Abstract
The intricacy of the maternal immune system arises from its ability to prevent a maternal immune response against a semi-allogenic fetus, while protecting the mother against harmful pathogens. However, these immunological adaptations may also make pregnant women vulnerable to developing adverse complications from respiratory viral infections. While the influenza and SARS pandemics support this theory, there is less certainty regarding the clinical impact of SARS-CoV-2 in pregnancy. In the current COVID-19 pandemic, vaccine development is key to public preventative strategies. Whilst most viral vaccines are able to induce a seroprotective antibody response, in some high-risk individuals this may not correlate with clinical protection. Some studies have shown that factors such as age, gender, and chronic illnesses can reduce their effectiveness and in this review, we discuss how pregnancy may affect the efficacy and immunogenicity of vaccines. We present literature to support the hypothesis that pregnant women are more susceptible to respiratory viral infections and may not respond to vaccines as effectively. In particular, we focus on the clinical implications of important respiratory viral infections such as influenza during pregnancy, and the pregnancy induced alterations in important leukocytes such as TFH, cTFH and B cells, which play an important role in generating long-lasting and high-affinity antibodies. Finally, we review how this may affect the efficacy of vaccines against influenza in pregnancy and highlight areas that require further research.
Highlights
It is interesting to consider whether a pregnancy-specific immune response increases the susceptibility of pregnant women to adverse clinical outcomes in association with respiratory viruses and, if so, what is the nature of this response? pregnancy-specific alterations of the respiratory system may play a role, contributing to increased morbidity and mortality when compared to that of the general population
We propose the hypothesis that immune responses unique to pregnancy influence the natural history of respiratory viral infections in this population even after vaccination
This study showed that the frequency of CD45RO+ CXCR5+ expressing circulatory TFH (cTFH) cells, which are thought to represent the circulatory counterpart to germinal centre (GC) T follicular helper cells (TFH) with similar functions, are increased in pregnancy and these cTFH express more inducible co-stimulator (ICOS) when compared with non-pregnant controls [86,87]
Summary
It is interesting to consider whether a pregnancy-specific immune response increases the susceptibility of pregnant women to adverse clinical outcomes in association with respiratory viruses and, if so, what is the nature of this response? pregnancy-specific alterations of the respiratory system may play a role, contributing to increased morbidity and mortality when compared to that of the general population. It is interesting to consider whether a pregnancy-specific immune response increases the susceptibility of pregnant women to adverse clinical outcomes in association with respiratory viruses and, if so, what is the nature of this response? Physiological changes may influence susceptibility and clinical severity of illness but altered pregnancy-induced immune responses may play a key role in attenuating antibody responses in pregnancy. In this perspective piece, we propose the hypothesis that immune responses unique to pregnancy influence the natural history of respiratory viral infections in this population even after vaccination. We present supportive data and highlight areas for further research
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