Maternal–Fetal Transfer of Anti-SARS-CoV-2 Antibodies in Amniotic Fluid: Insights from Maternal Vaccination and COVID-19 Infection

Author:

Sgayer Inshirah12ORCID,Odeh Marwan12,Gal-Tanamy Meital2ORCID,Shehadeh Mona23ORCID,Rechnitzer Hagai24ORCID,Haddad Yousef1,Hamoudi Rudi1,Mousa Nisreen Kinaani5,Dakwar Vivian Abu Uksa5,Wolf Maya Frank12,Falik Zaccai Tzipora C.25,Lowenstein Lior12

Affiliation:

1. Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya 22000, Israel

2. Azrieli Faculty of Medicine, Bar Ilan University, Safed 13100, Israel

3. Clinical Laboratories Division, Galilee Medical Center, Nahariya 22000, Israel

4. Clinical Microbiology, Galilee Medical Center, Nahariya 22000, Israel

5. Institute of Human Genetics, Galilee Medical Center, Nahariya 22000, Israel

Abstract

Objectives: As the COVID-19 pandemic wanes, understanding maternal–fetal antibody transfer remains crucial for optimizing vaccination strategies. This study evaluates anti-SARS-CoV-2 antibody levels in amniotic fluid following maternal BNT162b2 mRNA vaccination and/or COVID-19 infection during early pregnancy, focusing on the first and second trimesters. Methods: A retrospective cohort study was conducted at a tertiary university-affiliated hospital, involving 149 pregnant women who underwent amniocentesis. Anti-SARS-CoV-2 spike IgG levels were measured in amniotic fluid samples. Participants were categorized based on vaccination and infection status: vaccine-only, infection-only, vaccine + infection, and no vaccine/infection. Correlations between antibody levels and the time since vaccination or infection were analyzed. Results: The vaccine + infection group had a higher proportion of positive antibody levels compared to the vaccine-only group (63.6% vs. 35.9%, p = 0.029). Median SARS-CoV-2 IgG levels were significantly higher in the vaccine + infection group (283.0 AU/mL) than in the vaccine-only group (64.1 AU/mL, p = 0.006). Women who received three vaccine doses had higher antibody levels and more positive antibody rates compared to those with one or two doses. A significant negative correlation was found between antibody levels and the interval since the last vaccine dose or infection. Conclusions: Our results indicate the presence of anti-SARS-CoV-2 antibodies in the amniotic fluid, reflecting antibody transfer during early pregnancy. However, a noticeable decrease in immunity was observed, as indicated by declining amniotic fluid antibody levels over time. Further studies are needed to determine the optimal timing and number of boosters required to protect against new variants of SARS-CoV-2.

Publisher

MDPI AG

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