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Protecting Pregnant Women and Their Infants From COVID-19: Clues From Maternal Viral Loads, Antibody Responses, and Placentas

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The study by Edlow and colleagues1 carefully characterizes several key biologic parameters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy, including maternal viral load and antibody response, transplacental antibody transfer, and placental pathology in 64 pregnant women with reverse transcription–polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection. Women were prospectively enrolled at 3 Harvard-affiliated hospitals in Boston, Massachusetts, (ie, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, and Brigham and Women’s Hospital) during the first wave of the pandemic in the Northeast during April 2, 2020 through June 13, 2020. A major strength of this study is that it included 2 comparison groups that were enrolled contemporaneously at the same hospitals as the cases: pregnant women with RT-PCR results negative for SARS-CoV-2 infection, as well as nonpregnant women of reproductive age.1 For characterizing viral load and antibody response in pregnancy, a control group of nonpregnant women of reproductive age with SARS-CoV-2 infection is most appropriate. For characterizing differences in transplacental antibody transfer and placental pathology, a control group of pregnant women without SARS-CoV-2 infection is most appropriate. In addition, as a comparison for evaluation of mother-to-neonate transfer of anti–SARS-CoV-2 antibodies, Edlow et al1 included measurement of mother-to-neonate transfer of anti-influenza antibodies. These careful studies with inclusion of appropriate control analyses bring us closer to understanding not only the characteristics of SARS-CoV-2, but the characteristics of other viruses during pregnancy; these could provide insight to the characteristics of viruses that might emerge in the future.

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Article Information

Published: December 22, 2020. doi:10.1001/jamanetworkopen.2020.30564

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Jamieson DJ et al. JAMA Network Open.

Corresponding Author: Denise J. Jamieson, MD, MPH, Department of Gynecology and Obstetrics, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Cir, Ste 4208, Atlanta, GA 30322 (djamieson@emory.edu).

Conflict of Interest Disclosures: None reported.

References
1.
Edlow  AG , Li  JZ , Collier  AY ,  et al.  Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic.   JAMA Netw Open. 2020;3(12):e2030455. doi:10.1001/jamanetworkopen.2020.30455Google Scholar
2.
Vivanti  AJ , Vauloup-Fellous  C , Prevot  S ,  et al.  Transplacental transmission of SARS-CoV-2 infection.   Nat Commun. 2020;11(1):3572. doi:10.1038/s41467-020-17436-6PubMedGoogle ScholarCrossref
3.
Flaherman  VJ , Afshar  Y , Boscardin  J ,  et al.  Infant outcomes following maternal infection with SARS-CoV-2: first report from the PRIORITY study.   Clin Infect Dis. 2020;ciaa1411. doi:10.1093/cid/ciaa1411PubMedGoogle Scholar
4.
Pique-Regi  R , Romero  R , Tarca  AL ,  et al.  Does the human placenta express the canonical cell entry mediators for SARS-CoV-2?   Elife. 2020;9:9. doi:10.7554/eLife.58716PubMedGoogle ScholarCrossref
5.
Salvatore  CM , Han  JY , Acker  KP ,  et al.  Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study.   Lancet Child Adolesc Health. 2020;4(10):721-727. doi:10.1016/S2352-4642(20)30235-2PubMedGoogle ScholarCrossref
6.
Zambrano  LD , Ellington  S , Strid  P ,  et al; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team.  Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status—United States, January 22-October 3, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(44):1641-1647. doi:10.15585/mmwr.mm6944e3PubMedGoogle ScholarCrossref
7.
Allotey  J , Stallings  E , Bonet  M ,  et al; for PregCOV-19 Living Systematic Review Consortium.  Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis.   BMJ. 2020;370:m3320. doi:10.1136/bmj.m3320PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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