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Morrison K, Cullen L, James AB, Chua V, Sullivan C, Robertson C, Carruthers J, Wood R, Jeffrey K, MacDonald C, Shah SA, Rudan I, Simpson CR, McCowan C, Vittal Katikireddi S, Grange Z, Ritchie L, Sheikh A. Predictors of incomplete COVID-19 vaccine schedule among adults in Scotland: Two retrospective cohort analyses of the primary schedule and third dose. Vaccine 2023; 41:5863-5876. [PMID: 37598025 DOI: 10.1016/j.vaccine.2023.07.070] [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: 05/11/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Vaccination continues to be the key public health measure for preventing severe COVID-19 outcomes. Certain groups may be at higher risk of incomplete vaccine schedule, which may leave them vulnerable to COVID-19 hospitalisation and death. AIM To identify the sociodemographic and clinical predictors for not receiving a scheduled COVID-19 vaccine after previously receiving one. METHODS We conducted two retrospective cohort studies with ≥3.7 million adults aged ≥18 years in Scotland. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) of not receiving a second, and separately a third dose between December 2020 and May 2022. Independent variables included sociodemographic and clinical factors. RESULTS Of 3,826,797 people in the study population who received one dose, 3,732,596 (97.5%) received two doses, and 3,263,153 (86.5%) received all doses available during the study period. The most strongly associated predictors for not receiving the second dose were: being aged 18-29 (reference: 50-59 years; aOR:4.26; 95% confidence interval (CI):4.14-4.37); hospitalisation due to a potential vaccine related adverse event of special interest (AESI) (reference: not having a potential AESI, aOR:3.78; 95%CI: 3.29-4.35); and living in the most deprived quintile (reference: least deprived quintile, aOR:3.24; 95%CI: 3.16-3.32). The most strongly associated predictors for not receiving the third dose were: being 18-29 (reference: 50-59 years aOR:4.44; 95%CI: 4.38-4.49), living in the most deprived quintile (reference: least deprived quintile aOR:2.56; 95%CI: 2.53-2.59), and Black, Caribbean, or African ethnicity (reference: White ethnicity aOR:2.38; 95%CI: 2.30-2.46). Pregnancy, previous vaccination with mRNA-1273, smoking history, individual and household severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, and having an unvaccinated adult in the household were also associated with incomplete vaccine schedule. CONCLUSION We observed several risk factors that predict incomplete COVID-19 vaccination schedule. Vaccination programmes must take immediate action to ensure maximum uptake, particularly for populations vulnerable to severe COVID-19 outcomes.
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Affiliation(s)
| | - Lucy Cullen
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Vera Chua
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Chris Robertson
- Public Health Scotland, Glasgow, Scotland, UK; University of Strathclyde, Glasgow, UK
| | | | - Rachael Wood
- Public Health Scotland, Glasgow, Scotland, UK; Usher Institute, University of Edinburgh, Scotland, UK
| | - Karen Jeffrey
- Usher Institute, University of Edinburgh, Scotland, UK
| | | | | | - Igor Rudan
- Usher Institute, University of Edinburgh, Scotland, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Scotland, UK; School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow, Scotland, UK; School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Zoe Grange
- Public Health Scotland, Glasgow, Scotland, UK
| | - Lewis Ritchie
- School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Scotland, UK
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2
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Lindsay L, Calvert C, Shi T, Carruthers J, Denny C, Donaghy J, Hopcroft LEM, Hopkins L, Goulding A, McLaughlin T, Moore E, Taylor B, Bhaskaran K, Katikireddi SV, McCabe R, McCowan C, Simpson CR, Robertson C, Sheikh A, Wood R, Stock SJ. Neonatal and maternal outcomes following SARS-CoV-2 infection and COVID-19 vaccination: a population-based matched cohort study. Nat Commun 2023; 14:5275. [PMID: 37644002 PMCID: PMC10465539 DOI: 10.1038/s41467-023-40965-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
Understanding the impact of SARS-CoV-2 infection and COVID-19 vaccination in pregnancy on neonatal and maternal outcomes informs clinical decision-making. Here we report a national, population-based, matched cohort study to investigate associations between SARS-CoV-2 infection and, separately, COVID-19 vaccination just before or during pregnancy and the risk of adverse neonatal and maternal outcomes among women in Scotland with a singleton pregnancy ending at ≥20 weeks gestation. Neonatal outcomes are stillbirth, neonatal death, extended perinatal mortality, preterm birth (overall, spontaneous, and provider-initiated), small-for-gestational age, and low Apgar score. Maternal outcomes are admission to critical care or death, venous thromboembolism, hypertensive disorders of pregnancy, and pregnancy-related bleeding. We use conditional logistic regression to derive odds ratios adjusted for socio-demographic and clinical characteristics (aORs). We find that infection is associated with an increased risk of preterm (aOR=1.36, 95% Confidence Interval [CI] = 1.16-1.59) and very preterm birth (aOR = 1.90, 95% CI 1.20-3.02), maternal admission to critical care or death (aOR=1.72, 95% CI = 1.39-2.12), and venous thromboembolism (aOR = 2.53, 95% CI = 1.47-4.35). We find no evidence of increased risk for any of our outcomes following vaccination. These data suggest SARS-CoV-2 infection during pregnancy is associated with adverse neonatal and maternal outcomes, and COVID-19 vaccination remains a safe way for pregnant women to protect themselves and their babies against infection.
