Use of diagnostics for serosurveillance studies in pregnant individuals
during the SARS-CoV-2 pandemic
Abstract
Pregnant individuals are known to be at increased risk of worse outcomes
from COVID-19 infection. Recent data suggests that they are also more
likely to exhibit milder symptoms and have higher rates of asymptomatic
infection. The health impacts of milder disease are less well-described
but may include adverse perinatal outcomes. Serosurveillance can help
describe accurately background rates of seropositivity in populations
with high rates of asymptomatic infection. The seroprevalence of
SARS-CoV-2 infection prior to vaccine availability was assessed in two
large maternity centres. Of 437 pregnant individuals, seven were
positive on initial screening, with one false positive identified on
subsequent confirmatory testing. An overall seropositivity rate of 1.4%
was found. No adverse pregnancy outcomes were identified. Confirmatory
testing was performed with four commercial antibody-based assays and an
in-house microneutralisation assay. Wantai SARS-CoV-2
receptor-binding-domain total antibody performed best, similar to
previous reports. Serological surveillance can estimate infection rates
not captured by acute PCR testing, and may assist with contact tracing,
estimation of immunity rates and inform public health policy in at-risk
groups. Evaluation of serological assays should be integrated into
serosurveillance initiatives.