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Fernández-García S, Del Campo-Albendea L, Sambamoorthi D, Sheikh J, Lau K, Osei-Lah N, Ramkumar A, Naidu H, Stoney N, Sundaram P, Sengupta P, Mehta S, Attarde S, Maddock S, Manning M, Meherally Z, Ansari K, Lawson H, Yap M, Kew T, Punnoose A, Knight C, Sadeqa E, Cherian J, Ravi S, Chen W, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Gottlieb SL, Bonet M, Moss N, Zamora J, Allotey J, Thangaratinam S. Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e014247. [PMID: 38580375 PMCID: PMC11002410 DOI: 10.1136/bmjgh-2023-014247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Major databases between December 2019 and January 2023. STUDY SELECTION Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included. QUALITY ASSESSMENT, DATA EXTRACTION AND ANALYSIS Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs. RESULTS Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women). CONCLUSION COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women. PROSPERO REGISTRATION NUMBER CRD42020178076.
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Affiliation(s)
- Silvia Fernández-García
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Laura Del Campo-Albendea
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
| | | | - Jameela Sheikh
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Karen Lau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nana Osei-Lah
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Anoushka Ramkumar
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Harshitha Naidu
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicole Stoney
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Paul Sundaram
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Samay Mehta
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Shruti Attarde
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sophie Maddock
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Millie Manning
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Kehkashan Ansari
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Heidi Lawson
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Magnus Yap
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Tania Kew
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Andriya Punnoose
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Chloe Knight
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Eyna Sadeqa
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Jiya Cherian
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sangamithra Ravi
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Wentin Chen
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | - Madelon van Wely
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Elizabeth van Leeuwen
- Amsterdam UMC Location AMC Department of Obstetrics Gynecology, Amsterdam, The Netherlands
| | - Elena Kostova
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Heinke Kunst
- Queen Mary University of London Blizard Institute, London, UK
- Barts Health NHS Trust, London, UK
| | - Asma Khalil
- St George's University of London, London, UK
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Edna Kara
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Caron Rahn Kim
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Anna Thorson
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Olufemi T Oladapo
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Lynne Mofenson
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | | | - Javier Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Gigase FAJ, Graziani M, Castro J, Lesseur C, Rommel AS, Flores T, Perez-Rodriguez MM, Dolan S, Stone J, Janevic T, Lieb W, Bergink V, de Witte LD. The effect of SARS-CoV-2 infection and vaccination on Th17 and regulatory T cells in a pregnancy cohort in NYC. Front Immunol 2024; 15:1350288. [PMID: 38504979 PMCID: PMC10948419 DOI: 10.3389/fimmu.2024.1350288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Disturbances in T-cells, specifically the Th17/Treg balance, have been implicated in adverse pregnancy outcomes. We investigated these two T-cell populations following pre-pregnancy and pregnancy SARS-CoV-2 infection and COVID-19 vaccination in 351 participants from a pregnancy cohort in New York City (Generation C; 2020-2022). SARS-CoV-2 infection status was determined via laboratory or medical diagnosis and COVID-19 vaccination status via survey and electronic medical records data. Peripheral blood mononuclear cells (PBMCs) were collected at routine prenatal visits throughout gestation (median 108 days; IQR 67-191 days) with repeated measures for 104 participants (29.6%). T-cell populations CD4+/CD3+, Th17/CD4+, Treg/CD4+ and the Th17/Treg ratio were quantified using flow cytometry. Results showed that inter-individual differences are a main influencing factor in Th17 and Treg variance, however total variance explained remained small (R2 = 15-39%). Overall, Th17 and Treg populations were not significantly affected by SARS-CoV-2 infection during pregnancy in adjusted linear mixed models (p>0.05), however comparison of repeated measures among SARS-CoV-2 infected participants and non-infected controls suggests a relative increase of the Th17/Treg ratio following infection. In addition, the Th17/Treg ratio was significantly higher after SARS-CoV-2 infection prior to pregnancy (10-138 weeks) compared to controls (β=0.48, p=0.003). COVID-19 vaccination was not associated with Th17 and Treg cells. Our findings suggest an impact of SARS-CoV-2 infection on the Th17/Treg ratio, likely depending on severity of infection, yet the observed trends and their potential consequences for pregnancy outcomes require further investigation. Our study contributes to growing evidence that COVID-19 vaccination during pregnancy does not lead to an exacerbated immune response.
