Reductions in stillbirths and preterm birth in COVID-19–vaccinated women: a multicenter cohort study of vaccination uptake and perinatal outcomes

Hui, Lisa; Marzan, Melvin Barrientos; Rolnik, Daniel L.; Potenza, Stephanie; Pritchard, Natasha; Said, Joanne; Palmer, Kirsten; Whitehead, Clare; Sheehan, Penelope M.; Ford, Jolyon; Mol, Ben Willem J.; Walker, Susan

doi:10.1016/j.ajog.2022.10.040

Cited by 40 publications

(49 citation statements)

References 18 publications

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“…All included studies reported that only pregnant women without a history of SARS‐CoV‐2 infection were included in their analyses. Vaccinated women were in their first trimester at the time of vaccination only in two studies, 24,36 while in four studies, they were in their second and third trimesters, 10,17,19,37 and 13 studies included women from all three trimesters 11,18,20–23,26,38–43 . BNT162b2 (Pfizer‐BioNTech, 27 studies), mRNA‐1273 (Moderna, 17 studies), ChAdOx1 nCoV‐19 (Oxford‐AstraZeneca, 7 studies), and Ad26.COV.2.S (Janssen, 4 studies) were the different vaccine types in included studies.…”

Section: Resultsmentioning

confidence: 99%

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Effects of COVID‐19 vaccination during pregnancy on SARS‐CoV‐2 infection and maternal and neonatal outcomes: A systematic review and meta‐analysis

Rahmati

Yon

Lee

et al. 2023

Reviews in Medical Virology

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SARS‐CoV‐2 infection during pregnancy is associated with adverse maternal and neonatal outcomes, but no systematic synthesis of evidence on COVID‐19 vaccination during pregnancy against these outcomes has been undertaken. Thus, we aimed to assess the collective evidence on the effects of COVID‐19 vaccination during pregnancy on maternal and neonatal outcomes. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to 1 November 2022. A systematic review and meta‐analysis were performed to calculate pooled effects size and 95% confidence interval (CI). We evaluated 30 studies involving 862,272 individuals (308,428 vaccinated and 553,844 unvaccinated). Overall pooled analyses in pregnant women during pregnancy showed reduced risks of SARS‐CoV‐2 infection by 60% (41%–73%), COVID‐19 hospitalisation during pregnancy by 53% (31%–69%), and COVID‐19 intensive care unit (ICU) admission by 82% (12%–99%). Neonates of vaccinated women were 1.78 folds more likely to acquire SARS‐CoV‐2 infection during the first 2, 4 and 6 months of life during the Omicron period. The risk of stillbirth was reduced by 45% (17%–63%) in association with vaccination (vs. no vaccination) in pregnancy. A decrease of 15% (3%–25%), 33% (14%–48%), and 33% (17%–46%) in the odds of preterm births before 37, 32 and 28 weeks' gestation were associated with vaccination (vs. no vaccination) in pregnancy, respectively. The risk of neonatal ICU admission was significantly lower by 20% following COVID‐19 vaccination in pregnancy (16%–24%). There was no evidence of a higher risk of adverse outcomes including miscarriage, gestational diabetes, gestational hypertension, cardiac problems, oligohydramnios, polyhydramnios, unassisted vaginal delivery, cesarean delivery, postpartum haemorrhage, gestational age at delivery, placental abruption, Apgar score at 5 min below 7, low birthweight (<2500 g), very low birthweight (<1500 g), small for gestational age, and neonatal foetal abnormalities. COVID‐19 vaccination during pregnancy is safe and highly effective in preventing maternal SARS‐CoV‐2 infection in pregnancy, without increasing the risk of adverse maternal and neonatal outcomes, and is associated with a reduction in stillbirth, preterm births, and neonatal ICU admission. Importantly, maternal vaccination did not reduce the risk of neonatal SARS‐CoV‐2 infection during the first 6 months of life during the Omicron period.

