key: cord-1046697-m4mpcoab
authors: Zullo, Fabrizio; Di Mascio, Daniele; Saccone, Gabriele
title: COVID-19 Antibody Testing in Pregnancy
date: 2020-05-18
journal: Am J Obstet Gynecol MFM
DOI: 10.1016/j.ajogmf.2020.100142
sha: 7decdcaf23a05bd617e2d976117e559f9f0eeae1
doc_id: 1046697
cord_uid: m4mpcoab

nan

The novel coronavirus 2019, or Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), 21 is the virus responsible for COVID-19 infection, which can has been associated with maternal and 22 perinatal morbidity and mortality. 1, 2 Almost all patients with COVID-19 infection test positive for 23 antiviral immunoglobulin-G (IgG) within about 10-20 days after symptom onset (Figure 1 ), but the 24 clinical value of antibody testing has not yet been completely elucidated, either in non-pregnant or 25 even more pregnant patients. 3

There are different ways to test for antibody against SARS-CoV-2. The three most common 27 methods currently are IgM and IgG titer measured by either chemiluminescence immunoassay 28 analysis, or enzyme-linked immunosorbent assay (ELISA); and a rapid (results within 15 minutes)

IgM-IgG combined antibody test. .3 Their sensitivities and specificities are still being studied and 30 vary, but have been reported to be about 48%, 89%, and 89%, respectively; and 100%, 91%, and 31 91%, respectively. 3-5

Testing pregnant women for antibody response to COVID-19 may have different advantages, 33 including identifying: 1. Possibly 'healed' women (e.g. IgG positive) never tested with real-time 34 reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasopharyngeal (NP) swab 35 specimens; 2. Women still at risk for COVID-19 infection (e.g. IgM and IgG negative).

Women who do know their infectious status represent a potential threat to others, including 37 healthcare workers (HCWs) and other patients. Indeed, some governments have suggested that the 38 detection of antibodies to SARS-CoV-2 could serve as the basis for an "immunity passport" or 39 "risk-free certificate" (digital or physical documents that certify an individual has been infected and 40 is purportedly immune to SARS-CoV-2) that would enable individuals to, for example, return to 41 work or travel assuming that they are protected against re-infection. 6 

The use of the point-of-care rapid combined antibody test can be of paramount importance in 43 obstetric healthcare settings and may be particularly helpful in testing women before outpatient We are now also testing women scheduled for outpatient visits. Those tested positive to either IgM 69 or IgG at the rapid combined antibody test, have NP swab offered, and the outpatient appointment is 70 postponed, as shown in Figure 2B . Women with prior infection, and 'certified' recovered because 71 of two negative NP swabs 24 hours apart, are not tested for antibody response to It would also be helpful, if available, to test visitors, and HCWs. In our Department, we have 73 mandatory rapid antibody testing for all HCWs every 7 days. HCWs positive to either IgM or IgG 74 self-isolate at home, waiting for the results of the NP swab.

In summary, we recommend testing for antibody response to SARS-CoV-2 for pregnant women 

Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a 95 US cohort study

COVID-19 infection among asymptomatic and symptomatic pregnant women: 101 Two weeks of confirmed presentations to an affiliated pair of New York City hospitals

Interpreting Diagnostic Tests for SARS-CoV-2

Diagnostic value 106 and dynamic variance of serum antibody in coronavirus disease 2019

Development and Clinical Application of A Rapid IgM-IgG Combined Antibody 111 Test for SARS-CoV-2 Infection Diagnosis

Privileges and Immunity Certification During the COVID-19