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Affiliation(s)
- Frederieke A. J. Gigase
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Mara Graziani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Human Genetics, Radboud University Medical Center (UMC), Nijmegen, Netherlands
| | - Juliana Castro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Corina Lesseur
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anna-Sophie Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Tammy Flores
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Siobhan Dolan
- Department of Obstetrics and Gynecology, Stamford Health, Stamford, CT, United States
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Teresa Janevic
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Whitney Lieb
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Lot D. de Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Human Genetics, Radboud University Medical Center (UMC), Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Center (UMC), Nijmegen, Netherlands
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3
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Wang J, Deng Y, Wang W. COVID-19 vaccination during pregnancy and adverse perinatal outcomes: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2024:trad093. [PMID: 38291854 DOI: 10.1093/trstmh/trad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/05/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024] Open
Abstract
We aimed to estimate the associations between coronavirus disease 2019 (COVID-19) vaccination during pregnancy and the risks of adverse perinatal outcomes. We performed a literature search in PubMed, Web of Science and Embase to identify eligible studies published up to 24 September 2023, yielding 39 included studies. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated with a random effects model. The pooled results showed that COVID-19 vaccination during pregnancy (any type or dose of COVID-19 vaccination during any trimester) was not associated with an increased risk of adverse perinatal outcomes. In particular, COVID-19 vaccination in the third trimester was associated with a decreased risk of preterm birth (<37 weeks) (RR 0.85 [95% CI 0.74 to 0.98]), 5-min Apgar <7 (RR 0.87 [95% CI 0.78 to 0.97]) and neonatal intensive care unit (NICU) admission (RR 0.90 [95% CI 0.86 to 0.95]). The inverse associations were also found in analysis of one-dose vaccination during pregnancy and the risk of miscarriage (RR 0.83 [95% CI 0.72 to 0.96]) and preterm birth (<37 weeks) (RR 0.90 [95% CI 0.80 to 1.00]) and two-dose vaccination during pregnancy and the risk of NICU admission (RR 0.86 [95% CI 0.76 to 0.96]). COVID-19 vaccination during pregnancy does not increase the risk of negative outcomes for the mother or baby.
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Affiliation(s)
- Jia Wang
- Public Health Department, Weihai Maternal and Child Health Hospital, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong, China
| | - Yuzhi Deng
- Public Health Department, Weihai Maternal and Child Health Hospital, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 308 Ningxia Road, Qingdao, Shandong, China
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4
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Macías Saint-Gerons D, Castro JL, Colomar M, Rojas E, Sosa C, Ropero AM, Serruya SJ, Pastor D, Chiu M, Velandia-Gonzalez M, Abalos E, Durán P, Gomez Ponce de León R, Tomasso G, Mainero L, Rubino M, De Mucio B. Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites. Nested case-control analysis of the immunization-associated risk: A study protocol. BMJ Open 2024; 14:e073095. [PMID: 38286697 PMCID: PMC10826566 DOI: 10.1136/bmjopen-2023-073095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/01/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION COVID-19 is associated with higher morbimortality in pregnant people compared with non-pregnant people. At present, the benefits of maternal immunisation are considered to outweigh the risks, and therefore, vaccination is recommended during pregnancy. However, additional information is needed on the safety of the vaccines in this population. METHODS AND ANALYSIS This a retrospective cohort nested case-control study in pregnant people who attended maternity hospitals from eight Latin American and Caribbean countries. A perinatal electronic clinical history database with neonatal and obstetric information will be used. The proportion of pregnant people immunised with COVID-19 vaccines of the following maternal and neonatal events will be described: preterm infant, small for gestational age, low birth weight, stillbirth, neonatal death, congenital malformations, maternal near miss and maternal death. Moreover, the risk of prematurity, small for gestational age and low birth weight associated with exposure to COVID-19 vaccines will be estimated. Each case will be matched with two groups of three randomly selected controls. Controls will be matched by hospital and mother's age (±3 years) with an additional matching by delivery date and conception time in the first and second control groups, respectively. The estimated required sample size for the main analysis (exposure to any vaccine) concerning 'non-use' is at least 1009 cases (3027 controls) to detect an increased probability of vaccine-associated event risk of 30% and at least 650 cases (1950 controls) to detect 30% protection. Sensitivity and secondary analyses considering country, type of vaccine, exposure windows and completeness of immunisation will be reported. ETHICS The study protocol was reviewed by the Ethical Review Committee on Research of the Pan American Health Organization. Patient informed consent was waived due to the retrospective design and the utilisation of anonymised data (Ref. No: PAHOERC.0546.01). Results will be disseminated in open access journals.
