Obstetric and Neonatal Outcomes following COVID-19 Vaccination in Pregnancy

Abstract

COVID-19 infection imposes a risk for pregnant individuals and may lead to adverse maternal and obstetric outcomes. This is a retrospective cohort study of all women giving birth between March and July 2021 at a single tertiary center. Obstetric and neonatal outcomes were compared between vaccinated and non-vaccinated pregnant women with singleton pregnancies. Women with prior COVID-19 infection, multiple gestations and stillbirth were excluded from the study. Of 4708 women who delivered during the study period, 3700 met the eligibility criteria, of whom 3240 were vaccinated during pregnancy. Compared with the non-vaccinated group, the vaccinated group was characterized by a lower rate of smoking (3.70% vs 6.67%, p = 0.0028), whereasother maternal characteristics were not significantly different. Multivariable analysis demonstrated that COVID-19 mRNA vaccination was not significantly associated with increased risk of preterm birth as well as other adverse obstetric outcomes including hypertensive diseases of pregnancy, cesarean delivery and small for gestational age. However, a significantly lower risk for meconium-stained amniotic fluid was observed among the vaccinated group (adjusted odds ratio 0.63; 95% confidence interval, 0.46–0.86, p = 0.0039). Moreover, the vaccine was not significantly associated with increased risk of neonatal adverse outcomes including respiratory complications and NICU hospitalization. In conclusion, BNT162b2 messenger RNA vaccination during pregnancy was not associated with an increased rate of adverse obstetric and neonatal outcomes. Therefore, in view of its safety on one hand, and the risk associated with COVID-19 disease in pregnancy on the other hand, BNT 162b2 COVID-19 vaccine should be recommended for pregnant women.

COVID-19 Vaccine During Pregnancy and Perinatal Outcomes

“…Moreover, the average birth weight of newborns delivered by unvaccinated women was similar to that of newborns delivered by vaccinated women; however, the birth weight increased after the second dose and even more after the third dose. As confirmed by previously published studies, no difference in gestational age and birth weight was observed between vaccinated and unvaccinated pregnant women (27)(28)(29)(30)(31).…”

The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes

“…There have now been several large population studies that examine the impact of COVID-19 vaccination on birth outcomes. [19] , [20] , [45] , [65] , [66] , [67] , [107] , [108] , [109] , [110] , [111] Lower rates of very preterm birth (<32 weeks gestation) was observed in vaccinated pregnant people in Ontario, Canada (34% reduction) and Sweden (22% reduction), [67] but no difference was observed in Norway. [67] Several studies reported no association of vaccination status with preterm birth, stillbirth, small for gestational age, very low birth weight, infant mortality, or neonatal hospitalizations.…”

“… [67] Several studies reported no association of vaccination status with preterm birth, stillbirth, small for gestational age, very low birth weight, infant mortality, or neonatal hospitalizations. [19] , [20] , [45] , [65] , [66] , [67] , [106] , [107] , [108] , [110] , [111] Two studies reported 40-43% reductions in the rate of stillbirth in vaccinated people and the effect remained even after adjusting for common cofactors. [20] , [110] Another reported a slight decrease in risk for NICU admission in babies born to people receiving at least one-dose compared to those born to unvaccinated people.…”

Systematic review and meta-analysis of neonatal outcomes of COVID-19 vaccination in pregnancy

“…1). [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Of the 15 studies, 2 case-control studies and 13 cohort studies reported on 90443 vaccinated pregnant women and 265063 unvaccinated pregnant women. The included studies reported data from six countries: Israel, UK, Romania, Canada, US, Sweden, and Norway (Table 1).…”

“…20,21 Nevertheless, several individual observational studies exploring the effects of COVID-19 vaccines on pregnancy and perinatal outcomes have included preterm birth, small for gestation (SGA), NICU admission and so on for neonatal outcomes. [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Due to the importance of neonatal outcomes after maternal pregnancy, there is an immediate need for a systematic review and meta-analysis of published data to clarify differences in neonatal outcomes between COVID-19 vaccination during pregnancy and unvaccination during pregnancy.…”