Data associated with the publication: Reduced control of SARS-CoV-2 infection associates with lower mucosal antibody responses in pregnancy

Pregnant patients are at greater risk of hospitalization with severe COVID-19 than non-pregnant people. This was a retrospective observational cohort study of remnant clinical specimens from patients who visited acute care hospitals within the Johns Hopkins Health System (JHHS) in the Baltimore, MD-Washington, DC area between October 2020-May 2022. Participants included confirmed SARS-CoV-2 infected pregnant people and matched non-pregnant people (matching criteria included age, race/ethnicity, area deprivation index, insurance status, and vaccination status to ensure matched demographics). The primary dependent measures were clinical COVID-19 outcomes, infectious virus recovery, viral RNA levels, and mucosal anti-spike (S) IgG titers from upper respiratory tract samples. A total of 452 individuals (117 pregnant and 335 non-pregnant) were included in the study, with both vaccinated and unvaccinated individuals represented. Pregnant patients were at increased risk of hospitalization (OR = 4.2; CI = 2.0-8.6), intensive care unit admittance (OR = 4.5; CI = 1.2-14.2), and of being placed on supplemental oxygen therapy (OR = 3.1; CI =1.3-6.9). Individuals infected during their 3rd trimester had higher mucosal anti-S IgG titers and lower viral RNA levels (P< 0.05) than those infected during their 1st or 2nd trimesters. Pregnant individuals experiencing breakthrough infections due to the Omicron variant had reduced anti-S IgG compared to non-pregnant patients (P< 0.05). The observed increased severity of COVID-19 and reduced mucosal antibody responses particularly among pregnant participants infected with the omicron variant suggest that maintaining high levels of SARS-CoV-2 immunity through booster vaccines may be important for protection of this at-risk population. (2024-02)