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Section: Resultsmentioning

confidence: 99%

“…Emerging evidence from large‐scale cohort studies suggests that vaccination during pregnancy is not associated with any adverse maternal and neonatal outcomes 17,19,21–26 . Recently, several systematic reviews and meta‐analyses on the effectiveness of COVID‐19 vaccination during pregnancy have been published 27–30 .…”

Section: Introductionmentioning

confidence: 99%

Effects of COVID‐19 vaccination during pregnancy on SARS‐CoV‐2 infection and maternal and neonatal outcomes: A systematic review and meta‐analysis

Rahmati

Yon

Lee

et al. 2023

Reviews in Medical Virology

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“…Pregnancy by itself does not represent a cause for increased risks of any adverse outcome, following COVID-19 vaccination [ 82 ], while the overall risk of the occurrence of an acute adverse event requiring medical attention is low (<1%) and similar in pregnant and unvaccinated pregnant patients [ 83 ]. Direct or indirect harmful effects on fertility, embryo/fetal development, pregnancy outcome, parturition, or short-term postnatal development of offspring were not detected [ 75 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ]. A recent metaanalysis did not find significant differences in assisted reproductive outcomes between vaccinated and unvaccinated women [ 98 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Pharmacotherapy in Pregnancy: A Literature Review of Current Therapeutic Choices

Akinosoglou

Schinas

Rigopoulos

et al. 2023

Viruses

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The clinical management of COVID-19 in pregnant women, who are considered a vulnerable population, remains uncertain even as the pandemic subsides. SARS-CoV-2 affects pregnant individuals in multiple ways and has been associated with severe maternal morbidity and mortality, as well as neonatal complications. The unique anatomy and physiology of gestation make managing COVID-19 in this population a complex and challenging task, emphasizing the importance of spreading knowledge and expertise in this area. Therapeutic interventions require distinct clinical consideration, taking into account differences in pharmacokinetics, vertical transmission, drug toxicities, and postnatal care. Currently, there is limited data on antiviral and immunomodulating COVID-19 pharmacotherapy in pregnancy. Some medication has been shown to be safe and well tolerated among pregnant women with COVID-19; however, the lack of randomized clinical trials and studies in this patient population is evident. Available vaccines are considered safe and effective, with no evidence of harm to the fetus, embryo development, or short-term postnatal development. Pregnant women should be counseled about the risks of SARS-CoV-2 infection and informed of available ways to protect themselves and their families. Effective treatments for COVID-19 should not be withheld from pregnant individuals, and more research is needed to ensure the best outcomes.

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“…The effects of SARS-CoV-2 on the health of pregnant individuals and their offspring may vary based on SARS-CoV-2 variant, gestational age at infection, and maternal health and vaccination status. [7][8][9][10][11][12] Existing data demonstrate that the Delta variant results both in the highest risk of maternal critical illness and stillbirth, and in the most profound placental effects. 7,8 Vaccination has been found to be protective against both severe maternal COVID-19 and adverse pregnancy outcomes, and may also influence the incidence of PASC in this population.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Vaccination has been found to be protective against both severe maternal COVID-19 and adverse pregnancy outcomes, and may also influence the incidence of PASC in this population. [9][10][11] The National Institute of Health's (NIH) RECOVER initiative has a unique opportunity to study the post-acute sequelae of SARS-CoV-2 acquired in pregnancy. RECOVER-Pregnancy will enroll maternal-child dyads to investigate the effects of SARS-CoV-2 acquired during pregnancy on the long-term health of both the pregnant person and their offspring who were exposed to SARS-CoV-2 in utero.…”

Section: Introductionmentioning

confidence: 99%

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design

Metz

Clifton

Gallagher

et al. 2023

Preprint

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Importance: Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER-Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. Methods: RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. Discussion: RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero.

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Reductions in stillbirths and preterm birth in COVID-19–vaccinated women: a multicenter cohort study of vaccination uptake and perinatal outcomes

Cited by 40 publications

References 18 publications

Effects of COVID‐19 vaccination during pregnancy on SARS‐CoV‐2 infection and maternal and neonatal outcomes: A systematic review and meta‐analysis

Effects of COVID‐19 vaccination during pregnancy on SARS‐CoV‐2 infection and maternal and neonatal outcomes: A systematic review and meta‐analysis

COVID-19 Pharmacotherapy in Pregnancy: A Literature Review of Current Therapeutic Choices

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design

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