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Affiliation(s)
- Diego Macías Saint-Gerons
- Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - José Luis Castro
- Fundación para la innovación, la formación, la investigación y el desarrollo comunitario (FUNDEC), Santa Cruz de Tenerife, Spain
| | - Mercedes Colomar
- Unidad de Investigación Clínica y Epidemiológica Montevideo, Montevideo, Uruguay
- Deparment of Preventive and Social Medicine, School of Medicine, Montevideo, Uruguay
| | - Edgard Rojas
- Innovation, Access to Medicines and Health Technologies (IMT), PAHO, Washington, District of Columbia, USA
| | - Claudio Sosa
- Department of Obstetrics and Gynecology, Pereira Rossell Hospital, School of Medicine, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | | | - Suzanne Jacob Serruya
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | | | | | | | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Pablo Durán
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | | | - Giselle Tomasso
- Unidad de Investigación Clínica y Epidemiológica Montevideo, Montevideo, Uruguay
| | - Luis Mainero
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | - Marcelo Rubino
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | - Bremen De Mucio
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
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5
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Cimolai N. COVID-19 among infants: key clinical features and remaining controversies. Clin Exp Pediatr 2024; 67:1-16. [PMID: 38013408 PMCID: PMC10764668 DOI: 10.3345/cep.2023.00794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/11/2023] [Accepted: 09/19/2023] [Indexed: 11/29/2023] Open
Abstract
Infants aged <1 year represent a seemingly more susceptible pediatric subset for infections. Despite this, coronavirus disease 2019 (COVID-19) infection has not been proven as more serious in this age group (outside the very early neonatal period) than in others. Indeed, a considerable number of asymptomatic infections have been recorded, and the symptoms and morbidity associated with COVID- 19 differ minimally from those of other respiratory viral infections. Whether due to an abundance of caution or truly reduced susceptibility, infections in infants have not raised the same profile as those in other age groups. In addition to direct severe acute respiratory syndrome coronavirus 2 diagnostic tests, laboratory markers that differentiate COVID-19 from other viral infections lack specificity in infants. Gastrointestinal presentations are common, and the neurological complications of infection mirror those of other respiratory viral infections. There have been relatively few reports of infant deaths. Under appropriate precautions, breastfeeding in the context of maternal infections has been associated with tangible but infrequent complications. Vaccination during pregnancy provides protection against infection in infants, at least in the early months of life. Multi-inflammatory syndrome in children and multi-inflammatory syndrome in neonates are commonly cited as variants of COVID-19; however, their clinical definitions remain controversial. Similarly, reliable definitions of long COVID in the infant group are controversial. This narrative review examines the key clinical and laboratory features of COVID-19 in infants and identifies several areas of science awaiting further clarification.
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Affiliation(s)
- Nevio Cimolai
- Faculty of Medicine, The University of British Columbia and Children’s and Women’s Health Centre of British Columbia, Vancouver, Canada
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Celik IH, Ozkaya Parlakay A, Canpolat FE. Management of neonates with maternal prenatal coronavirus infection and influencing factors. Pediatr Res 2024; 95:436-444. [PMID: 37857851 DOI: 10.1038/s41390-023-02855-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/09/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
The coronavirus disease 2019 (COVID-19) in pregnancy causes adverse outcomes for both the mother and the fetus. Neonates are at risk of vertical transmission and in-utero infection. Additionally, intensive care unit (ICU) admission and impairment in the organ systems of the mother are associated with neonatal outcomes, including impaired intrauterine growth, prematurity, and neonatal ICU admission. The management of neonates born from infected mothers has changed over the progress of the pandemic. At the beginning of the pandemic, cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoiding of skin-to-skin contact, breast milk, and breastfeeding were the main practices to reduce vertical and horizontal transmission risk in the era of insufficient knowledge. The effects of antenatal steroids and delayed cord clamping on COVID-19 were also not known. As the pandemic progressed, data showed that prenatal, delivery room, and postnatal care of neonates can be performed as pre-pandemic practices. Variants and vaccines that affect clinical course and outcomes have emerged during the pandemic. The severity of the disease and the timing of infection in pregnancy also influence maternal and neonatal outcomes. The knowledge and lessons from COVID-19 will be helpful for the next pandemic if it happens. IMPACT: Prenatal infection with COVID-19 is associated with adverse maternal and neonatal outcomes. Our review includes the management of neonates with prenatal COVID-19 infection exposure, maternal-fetal, delivery room, and postnatal care of neonates, clinical features, treatment of neonates, and influencing factors such as variants, vaccination, severity of maternal disease, and timing of infection during pregnancy. There is a growing body of data and evidence about the COVID-19 pandemic. The knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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Affiliation(s)
- Istemi Han Celik
- University of Health Sciences Turkey; Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye.
