Neonatal outcomes following maternal SARS-CoV-2 infection in pregnancy - longitudinal follow-up and assessment of transplacental antibody transfer

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in pregnancy has been associated with multiple adverse pregnancy outcomes, including the risk of in utero mother-to-child transmission. Short- and long-term outcomes of SARS-CoV-2 exposed neonates and the extent to which maternal SARS-CoV-2 antibodies are transferred to neonates are still unclear. METHODS: Prospective observational study enrolling neonates born to mothers with SARS-CoV-2 infection in pregnancy, between April 2020-April 2021. Neonates were evaluated at birth and enrolled in a 12-month follow-up. SARS-CoV-2 IgG transplacental transfer ratio was assessed in mother-neonate dyads at birth. Maternal derived IgG were followed in infants until negativizing. RESULTS: Of 2745 neonates, 106 (3.9%) were delivered by mothers with SARS-CoV-2 infection in pregnancy. Seventy-six of 106 (71.7%) mothers were symptomatic. Median gestational age and mean birth weight were 39 weeks (range 25+5-41+4) and 3305 grams (SD 468). Six of 106 (6%) neonates were born preterm, without significant differences between asymptomatic and symptomatic mothers (P=0.67). No confirmed cases of in utero infection were detected. All infants had normal cerebral ultrasound and clinical evaluation at birth and during follow-up, until a median age of 7 months (range 5-12). All mothers and 96/106 (90.5%) neonates had detectable SARS-CoV-2 IgG at birth. Transplacental transfer ratio was higher following second trimester maternal infections (mean 0.940.46 versus 1.070.64 versus 0.750.44, P=0.039), but was not significantly different between asymptomatic and symptomatic women (P=0.20). IgG level in infants progressively decreased after birth: at 3 months 53% (51/96) and at four months 68% (63/96) had lost maternal antibodies respectively. The durability of maternal antibodies was positively correlated to the IgG level at birth (r=0.66; P<0.00001). CONCLUSIONS: Maternal SARS-CoV-2 infection was not associated with increased neonatal or long-term morbidity. No cases of confirmed in utero infection were detected. Efficient transplacental IgG transfer was found following second trimester maternal infections.

Lives apart? Experiences of transnational motherhood by Georgian labour migrants to Italy and their children

International labour migration processes of the last decades saw increasing numbers of solo female migrants employed in the developed countries. Many of these women were mothers who left their children in the sending countries and thus gave rise to a controversial phenomenon of transnational motherhood. The present thesis is based on the first empirical study of intergenerational narratives of mothers, Georgian labour migrants to Italy, and their children, left behind in Georgia. Mothers’ international labour migration is a challenge to the traditional ideology of motherhood. Although unconsciously migrant mothers often adhere to “alternative”, “rational”, future-oriented model(s) of parenting, they continue to live their experiences in the framework of traditional understandings of motherhood, which appears to be unequipped to “frame” transnational motherhood as, from its point of view, mothers’ choice to leave their children is reprehensible, yet transnational mothers’ physical absence is not an equivalent of “leaving” their children. Informants’ narratives strongly suggest that long periods of physical separation did not jeopardize bonds between mothers and children in transnational families. While informants’ selection bias is probable, the mother-child bond was not “broken” and the very essence of motherhood remained intact. Many forms of mothers’ and children’s online co-presence were documented during the interviews. Interviews also prove that the Internet cannot be considered a solution to the problem of family separation, experienced painfully by both mothers and children: it may reduce the pain caused by separation, but cannot be a substitute for mothers’ physical absence from their families. Despite the pain caused by separation, mothers’ emigration appeared to be the right decision made for the good of the family. Interviewed mothers almost univocally reported readiness to “keep going on”, and continue working in emigration to help their children until physically able to do so, because, as they put it, “motherhood never ends”.