Am J Perinatol
DOI: 10.1055/a-2192-0655
Original Article

Investigation of Anti-SARS-CoV-2-specific IgG Levels in Breast Milk after Vaccination or COVID-19 Infection

1   Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayıs University, School of Medicine, Samsun, Turkey
,
2   Department of Medical Microbiology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
,
3   Department of Neonatology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
,
1   Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayıs University, School of Medicine, Samsun, Turkey
,
1   Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayıs University, School of Medicine, Samsun, Turkey
,
2   Department of Medical Microbiology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
,
1   Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayıs University, School of Medicine, Samsun, Turkey
› Author Affiliations

Abstract

Objective Newborns are vulnerable to all types of infections due to their developing immune system. To compensate for their immune immaturity, newborns rely on the passive transfer of antibodies through the placenta and own mother's breast milk (BM). In the present study, we investigated whether vaccination against SARS-CoV-2 leads to the presence of antibodies in BM. Furthermore, we compared the levels of SARS-CoV-2-specific anti-spike (anti-S) IgG antibodies in the BM of mothers who were vaccinated against Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or had coronavirus disease 2019 (COVID-19) infection naturally or were vaccinated after natural infection.

Study Design This was a prospective cohort study conducted in the Ondokuz Mayis University Faculty of Medicine. Forty-six mothers who had at least two doses of the BNT162b2 messenger RNA-based vaccine and/or had a history of symptomatic COVID-19 infection were included in the study. BM samples were analyzed by the Abbott Architect SARS-CoV-2 IgG II Quant kit following the manufacturer's instructions.

Results Forty-six mothers with an average age of 29.7 ± 5.7 years participated the study: 18 (39.1%) had COVID-19 infection + BTN162b2 vaccine, 17 (37.0%) had BTN162b2 vaccine, and 11 (23.9%) had natural infection. The highest SARS-CoV-2-specific anti-S IgG antibody titers in BM were found in mothers who were vaccinated following the infection (anti-SARS-CoV-2 IgG: 32.48 ± 57.1 arbitrary units AU/mL). However, no significant difference in anti-SARS-CoV-2 antibody levels was observed between the three groups (p = 0.641). No antibody was detected in 15.2% of BM samples.

Conclusion Both vaccination and natural COVID-19 infection during pregnancy leads to the passive transfer of specific anti-SARS-CoV-2 IgG antibodies to BM. These results are important to overcome vaccine hesitancy and increase vaccination levels in expectant mothers.

Key Points

  • We investigated the levels of SARS-CoV-2 antibodies in BM after natural infection and vaccination.

  • Anti-SARS-CoV-2 IgG antibodies were detected in 39 (84.8%) BM samples.

  • The highest titers in BM were found in mothers who were vaccinated following natural infection.

Authors' Contributions

All of the authors have seen and approved the manuscript. Currently, it has not been sent to any other journal for publication.


Ethical Approval

The study was approved by the Ondokuz Mayıs University, Medical Faculty Clinical Research Ethics Committee (reference number: 2021/518).