| | - Aslinur Ozkaya Parlakay
- Ankara Yildirim Beyazit University; Ankara Bilkent City Hospital, Department of Pediatrics, Pediatric Infectious Diseases Unit, Ankara, Türkiye
| | - Fuat Emre Canpolat
- University of Health Sciences Turkey, Ankara Bilkent City Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
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7
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Jorgensen SCJ, Drover SSM, Fell DB, Austin PC, D’Souza R, Guttmann A, Buchan SA, Wilson SE, Nasreen S, Schwartz KL, Tadrous M, Wilson K, Kwong JC. Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy. JAMA Pediatr 2023; 177:1314-1323. [PMID: 37870875 PMCID: PMC10594175 DOI: 10.1001/jamapediatrics.2023.4499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/12/2023] [Indexed: 10/24/2023]
Abstract
Importance The study team previously showed that maternal mRNA COVID-19 vaccination during pregnancy confers protection against SARS-CoV-2 infection and COVID-19-related hospital admission in newborns and young infants. In this study, the study team evaluated newborn and early infant safety outcomes following maternal messenger RNA (mRNA) COVID-19 vaccination during pregnancy, for which there is limited comparative epidemiological evidence. Objective To determine if maternal mRNA COVID-19 vaccination during pregnancy is associated with adverse newborn and early infant outcomes. Design, Setting, and Participants This population-based retrospective cohort study took place in Ontario, Canada, using multiple linked health administrative databases. Singleton live births with an expected delivery date between May 1, 2021, and September 2, 2022, were included. Data were analyzed from January 2023 through March 2023. Exposure Maternal mRNA COVID-19 vaccination (1 or more doses) during pregnancy. Main Outcomes and Measures Severe neonatal morbidity (SNM), neonatal death, neonatal intensive care unit (NICU) admission, neonatal readmission, and hospital admission up to 6 months of age. The study team calculated inverse probability of treatment weighted risk ratios (RRs) and fit weighted Cox proportional hazards regression models comparing outcomes in infants of mothers who received COVID-19 vaccination during pregnancy with those who received no COVID-19 vaccine doses before delivery. Results In total, 142 006 infants (72 595 male [51%]; mean [SD] gestational age at birth, 38.7 [1.7] weeks) were included; 85 670 were exposed to 1 or more COVID-19 vaccine doses in utero (60%). Infants of vaccinated mothers had lower risks of SNM (vaccine exposed 7.3% vs vaccine unexposed 8.3%; adjusted RR [aRR], 0.86; 95% CI, 0.83-0.90), neonatal death (0.09% vs 0.16%; aRR, 0.47; 95% CI, 0.33-0.65), and NICU admission (11.4% vs 13.1%; aRR, 0.86; 95% CI, 0.83-0.89). There was no association between maternal vaccination during pregnancy and neonatal readmission (5.5% vs 5.1%; adjusted hazard ratio, 1.03; 95% CI, 0.98-1.09) or 6-month hospital admission (8.4% vs 8.1%; adjusted hazard ratio, 1.01; 95% CI, 0.96-1.05). Conclusions and Relevance In this population-based cohort study in Ontario, Canada, maternal mRNA COVID-19 vaccination during pregnancy was associated with lower risks of SNM, neonatal death, and NICU admission. In addition, neonatal and 6-month readmissions were not increased in infants of mothers vaccinated during pregnancy.
