Antibody Levels in Thai Pregnant Women and Cord Blood Following Heterologous COVID-19 Vaccination
Abstract
Objective: To assess maternal and cord blood SARS-CoV-2 anti-receptor binding domain (RBD) immunoglobulin G (IgG) levels in Thai pregnant women following different COVID-19 vaccine regimens, and identify factors influencing these levels.
Material and Methods: A cross-sectional study was conducted at a quaternary care hospital in Thailand between April 2022 and February 2023 to evaluate anti-RBD IgG levels at delivery among singleton pregnant women. Participants received either two doses of COVID-19 vaccines, ChAdOx1, BNT162b2, or mRNA-1273 in any combination, or three doses, with one of these vaccines administered as the final dose. Spearman’s correlation was used to assess the relationship between the maternal and cord blood antibody levels. Non-linear least squares regression estimated the effect of time since the last vaccination, while multivariable models identified factors influencing antibody concentrations. Significance was set at p-value<0.05.
Results: Eighty-five pregnant women were enrolled. Median (interquartile ranges [IQR]) SARS-CoV-2 anti-RBD IgG levels were 1,123 (552–2,707) AU/mL in maternal blood and 2,100 (888–4,687) AU/mL in cord blood (BAU/mL=AU/mL×0.142), with a positive correlation and an antibody transfer ratio of 1.63. From the second trimester, shorter intervals since the last vaccine dose were linked to higher antibody levels—maternal levels rose by 14% per week and cord levels by 17.8% (p-value=0.016). Maternal obesity was associated with lower antibody levels. The highest levels were seen with a regimen of one inactivated and two viral vector vaccines.
Conclusion: Maternal and cord blood anti-RBD IgG levels were positively correlated and influenced by vaccine timing, regimen, and maternal obesity.
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