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Pediatr Infect Dis J
. 2024 Nov 1;43(11):1065-1073.
doi: 10.1097/INF.0000000000004510. Epub 2024 Aug 13. Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum
Flor M Munoz 1 , Richard Beigi 2 , Christine M Posavad 3 , Clifton Kelly 4 , Martina L Badell 5 , Katherine Bunge 2 , Mark J Mulligan 6 , Lalitha Parameswaran 6 , Barbra A Richardson 7 , Courtney Olsen-Chen 8 , Richard M Novak 9 , Rebecca C Brady 10 , Emily DeFranco 10 , Jeffrey S Gerber 11 , Mallory Shriver 12 , Mehul S Suthar 13 , Rhea Coler 14 , Bryan J Berube 14 , So Hee Kim 4 , Jeanna M Piper 15 , Joy Miedema 16 , Marcela Pasetti 12 , Kathleen M Neuzil 12 , Cristina V Cardemil 15 ; DMID Study Group
Affiliations
Background: Following maternal COVID-19 vaccination, the persistence of antibodies in sera and breast milk for mothers and infants is not well characterized. We sought to describe the persistence of antibodies through 2 months after delivery in maternal and infant serum and breast milk following maternal COVID-19 mRNA vaccination and to examine differences by receipt of booster dose during pregnancy or postpartum.
Methods: This is a prospective cohort study with enrollment from July 2021 to January 2022 at 9 US academic sites. Pregnant or postpartum participants and their infants were enrolled after COVID-19 mRNA monovalent vaccination during pregnancy (primary 2-dose series) with booster (third dose) vaccination during pregnancy or within 2 months post-partum. SARS-CoV-2-binding and functional antibody responses at delivery and 2 months after delivery in mothers and infants were measured by spike and receptor-binding domain immunoglobulin (Ig) G, pseudovirus and live neutralizing antibody (nAb) titers to ancestral and Omicron BA.1 and BA.5 strains. Breast milk spike and receptor-binding domain IgG and IgA titers were also measured.
Results: A total of 237 maternal/infant dyads were included (110 primary series during pregnancy, 99 pregnancy booster and 28 postpartum booster). A pregnancy booster resulted in 2.2-4.7-fold higher IgG and nAb at delivery and 2 months for both mothers and infants compared to the primary series alone (P < 0.001 for all comparisons). While infant IgG and nAb titers decreased by 2 months of age, the proportion of infants with detectable nAb at 2 months was greater in infants of mothers boosted during pregnancy compared with primary series for all variants (D614G: 99% vs. 56%; BA.1: 56% vs. 4% and BA.5: 57% vs. 9%; P < 0.001 for all comparisons). Breast milk spike IgA and IgG were present in 64%-100% and 100% of participants, respectively, and those boosted during pregnancy or postpartum had 3.1-4.6-fold higher levels of breast milk antibodies at 2 months compared to primary series during pregnancy (P < 0.001).
Conclusions: mRNA COVID-19 monovalent booster vaccination during pregnancy results in significantly higher maternal and infant serum-binding IgG and nAb titers compared to a primary 2-dose series, including against Omicron variants, through 2 months of age. Breast milk antibodies following maternal vaccination during pregnancy or postpartum may provide additional protection during early infancy.
. 2024 Nov 1;43(11):1065-1073.
doi: 10.1097/INF.0000000000004510. Epub 2024 Aug 13. Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum
Flor M Munoz 1 , Richard Beigi 2 , Christine M Posavad 3 , Clifton Kelly 4 , Martina L Badell 5 , Katherine Bunge 2 , Mark J Mulligan 6 , Lalitha Parameswaran 6 , Barbra A Richardson 7 , Courtney Olsen-Chen 8 , Richard M Novak 9 , Rebecca C Brady 10 , Emily DeFranco 10 , Jeffrey S Gerber 11 , Mallory Shriver 12 , Mehul S Suthar 13 , Rhea Coler 14 , Bryan J Berube 14 , So Hee Kim 4 , Jeanna M Piper 15 , Joy Miedema 16 , Marcela Pasetti 12 , Kathleen M Neuzil 12 , Cristina V Cardemil 15 ; DMID Study Group
Affiliations
- PMID: 39774938
- PMCID: PMC11711698 (available on 2025-11-01)
- DOI: 10.1097/INF.0000000000004510
Background: Following maternal COVID-19 vaccination, the persistence of antibodies in sera and breast milk for mothers and infants is not well characterized. We sought to describe the persistence of antibodies through 2 months after delivery in maternal and infant serum and breast milk following maternal COVID-19 mRNA vaccination and to examine differences by receipt of booster dose during pregnancy or postpartum.
Methods: This is a prospective cohort study with enrollment from July 2021 to January 2022 at 9 US academic sites. Pregnant or postpartum participants and their infants were enrolled after COVID-19 mRNA monovalent vaccination during pregnancy (primary 2-dose series) with booster (third dose) vaccination during pregnancy or within 2 months post-partum. SARS-CoV-2-binding and functional antibody responses at delivery and 2 months after delivery in mothers and infants were measured by spike and receptor-binding domain immunoglobulin (Ig) G, pseudovirus and live neutralizing antibody (nAb) titers to ancestral and Omicron BA.1 and BA.5 strains. Breast milk spike and receptor-binding domain IgG and IgA titers were also measured.
Results: A total of 237 maternal/infant dyads were included (110 primary series during pregnancy, 99 pregnancy booster and 28 postpartum booster). A pregnancy booster resulted in 2.2-4.7-fold higher IgG and nAb at delivery and 2 months for both mothers and infants compared to the primary series alone (P < 0.001 for all comparisons). While infant IgG and nAb titers decreased by 2 months of age, the proportion of infants with detectable nAb at 2 months was greater in infants of mothers boosted during pregnancy compared with primary series for all variants (D614G: 99% vs. 56%; BA.1: 56% vs. 4% and BA.5: 57% vs. 9%; P < 0.001 for all comparisons). Breast milk spike IgA and IgG were present in 64%-100% and 100% of participants, respectively, and those boosted during pregnancy or postpartum had 3.1-4.6-fold higher levels of breast milk antibodies at 2 months compared to primary series during pregnancy (P < 0.001).
Conclusions: mRNA COVID-19 monovalent booster vaccination during pregnancy results in significantly higher maternal and infant serum-binding IgG and nAb titers compared to a primary 2-dose series, including against Omicron variants, through 2 months of age. Breast milk antibodies following maternal vaccination during pregnancy or postpartum may provide additional protection during early infancy.