Publication History

Received: 21 November 2022

Accepted: 12 October 2023

Accepted Manuscript online:
16 October 2023

Article published online:
14 November 2023

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  • References

  • 1 Götzinger F, Santiago-García B, Noguera-Julián A. et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health 2020; 4 (09) 653-661
  • 2 Steffes LC, Cornfield DN. Coronavirus disease 2019 respiratory disease in children: clinical presentation and pathophysiology. Curr Opin Pediatr 2021; 33 (03) 302-310
  • 3 Kim L, Whitaker M, O'Halloran A. et al. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19 - COVID-NET, 14 States, March 1–July 25, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (32) 1081-1088
  • 4 Kwak JH, Lee SY, Choi JW. Clinical features, diagnosis, and outcomes of multisystem inflammatory syndrome in children associated with coronavirus disease 2019. Clin Exp Pediatr 2021; 64 (02) 68-75
  • 5 Ludvigsson JF. Children are unlikely to be the main drivers of the COVID-19 pandemic - a systematic review. Acta Paediatr 2020; 109 (08) 1525-1530
  • 6 Quitadamo PA, Comegna L, Cristalli P. Anti-infective, anti-inflammatory, and immunomodulatory properties of breast milk factors for the protection of infants in the pandemic from COVID-19. Front Public Health 2020; 8: 589736
  • 7 Chambers C, Krogstad P, Bertrand K. et al. Evaluation for SARS-CoV-2 in breast milk from 18 infected women. JAMA 2020; 324 (13) 1347-1348
  • 8 Pace RM, Williams JE, Järvinen KM. et al. Characterization of SARS-CoV-2 RNA, antibodies, and neutralizing capacity in milk produced by women with COVID-19. mBio 2021; 12: e03192-20
  • 9 World Health Organization. Breastfeeding and COVID-19. Scientific Brief. 2020. Accessed November 4, 2022 at: https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19
  • 10 Payne S, Quigley MA. Breastfeeding and infant hospitalisation: analysis of the UK 2010 Infant Feeding Survey. Matern Child Nutr 2017; 13 (01) e12263
  • 11 Hanson LA. Session 1: Feeding and infant development breast-feeding and immune function. Proc Nutr Soc 2007; 66 (03) 384-396
  • 12 Young BE, Seppo AE, Diaz N. et al. Association of human milk antibody induction, persistence, and neutralizing capacity with SARS-CoV-2 infection vs mRNA vaccination. JAMA Pediatr 2022; 176 (02) 159-168
  • 13 Gray KJ, Bordt EA, Atyeo C. et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol 2021; 225 (03) 303.e1-303.e17
  • 14 Prabhu M, Murphy EA, Sukhu AC. et al. Antibody response to coronavirus disease 2019 (COVID-19) messenger RNA vaccination in pregnant women and transplacental passage into cord blood. Obstet Gynecol 2021; 138 (02) 278-280
  • 15 Nasr MC, Geerling E, Pinto AK. Impact of obesity on vaccination to SARS-CoV-2. Front Endocrinol (Lausanne) 2022; 13: 898810
  • 16 Yang X, Fox A, DeCarlo C. et al. Comparative profiles of SARS-CoV-2 Spike-specific human milk antibodies elicited by mRNA- and adenovirus-based COVID-19 vaccines. Breastfeed Med 2022; 17 (08) 638-646
  • 17 McGuire MK, Seppo A, Goga A. et al. Best practices for human milk collection for COVID-19 research. Breastfeed Med 2021; 16 (01) 29-38
  • 18 Pace RM, Williams JE, Järvinen KM. et al. COVID-19 and human milk: SARS-CoV-2, antibodies, and neutralizing capacity. mBio 2021; Feb 9; 12 (01) e03192-20
  • 19 Hanna N, Heffes-Doon A, Lin X. et al. Detection of messenger RNA COVID-19 vaccines in human breast milk. JAMA Pediatr 2022; 176 (12) 1268-1270
  • 20 Whited N, Cervantes J. Antibodies against SARS-CoV-2 in human breast milk after vaccination: a systematic review and meta-analysis. Breastfeed Med 2022; 17 (06) 475-483
  • 21 Flannery DD, Gouma S, Dhudasia MB. et al. Comparison of maternal and neonatal antibody levels after covid-19 vaccination vs SARS-CoV-2 infection. JAMA Netw Open 2022; 5 (11) e2240993
  • 22 Kugelman N, Nahshon C, Shaked-Mishan P. et al. Maternal and neonatal SARS-CoV-2 Immunoglobulin G antibody levels at delivery after receipt of the BNT162b2 Messenger RNA COVID-19 vaccine during the second trimester of pregnancy. JAMA Pediatr 2022; 176 (03) 290-295
  • 23 Rottenstreich A, Zarbiv G, Oiknine-Djian E. et al. Timing of SARS-CoV-2 vaccination during the third trimester of pregnancy and transplacental antibody transfer: a prospective cohort study. Clin Microbiol Infect 2022; 28 (03) 419-425
  • 24 van Keulen BJ, Romijn M, Bondt A. et al. Human milk from previously COVID-19-infected mothers: the effect of pasteurization on specific antibodies and neutralization capacity. Nutrients 2021; 13 (05) 1645