Peripartum Outcomes Associated With COVID-19 Vaccination During Pregnancy

Abstract

ImportanceThe risk and benefits of COVID-19 vaccination during pregnancy are under investigation. Pooled evidence regarding neonatal and maternal outcomes in association with COVID-19 vaccination during pregnancy is scarce.ObjectiveTo evaluate the association between COVID-19 vaccination during pregnancy and peripartum outcomes.Data SourcesPubMed and EMBASE databases were searched on April 5, 2022. Language restrictions were not applied.Study SelectionProspective trials and observational studies comparing the individuals who received at least 1 COVID-19 vaccination during pregnancy with those who did not and reporting the neonatal outcomes, including preterm birth, small for gestational age, low Apgar score, neonatal intensive care units (NICU) admission, and intrauterine fetal death (IFD).Data Extraction and SynthesisTwo independent investigators extracted relevant data from each study. Odds ratios (ORs) were calculated using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.Main Outcomes and MeasuresThe primary outcomes were the neonatal outcomes, including preterm birth, small for gestational age, low Apgar score, NICU admission, and IFD. The secondary outcomes were maternal outcomes, including maternal SARS-CoV-2 infection, cesarean delivery, postpartum hemorrhage, and chorioamnionitis.ResultsNine observational studies involving 81 349 vaccinated (mean age, 32-35 years) and 255 346 unvaccinated individuals during pregnancy (mean age, 29.5-33 years) were included. COVID-19 vaccination during pregnancy was associated with lower risk of NICU admission (OR, 0.88; 95% CI, 0.80-0.97) and IFD (OR, 0.73; 95% CI, 0.57-0.94), whereas there was no statistically significant association with preterm birth (OR, 0.89; 95% CI, 0.76-1.04), small for gestational age (OR, 0.99; 95% CI, 0.94-1.04), and low Apgar score (OR, 0.94; 95% CI, 0.87-1.02). COVID-19 vaccination during pregnancy was associated with a lower risk of maternal SARS-CoV-2 infection (OR, 0.46; 95% CI, 0.22-0.93), whereas it was not associated with increased risk of cesarean delivery (OR, 1.05; 95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95; 95% CI, 0.83-1.07), and chorioamnionitis (OR, 0.95; 95% CI, 0.83-1.07).Conclusions and RelevanceCOVID-19 vaccination during pregnancy was not associated with an increase in the risk of peripartum outcomes, was associated with a decreased risk of NICU admission, IFD, and maternal SARS-CoV-2 infection. Thus, COVID-19 vaccination should be encouraged for pregnant individuals.

Vaccination against SARS-CoV-2 in pregnancy during the Omicron wave: the prospective cohort study of the Italian obstetric surveillance system

“…In addition to known risk factors for severe COVID-19 disease among pregnant women (age ≥35 years, not Italian citizenship, and previous comorbidities) [ 15 ], this study detected a higher occurrence of severe outcomes among women without vaccine protection. Three recent systematic reviews described the effectiveness of vaccination against the original SARS-CoV-2 strain and the alpha and delta variants [ 6 , 8 , 12 ]. Our data confirmed that the lack of vaccine protection during pregnancy resulted in worse outcomes even during the Omicron circulation; the majority of women developing MSCD were unprotected and associated with the highest proportion of urgent/emergent CS and preterm birth.…”

“…Overall, the duration of the protection against severe disease, estimated to last four to six months after one or two doses of vaccine [ 9 , 10 , 11 ] and the vaccines’ immunogenicity and reactogenicity against SARS-CoV-2 in pregnancy seem to be similar to those observed in non-pregnant women [ 8 ]. A recent metanalysis reported a decreased risk of neonatal intensive care unit (NICU) admission and intrauterine fetal death and no increase in the risk of adverse peripartum outcomes among women who received at least one dose during pregnancy, compared to those who did not [ 12 ].…”

COVID-19 Vaccination During Pregnancy

“…To the Editor In their article, Watanabe and colleagues 1 reported that COVID-19 vaccination during pregnancy was not associated with an increased risk of peripartum outcomes and was associated with a decreased risk of neonatal intensive care unit admission, intrauterine fetal death, and maternal SARS-CoV-2 infection.…”

“…The timing and doses of COVID-19 vaccination during pregnancy may affect the peripartum outcomes. The study by Watanabe et al 1 showed that COVID-19 vaccination during the second or third trimester was associated with lower risks of preterm birth and small for gestational age vs those who did not receive COVID-19 vaccination during pregnancy. Multiple doses of the COVID-19 vaccine provided better preventive effect of COVID-19 and increased the immunological effect.…”

Pädiatrie aktuell – Forschung kurz notiert

“…Eine Studie aus New York untersuchte die Auswirkungen von COVID-19-Impfungen Schwangerer auf neonatale und maternale Outcome-Parameter [ 1 ]. Dabei wurden die Verläufe von 81.349 in der Schwangerschaft geimpften Schwangeren mit jenen von 255.346 Nichtgeimpften verglichen.…”