Anticorpos neutralizantes no leite e no sangue de lactantes vacinadas para SARS-CoV-2: uma revisão sistemática

Vieira, Ianne Stéfani Angelim; Rocha, Fernanda Mazzoli da; Vilarim, Marina; Rebelo, Fernanda; Marano, Daniele

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Brasil

Revista Paulista de Pediatria

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Brasil

Español English

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Sumário

Review Article • Rev. paul. pediatr. 43 • 2025 • https://doi.org/10.1590/1984-0462/2025/43/2023210 copiar

Anticorpos neutralizantes no leite e no sangue de lactantes vacinadas para SARS-CoV-2: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Comparar a presença de anticorpos neutralizantes contra o SARS-CoV-2 no leite materno e no sangue das lactantes vacinadas em relação àquelas não vacinadas.

Fontes de dados:

Foi efetuado registro no International Prospective Register of Systematic Reviews — PROSPERO (CRD42021287554) e foram seguidas as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Foram elegíveis estudos de coorte, caso-controle e transversais que avaliaram anticorpos contra o SARS-CoV-2 no leite e no sangue de lactantes vacinadas e tiveram como grupo controle lactantes não vacinadas. Utilizaram-se os Descritores em Ciências da Saúde (DeCs), Medical Subject Heading (MeSH) e Emtree para as bases Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online (Medline/PubMed) e Embase, respectivamente. Na Web of Science e Scopus foi feita adaptação da estratégia. Não foram estabelecid as restrições quanto ao período de publicação e idioma.

Síntese dos dados:

As buscas identificaram 233 registros. Foram excluídos 128 duplicados e 101 fora dos critérios de inclusão, e quatro estudos de coorte foram elegíveis. As lactantes vacinadas com Pfizer-BioNTech e Moderna apresentaram anticorpos contra SARS-CoV-2 no sangue e no leite materno.

Conclusões:

As mulheres lactantes vacinadas apresentaram níveis mais elevados de imunoglobulina G (IgG) e A (IgA) no soro e no leite materno em comparação com as mulheres não vacinadas.

Palavras-chave:
COVID-19; Leite humano; Vacina; Anticorpos; Revisão sistemática

Reference/country of study	Study design	Vaccine technology (trade name)	Follow up time (days)	Sample size		Eligibility criteria	Exclusion criteria

				Vaccinated lactating women	Unvaccinated lactating women
Jakuszko et al.,¹³13. Jakuszko K, Kościelska-Kasprzak K, Żabińska M, Bartoszek D, Poznański P, Rukasz D, et al. Immune response to vaccination against COVID-19 in breastfeeding health workers. Vaccines (Basel). 2021;9:663. https://doi.org/10.3390/vaccines9060663 https://doi.org/10.3390/vaccines9060663... Poland	Cohort	mRNA (Pfizer)	43	32	28	Vaccinated and unvaccinated lactating women against COVID-19	Lactating women previously infected with SARS-CoV-2
Nir et al.,¹⁵15. Nir O, Schwartz A, Toussia-Cohen S, Leibovitch L, Strauss T, Asraf K, et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol MFM. 2022;4:100492. https://doi.org/10.1016/j.ajogmf.2021.100492 https://doi.org/10.1016/j.ajogmf.2021.10... Israel	Cohort	mRNA (Pfizer)	59	64	11	Lactating women aged ≥18 years who received two doses of the BNT162 b2 mRNA vaccine against COVID-19 at least 14 days before childbirth	NI
Romero Ramírez et al.,⁵5. Romero Ramírez DS, Lara Pérez MM, Carretero Pérez MM, Suárez Hernández MI, Martín Pulido S, et al. SARS-CoV-2 antibodies in breast milk after vaccination. Pediatrics. 2021;148:e2021052286. https://doi.org/10.1542/peds.2021-052286 https://doi.org/10.1542/peds.2021-052286... Spain	Cohort	mRNA (Pfizer and Moderna)	62	100	24	Lactating healthcare workers who were breastfeeding their child at the time of SARS-CoV-2 vaccination	Participants with HIV infection, illnesses or treatment that cause immunosuppression, previous infections or ongoing symptoms compatible with COVID-19 at the time of recruitment
Valcarce et al.,¹⁴14. Valcarce V, Stafford LS, Neu J, Cacho N, Parker L, Mueller M, et al. Detection of SARS-CoV-2-specific IgA in the human milk of COVID-19 vaccinated lactating health care workers. Breastfeed Med. 2021;16:1004-9. https://doi.org/10.1089/bfm.2021.0122 https://doi.org/10.1089/bfm.2021.0122... United States	Cohort	mRNA (Pfizer and Moderna)	121	22^* *The group of vaccinated lactating women is the same group of unvaccinated (i.e., unexposed) women; however, before immunization.	22	Lactating women with no known history of COVID-19 infection; ≥18 years old, able to provide informed consent and receiving COVID-19 vaccine during lactation	Lactating women who did not complete sample collection

Reference	Vaccinated lactating women		Unvaccinated lactating women		Main results

	Antibodies in the blood	Antibodies in milk	Antibodies in the blood	Antibodies in milk
Jakuszko et al.¹³13. Jakuszko K, Kościelska-Kasprzak K, Żabińska M, Bartoszek D, Poznański P, Rukasz D, et al. Immune response to vaccination against COVID-19 in breastfeeding health workers. Vaccines (Basel). 2021;9:663. https://doi.org/10.3390/vaccines9060663 https://doi.org/10.3390/vaccines9060663...	IgM=ND	IgM=ND	IgM=ND	IgM=ND	The response to vaccination against SARS-CoV-2 is higher after the second dose. The levels of IgA and IgG antibodies in breast milk and serum of mothers after the COVID-19 vaccine were positively correlated. None of the serum and milk samples was positive for anti-SARS-CoV-2 IgM antibodies.
	IgG Day 8±1=4.62±3.57 Day 43±4=3,276.5±1,803.3	IgG Day 8±1=ND Day 43±4=6.43±4.33	IgG Day 8±1=3.41±0.80	IgG Day 8±1=ND
	IgA Day 8±1=0.33±0.37 Day 43±4=9.37±8.08	IgA Day 8±1=0.55±0.32 Day 43±4=2.73±2.13	IgA Day 8±1=0.17±0.07	IgA Day 8±1=0.69±0.39

