregnant, lactating, and nonpregnant women.
- Authors
Atyeo, Caroline; DeRiso, Elizabeth A.; Davis, Christine; Bordt, Evan A.; De Guzman, Rose M.; Shook, Lydia L.; Yonker, Lael M.; Fasano, Alessio; Akinwunmi, Babatunde; Lauffenburger, Douglas A.; Elovitz, Michal A.; Gray, Kathryn J.; Edlow, Andrea G.; Alter, Galit
- Abstract
COVID-19 and pregnancy: Pregnancy results in systemic changes to the maternal immune system that cause distinct responses to infection or vaccination. Here, Bordt et al. and Atyeo et al. investigated how pregnancy influences the immune response to infection with or vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bordt et al. characterized placental immune responses in women who were infected with SARS-CoV-2 during pregnancy. The authors observed differential placental immune responses between male and female fetuses that were associated with reduced antibody transfer to male fetuses. Atyeo et al. evaluated immune responses to mRNA vaccination in women who were pregnant, lactating, or not pregnant. The authors found that two doses of vaccine were required for pregnant or lactating women to achieve immune responses comparable to that of nonpregnant women. An accompanying Focus article discusses these findings and the need for vaccination against SARS-CoV-2 during pregnancy. Substantial immunological changes occur throughout pregnancy to render the mother immunologically tolerant to the fetus and allow fetal growth. However, additional local and systemic immunological adaptations also occur, allowing the maternal immune system to continue to protect the dyad against pathogens both during pregnancy and after birth through lactation. This fine balance of tolerance and immunity, along with physiological and hormonal changes, contributes to increased susceptibility to particular infections in pregnancy, including more severe coronavirus disease 2019 (COVID-19). Whether these changes also make pregnant women less responsive to vaccination or induce altered immune responses to vaccination remains incompletely understood. To define potential changes in vaccine response during pregnancy and lactation, we undertook deep sequencing of the humoral vaccine response in a group of pregnant and lactating women and nonpregnant age-matched controls. Vaccine-specific titers were comparable between pregnant women, lactating women, and nonpregnant controls. However, Fc receptor (FcR) binding and antibody effector functions were induced with delayed kinetics in both pregnant and lactating women compared with nonpregnant women after the first vaccine dose, which normalized after the second dose. Vaccine boosting resulted in high FcR-binding titers in breastmilk. These data suggest that pregnancy promotes resistance to generating proinflammatory antibodies and indicates that there is a critical need to follow prime-boost timelines in this vulnerable population to ensure full immunity is attained.
- Subjects
COVID-19 vaccines; LACTATION; COVID-19; MATERNALLY acquired immunity; VACCINE effectiveness; IMMUNE response
- Publication
Science Translational Medicine, 2021, Vol 13, Issue 617, p1
- ISSN
1946-6234
- Publication type
Article
- DOI
10.1126/scitranslmed.abi8631