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. 2024 Jul 22;11(7):ofae314.
doi: 10.1093/ofid/ofae314. eCollection 2024 Jul.

Transfer of Respiratory Syncytial Virus Prefusion F Protein Antibody in Low Birthweight Infants

Alisa B Kachikis  1 , Kalee Rumfelt  2 , Mindy Pike  1 , Monica Sosa  1 , Jennifer E Stolarczuk  1 , Hye Cho  3 , Linda O Eckert  1   4 , Emily T Martin  2 , Janet A Englund  5   6
Affiliations

Transfer of Respiratory Syncytial Virus Prefusion F Protein Antibody in Low Birthweight Infants

Alisa B Kachikis et al. Open Forum Infect Dis. .

Abstract

Background: Respiratory syncytial virus (RSV)-associated lower respiratory tract infection contributes significantly to morbidity/mortality worldwide in low birthweight (LBW) infants (<2500 g). Studies have demonstrated decreased maternal immunoglobulin G (IgG) transfer of various antibodies to LBW infants. We aimed to evaluate naturally acquired RSV anti-prefusion F protein (anti-preF) antibody transfer in pregnancies with LBW versus normal birthweight (NBW) infants.

Methods: In this cohort study conducted among pregnant individuals and their infants, we tested paired maternal and singleton infant cord samples for RSV anti-preF IgG via an electrochemiluminescence immunoassay, using linear regression to evaluate associations between LBW and anti-preF IgG. Covariates included seasonality, insurance, small-for-gestational-age birthweight, and gestational age at delivery.

Results: We tested maternal/cord RSV anti-preF IgG from 54 and 110 pregnancies with LBW and NBW infants, respectively. Of LBW infants, 22 (40.7%) were born both preterm and with small-for-gestational-age birthweight. The median (interquartile range) gestational age at delivery and birthweight were 34.0 (31.7-37.1) weeks and 1902 (1393-2276) g for LBW infants versus 39.1 (38.3-39.9) weeks and 3323 (3109-3565) g for NBW infants (both P < .001). In unadjusted comparisons, preterm infants had significantly lower cord anti-preF IgG levels and cord-maternal IgG ratios compared with full-term infants, while LBW infants had significantly lower cord-maternal IgG ratios than NBW infants (all P < .01). After adjustment for covariates, there was no difference in cord-maternal IgG ratios (β =-0.29 [95% confidence interval, -.63 to .05]) between LBW and NBW infants.

Conclusions: We documented robust transfer of maternal RSV anti-preF IgG in pregnancies with both LBW and NBW infants. Further studies are needed to assess immune protection in at-risk infants.

Keywords: RSV prefusion F protein antibody; high-risk pregnancies; low birthweight infants; respiratory syncytial virus; transplacental antibody transfer.

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Conflict of interest statement

Potential conflicts of interest. Outside the current work, A. B. K. was an unpaid consultant for Pfizer and GlaxoSmithKline and is a coinvestigator for studies funded by Merck and Pfizer. J. A. E. receives grant support to her institution from Merck, GlaxoSmithKline, AstraZeneca, and Pfizer and is a consultant for AbbVie, Ark Biopharma, AstraZeneca, GlaxoSmithKline, Moderna, Pfizer, Sanofi Pasteur, and Meissa Vaccines, outside the described work. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Box plots of cord and maternal respiratory syncytial virus (RSV) anti-prefusion F protein (anti-preF) immunoglobulin G (IgG) titers (in arbitrary units [AU] per milliliter) by birthweight category and gestational age (GA) at delivery. A, Entire cohort. B, All pregnancies with preterm deliveries (at <37 weeks’ GA). C, All pregnancies with full-term deliveries (at ≥37 weeks’ GA). D, All pregnancies with low birthweight (LBW) infants. E, Pregnancies with preterm deliveries and LBW infants. F, Pregnancies with full-term deliveries and LBW infants. G, All pregnancies with normal-birthweight (NBW) infants. H, Pregnancies with preterm deliveries and NBW infants. I, Pregnancies with full-term deliveries and NBW infants.
Figure 2.
Figure 2.
Correlation between maternal and cord respiratory syncytial virus (RSV) anti–prefusion F (anti-preF) protein immunoglobulin G (IgG) titers (in arbitrary units [AU] per milliliter) by birthweight category (normal birthweight [NBW] vs low birthweight [LBW]) and gestational age (GA) at delivery (preterm [GA <37 weeks] vs full-term [GA ≥37 weeks]). Visualization of correlations between maternal and infant log adjusted RSV anti-preF IgG across birthweight status and prematurity. Pearson correlation coefficients (PCCs) were calculated using untransformed RSV anti-preF IgG titers. *P < .001.
See this image and copyright information in PMC

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