key: cord-0940225-whzwfm28 authors: Sharma, Kandala Aparna; Singh, Nilanchali; Hillman, Sara; Mathur, Purva; Yadav, Kapil; Garg, Anapti; Dadhwal, Vatsla; Bhatla, Neerja title: Seroprevalence of SARS‐CoV‐2 antibodies among first‐trimester pregnant women during the second wave of the pandemic in India date: 2022-04-16 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.14189 sha: 3cbe6e5ca204bdce0625d21fcac76c1ea39d2f2c doc_id: 940225 cord_uid: whzwfm28 OBJECTIVE: Data on the immune response to SARS‐CoV‐2 during pregnancy are lacking and the potential role and effect of SARS‐CoV‐2 vaccination in pregnancy is yet to be completely investigated. METHOD: This is a cross‐sectional observational study wherein pregnant women were tested for SARS‐CoV‐2 immunoglobulin M and immunoglobulin G levels, irrespective of their infective status or presence or symptomatology. RESULT: Of the 220 pregnant women tested, 160 (72.7%) were SARS‐CoV‐2 IgG positive, 37 (16.8%) were SARS‐CoV‐2 IgM positive and 27 (16.9%) were both IgG and IgM positive. The average antibody titer found was 10.49 BAU/ml (±14.0) and 0.6 (±0.55) for anti‐SARS‐CoV‐2 IgG and IgM non neutralizing antibodies respectively. ROC analysis for SARS‐CoV‐2 IgG positivity showed a cut‐off value of 1.19 with a sensitivity of 99.3% (0.99 AUC, 95% CI) and specificity of 98.3% (0.99 AUC, 95% CI), respectively. Similarly, ROC analysis for SARS‐CoV‐2 IgM positivity showed a cut‐off value of 1 with a sensitivity of 97.3% (0.99 AUC, 95% CI) and specificity of 98.9% (0.99 AUC, 95% CI), respectively. CONCLUSION: First trimester sero‐molecular screening suggests a high prevalence of COVID antibodies in the study population of pregnant women in the first trimester, without the patients being symptomatic. SARS-CoV-2 to be used to conduct serosurveys in India. 6 Reports of cases of SARS-CoV-2 infection in pregnancy have been documented but are concentrated mainly in the second and third trimester of pregnancy. [7] [8] [9] [10] However, viral infections can be harmful to the fetus during the first trimester of pregnancy as well; SARS-CoV-2 is one of these serious infections is creating concerns for obstetricians [11] [12] [13] and pregnant women. Screening pregnant women has gained importance because of the high proportion of asymptomatic cases and because of the increasing evidence of adverse maternal and fetal outcomes related to COVID-19. 14 Data on the immune response to SARS-CoV-2 during pregnancy are lacking and the potential role and effect of SARS-CoV-2 vaccination in pregnancy is yet to be completely investigated. The aim of this study was to evaluate the seropositivity among pregnant women in their first trimester during the pandemic. This data will be further help, when the pregnancy outcomes are evaluated. We report epidemiologic data from a study investigating a cohort of women who became pregnant just before or during the COVID-19 pandemic during the second peak, from April 2021 to August 2021. Ethical approval was given by the institutional ethical committee. 298 pregnant women in the first trimester (11-13 weeks of gestation) were recruited at the rural center of the All India Institute of Medical Sciences, New Delhi. Data on demographic characteristics and COVID-19-related symptoms were collected using a structured questionnaire. Patients were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin M and immunoglobulin G levels. Only asymptomatic women, who have not been diagnosed with COVID-19 in the past 3 months, were recruited. Written, informed consent was obtained from all participants. VIDAS® (Biomerieux) SARS-CoV-2 IgM (qualitative) and VIDAS® SARS-CoV-2 IgG II (semi-quantitative) assay was used with automated VIDAS® system for detection of IgM and IgG respectively. Area under curve (AUC) with 95% was presented. A two-sided probability of P < 0.05 was considered to be statistically significant. A total of 298 women in the first trimester of pregnancy (11-13 weeks of pregnancy), were included in the study. Participants had an average age of 24.0 ± 4.1 years and a body-mass index of 22.51 ± 4.3 kg/m 2 . Of the 298 women, 94 (31.5%) were primigravidae, 61 (20.5%) had given birth once, 143 (47.9%) had been pregnant more than once. All women were homemakers, and none were smokers. One woman (0.3%) had essential hypertension. No women had associated medical disorders like type 1 or type 2 diabetes mellitus, chronic kidney disease or any other autoimmune disease. Other demographic details are presented in Table 1 A study evaluated the progression of seroprevalance of COVID anti- The present work highlights the crucial role of serum antibodies for early diagnosis of SARS-CoV-2 among asymptomatic pregnant patients. The specificity of real-time reverse transcription polymerase chain reaction (RT-PCR) for the detection of COVID-19 is remarkable, but its accuracy depends on the sampling quality. 15 Advantages of testing pregnant women for antibody response to COVID-19 are bring able to identify possibly "healed" women (e.g., IgG positive) who were never tested with RT-PCR assay using nasopharyngeal (NP) swab specimens and to also detect women who are still at risk for COVID-19 infection (e.g. IgM and IgG negative). Women who do not know their infective status represent a potential threat to others, including healthcare workers (HCWs) and other patients. Antibodies to SARS-CoV-2 could serve as the basis for an "immunity passport" or "risk-free certificate" (digital or physical documents that certify an individual has been infected and is purportedly immune to SARS-CoV-2). 16 This statement is yet not verified. Also, while evaluating the effect of COVID on pregnancy outcomes, the antibody evaluation might be useful. However, as seen from the data analysis, there was a high prevalence of COVID-like symptoms in seronegative women and vice-versa; that is say, no symptoms in women with positive IgG or IgM antibodies (Tables 2,3 ). According to the Indian Council of Medical Research, IgG antibody test for COVID-19 may be useful in serosurveys among asymptomatic individuals and the high-risk or vulnerable population to understand the proportion of population exposed to infection with SARS-CoV2 and thus, appropriate public health interventions for prevention and control of disease can be planned and implemented accordingly. 6 As our study clearly shows a high percentage of seropositivity in asymptomatic women, any research on maternal and neonatal outcomes, only on the basis of nasopharyngeal or oral testing in symptomatic women, may be flawed. This study may serve as a basic framework to detect vertical transmission of SARS-CoV-2 from mothers to fetuses and later to detect neonatal outcomes. A further follow-up of these pregnant woman may enlighten with the impact of COVID seropositivity on maternofetal outcomes, which our study is currently lacking. We report epidemiologic data from this study investigating a cohort of women who became pregnant just before or during the COVID-19 The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The data that support the findings of this study are available from the corresponding author upon reasonable request. 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