TY - JOUR T1 - Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: prospective cohort study JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2021-053036 VL - 11 IS - 7 SP - e053036 AU - Dongli Song AU - Mary Prahl AU - Stephanie L Gaw AU - Sudha Rani Narasimhan AU - Daljeet S Rai AU - Angela Huang AU - Claudia V Flores AU - Christine Y Lin AU - Unurzul Jigmeddagva AU - Alan Wu AU - Lakshmi Warrier AU - Justine Levan AU - Catherine B T Nguyen AU - Perri Callaway AU - Lila Farrington AU - Gonzalo R Acevedo AU - Veronica J Gonzalez AU - Anna Vaaben AU - Phuong Nguyen AU - Elda Atmosfera AU - Constance Marleau AU - Christina Anderson AU - Sonya Misra AU - Monica Stemmle AU - Maria Cortes AU - Jennifer McAuley AU - Nicole Metz AU - Rupalee Patel AU - Matthew Nudelman AU - Susan Abraham AU - James Byrne AU - Priya Jegatheesan Y1 - 2021/07/01 UR - http://bmjopen.bmj.com/content/11/7/e053036.abstract N2 - Objective To investigate maternal immunoglobulins’ (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterise neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively and passively acquired antibodies in infants.Design A prospective observational study.Setting Public healthcare system in Santa Clara County (California, USA).Participants Women with symptomatic or asymptomatic SARS-CoV-2 infection during pregnancy and their infants were enrolled between 15 April 2020 and 31 March 2021.Outcomes SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life.Results Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and 8 with severe-critical symptoms. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56% to 0.73%) and the cord blood was 58% (95% CI 0.49% to 0.66%). IgG levels significantly correlated between the maternal and cord blood (Rs=0.93, p<0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60–180 days before delivery compared with <60 days (1.2 vs 0.6, p<0.0001). Infant IgG seroreversion rates over follow-up periods of 1–4, 5–12, and 13–28 weeks were 8% (4 of 48), 12% (3 of 25), and 38% (5 of 13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to 6 months of age. Two newborns showed seroconversion at 2 weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection.Conclusions Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than 2 months before delivery. Maternally derived passive immunity may persist in infants up to 6 months of life. Neonates are capable of mounting a strong antibody response to perinatal SARS-CoV-2 infection.Data are available in a public, open access repository. De-identified data are published in Mendeley data sharing site and available in the following: doi:10.17632/6scfwt55fd.2. ER -