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Affiliation(s)
- Sarah C. J. Jorgensen
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deshayne B. Fell
- ICES, Toronto, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D’Souza
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
- The Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A. Buchan
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E. Wilson
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Sharifa Nasreen
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Hospital Research Institutes, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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8
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Chen Z, Mu X, Wang X, Zhang L, Liu G, Zheng J, Ding F. Association of Maternal Inactivated COVID-19 Vaccination within 3 Months before Conception with Neonatal Outcomes. Vaccines (Basel) 2023; 11:1710. [PMID: 38006042 PMCID: PMC10674970 DOI: 10.3390/vaccines11111710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
There is limited available data addressing whether inactivated COVID-19 vaccination before conception is associated with adverse neonatal outcomes. This cohort study included all singleton live births at our center from March 1 to June 30, 2022. According to whether a maternal inactivated COVID-19 vaccination had been administered within 3 months before conception or not, neonates were identified as being in the vaccinated or unvaccinated group. Vaccination information and clinical characteristics were extracted for analysis. Furthermore, neonatal outcomes were analyzed and compared between these two groups in the present study. The cohort included 856 eligible newborns, of whom 369 were exposed to maternal vaccination before conception and 487 were unexposed newborns. No differences were observed in rates of preterm birth, newborns being small for gestational age, or neonatal intensive care unit admission between exposed and unexposed newborns. Furthermore, even after adjusting for social-economic status and maternal characteristics, there remained no significant differences in these neonatal outcomes. Our study revealed no statistically significant differences between newborns born to women who received inactivated vaccines prior to conception compared with those who did not receive any vaccinations. In addition, our study also highlights the importance of considering COVID-19 vaccination before conception.
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Affiliation(s)
- Zhihui Chen
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China; (Z.C.); (X.M.); (L.Z.); (G.L.)
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300199, China;
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin 300052, China
| | - Xingbo Mu
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China; (Z.C.); (X.M.); (L.Z.); (G.L.)
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300199, China;
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin 300052, China
| | - Xinyan Wang
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300199, China;
- Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Lulu Zhang
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China; (Z.C.); (X.M.); (L.Z.); (G.L.)
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300199, China;
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin 300052, China
| | - Ge Liu
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China; (Z.C.); (X.M.); (L.Z.); (G.L.)
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300199, China;
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin 300052, China
| | - Jun Zheng
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China; (Z.C.); (X.M.); (L.Z.); (G.L.)
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300199, China;
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin 300052, China
| | - Fangrui Ding
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China; (Z.C.); (X.M.); (L.Z.); (G.L.)
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300199, China;
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin 300052, China
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9
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Fell DB, Török E, Sprague AE, Regan AK, Dhinsa T, Alton GD, Dimanlig-Cruz S, MacDonald SE, Buchan SA, Kwong JC, Wilson SE, Håberg SE, Gravel CA, Wilson K, Dunn SI, Shah PS, El-Chaâr D, Barrett J, Walker MC, Okun N, Dougan SD. Temporal trends and determinants of COVID-19 vaccine coverage and series initiation during pregnancy in Ontario, Canada, December 2020 to December 2021: A population-based retrospective cohort study. Vaccine 2023; 41:1716-1725. [PMID: 36759282 PMCID: PMC9894778 DOI: 10.1016/j.vaccine.2023.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Population-based COVID-19 vaccine coverage estimates among pregnant individuals are limited. We assessed temporal patterns in vaccine coverage (≥1 dose before or during pregnancy) and evaluated factors associated with vaccine series initiation (receiving dose 1 during pregnancy) in Ontario, Canada. METHODS We linked the provincial birth registry with COVID-19 vaccination records from December 14, 2020 to December 31, 2021 and assessed coverage rates among all pregnant individuals by month, age, and neighborhood sociodemographic characteristics. Among individuals who gave birth since April 2021-when pregnant people were prioritized for vaccination-we assessed associations between sociodemographic, behavioral, and pregnancy-related factors with vaccine series initiation using multivariable regression to estimate adjusted risk ratios (aRR) and risk differences (aRD) with 95% confidence intervals (CI). RESULTS Among 221,190 pregnant individuals, vaccine coverage increased to 71.2% by December 2021. Gaps in coverage across categories of age and sociodemographic characteristics decreased over time, but did not disappear. Lower vaccine series initiation was associated with lower age (<25 vs. 30-34 years: aRR 0.53, 95%CI 0.51-0.56), smoking (vs. non-smoking: 0.64, 0.61-0.67), no first trimester prenatal care visit (vs. visit: 0.80, 0.77-0.84), and residing in neighborhoods with the lowest income (vs. highest: 0.69, 0.67-0.71). Vaccine series initiation was marginally higher among individuals with pre-existing medical conditions (vs. no conditions: 1.07, 1.04-1.10). CONCLUSIONS COVID-19 vaccine coverage among pregnant individuals remained lower than in the general population, and there was lower vaccine initiation by multiple characteristics.
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Affiliation(s)
- Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Eszter Török
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Ann E Sprague
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Tavleen Dhinsa
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Gillian D Alton
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Sheryll Dimanlig-Cruz
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Wilson
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher A Gravel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
| | - Sandra I Dunn
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Darine El-Chaâr
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Mark C Walker
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Nannette Okun
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Shelley D Dougan
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
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