Nir et al.¹⁵15. Nir O, Schwartz A, Toussia-Cohen S, Leibovitch L, Strauss T, Asraf K, et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol MFM. 2022;4:100492. https://doi.org/10.1016/j.ajogmf.2021.100492 https://doi.org/10.1016/j.ajogmf.2021.10...	IgM=NI	IgM=NI	IgM=NI	IgM=NI	All blood and breast milk samples were positive for anti-SARS-CoV-2 IgG. Likewise, 98% of umbilical cord blood samples and 96% of neonatal blood were positive for anti-SARS-CoV-2 IgG.
	IgG=26.1 (22.0–39.7)	IgG=4.9 (3.8–6.0)	IgG=2.6 (0.9–3.5)	IgG=ND
	IgA=NI	IgA=NI	IgA=NI	IgA=NI

Romero Ramírez et al.⁵5. Romero Ramírez DS, Lara Pérez MM, Carretero Pérez MM, Suárez Hernández MI, Martín Pulido S, et al. SARS-CoV-2 antibodies in breast milk after vaccination. Pediatrics. 2021;148:e2021052286. https://doi.org/10.1542/peds.2021-052286 https://doi.org/10.1542/peds.2021-052286...	IgM=NI	IgM=0.04±0.08	IgM=NI	IgM=0.01±0.00	All vaccinated mothers developed anti-SARS-CoV-2 IgG antibodies in serum and milk samples. All breast milk samples contained IgG antibodies and 89% of them contained IgA antibodies. Highly significant correlation between antibody levels in serum and breast milk samples.
	IgG=3,379.64±1,639.46	IgG=12.19±11.74	IgG=0.41±0.37	IgG=0.02±0.05
	IgA=NI	IgA=1.73±1.59	IgA=NI	IgA=0.21±0.08

Valcarce et al.¹⁴14. Valcarce V, Stafford LS, Neu J, Cacho N, Parker L, Mueller M, et al. Detection of SARS-CoV-2-specific IgA in the human milk of COVID-19 vaccinated lactating health care workers. Breastfeed Med. 2021;16:1004-9. https://doi.org/10.1089/bfm.2021.0122 https://doi.org/10.1089/bfm.2021.0122...	IgM=NI	IgM=NI	IgM=NI	IgM=NI	Vaccines against COVID-19 induce the secretion of IgA and IgG in human milk. The peak of anti-SARS-CoV-2 IgA and IgG in human milk and plasma occurred seven to ten days after the second dose of the COVID-19 vaccine.
	IgG After the 2^nd dose=4.90±0.13	IgG After the 2^nd dose=1.77±0.20	IgG=3.27±0.04	IgG=0.08±0.02
	IgA After the 2^nd dose=3.66±0.05	IgA After the 2^nd dose=2.34±0.18	IgA=3.23±0.01	IgA=1.41±0.12

	Jakuszko et al.¹³13. Jakuszko K, Kościelska-Kasprzak K, Żabińska M, Bartoszek D, Poznański P, Rukasz D, et al. Immune response to vaccination against COVID-19 in breastfeeding health workers. Vaccines (Basel). 2021;9:663. https://doi.org/10.3390/vaccines9060663 https://doi.org/10.3390/vaccines9060663...	Nir et al.¹⁵15. Nir O, Schwartz A, Toussia-Cohen S, Leibovitch L, Strauss T, Asraf K, et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol MFM. 2022;4:100492. https://doi.org/10.1016/j.ajogmf.2021.100492 https://doi.org/10.1016/j.ajogmf.2021.10...	Romero Ramírez et al.⁵5. Romero Ramírez DS, Lara Pérez MM, Carretero Pérez MM, Suárez Hernández MI, Martín Pulido S, et al. SARS-CoV-2 antibodies in breast milk after vaccination. Pediatrics. 2021;148:e2021052286. https://doi.org/10.1542/peds.2021-052286 https://doi.org/10.1542/peds.2021-052286...	Valcarce et al.¹⁴14. Valcarce V, Stafford LS, Neu J, Cacho N, Parker L, Mueller M, et al. Detection of SARS-CoV-2-specific IgA in the human milk of COVID-19 vaccinated lactating health care workers. Breastfeed Med. 2021;16:1004-9. https://doi.org/10.1089/bfm.2021.0122 https://doi.org/10.1089/bfm.2021.0122...
Selection
Representativeness of exposed cohort	0	0	0	0
Unexposed cohort selection	1	1	1	1
Determination of exposure	1	1	1	1
Demonstration that the outcome of interest was not present at the beginning of the study	1	1	1	1
Comparability
Adjustments for the most important risk factors	1	1	1	1
Adjustments for other risk factors	1	1	1	1
Outcome
Determination of outcome	1	1	1	1
Was the segment sufficient for the outcome to occur?	1	1	1	1
Adequacy of cohort monitoring	1	1	1	1
Total quality score	8	8	8	8

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E-mail: rpp@spsp.org.br

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[1] *Corresponding author. E-mail: iannevieira.enf@gmail.com (I.S.A. Vieira)