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Affiliation(s)
| | - Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ting Shi
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Lisa E M Hopcroft
- Public Health Scotland, Edinburgh, Scotland, UK
- National Services Scotland, Edinburgh, Scotland, UK
| | | | - Anna Goulding
- Public Health Scotland, Edinburgh, Scotland, UK
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Emily Moore
- Public Health Scotland, Edinburgh, Scotland, UK
| | - Bob Taylor
- Public Health Scotland, Edinburgh, Scotland, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Edinburgh, Scotland, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ronan McCabe
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Edinburgh, Scotland, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, Scotland, UK.
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Sarah J Stock
- Public Health Scotland, Edinburgh, Scotland, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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3
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Goulding A, McQuaid F, Lindsay L, Agrawal U, Auyeung B, Calvert C, Carruthers J, Denny C, Donaghy J, Hillman S, Hopcroft L, Hopkins L, McCowan C, McLaughlin T, Moore E, Ritchie L, Simpson CR, Taylor B, Fenton L, Pollock L, Gale C, Kurinczuk JJ, Robertson C, Sheikh A, Stock S, Wood R. Confirmed SARS-CoV-2 infection in Scottish neonates 2020-2022: a national, population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:367-372. [PMID: 36609412 PMCID: PMC10313998 DOI: 10.1136/archdischild-2022-324713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To examine neonates in Scotland aged 0-27 days with SARS-CoV-2 infection confirmed by viral testing; the risk of confirmed neonatal infection by maternal and infant characteristics; and hospital admissions associated with confirmed neonatal infections. DESIGN Population-based cohort study. SETTING AND POPULATION All live births in Scotland, 1 March 2020-31 January 2022. RESULTS There were 141 neonates with confirmed SARS-CoV-2 infection over the study period, giving an overall infection rate of 153 per 100 000 live births (141/92 009, 0.15%). Among infants born to women with confirmed infection around the time of birth, the confirmed neonatal infection rate was 1812 per 100 000 live births (15/828, 1.8%). Two-thirds (92/141, 65.2%) of neonates with confirmed infection had an associated admission to neonatal or (more commonly) paediatric care. Six of these babies (6/92, 6.5%) were admitted to neonatal and/or paediatric intensive care; however, none of these six had COVID-19 recorded as their main diagnosis. There were no neonatal deaths among babies with confirmed infection. IMPLICATIONS AND RELEVANCE Confirmed neonatal SARS-CoV-2 infection was uncommon over the first 23 months of the pandemic in Scotland. Secular trends in the neonatal confirmed infection rate broadly followed those seen in the general population, although at a lower level. Maternal confirmed infection at birth was associated with an increased risk of neonatal confirmed infection. Two-thirds of neonates with confirmed infection had an associated admission to hospital, with resulting implications for the baby, family and services, although their outcomes were generally good. Ascertainment of confirmed infection depends on the extent of testing, and this is likely to have varied over time and between groups: the extent of unconfirmed infection is inevitably unknown.
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Affiliation(s)
| | - Fiona McQuaid
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | | | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Bonnie Auyeung
- School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Sam Hillman
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Hopcroft
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | - Louisa Pollock
- Child Health, University of Glasgow, Glasgow, UK
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
| | | | - Chris Robertson
- Public Health Scotland, Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Stock
- Public Health Scotland, Edinburgh, UK
- Obstetrics and Gynaecology, MRC Centre for Reproductive Health University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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4
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Calvert C, Carruthers J, Denny C, Donaghy J, Hopcroft LEM, Hopkins L, Goulding A, Lindsay L, McLaughlin T, Moore E, Taylor B, Loane M, Dolk H, Morris J, Auyeung B, Bhaskaran K, Gibbons CL, Katikireddi SV, O'Leary M, McAllister D, Shi T, Simpson CR, Robertson C, Sheikh A, Stock SJ, Wood R. A population-based matched cohort study of major congenital anomalies following COVID-19 vaccination and SARS-CoV-2 infection. Nat Commun 2023; 14:107. [PMID: 36609574 PMCID: PMC9821346 DOI: 10.1038/s41467-022-35771-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/22/2022] [Indexed: 01/08/2023] Open
Abstract
Evidence on associations between COVID-19 vaccination or SARS-CoV-2 infection and the risk of congenital anomalies is limited. Here we report a national, population-based, matched cohort study using linked electronic health records from Scotland (May 2020-April 2022) to estimate the association between COVID-19 vaccination and, separately, SARS-CoV-2 infection between six weeks pre-conception and 19 weeks and six days gestation and the risk of [1] any major congenital anomaly and [2] any non-genetic major congenital anomaly. Mothers vaccinated in this pregnancy exposure period mostly received an mRNA vaccine (73.7% Pfizer-BioNTech BNT162b2 and 7.9% Moderna mRNA-1273). Of the 6731 babies whose mothers were vaccinated in the pregnancy exposure period, 153 had any anomaly and 120 had a non-genetic anomaly. Primary analyses find no association between any vaccination and any anomaly (adjusted Odds Ratio [aOR] = 1.01, 95% Confidence Interval [CI] = 0.83-1.24) or non-genetic anomalies (aOR = 1.00, 95% CI = 0.81-1.22). Primary analyses also find no association between SARS-CoV-2 infection and any anomaly (aOR = 1.02, 95% CI = 0.66-1.60) or non-genetic anomalies (aOR = 0.94, 95% CI = 0.57-1.54). Findings are robust to sensitivity analyses. These data provide reassurance on the safety of vaccination, in particular mRNA vaccines, just before or in early pregnancy.
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Affiliation(s)
- Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Lisa E M Hopcroft
- Public Health Scotland, Glasgow, Scotland
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Anna Goulding
- Public Health Scotland, Glasgow, Scotland
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | | | | | | | - Bob Taylor
- Public Health Scotland, Glasgow, Scotland
| | - Maria Loane
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Helen Dolk
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Joan Morris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Bonnie Auyeung
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - David McAllister
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Ting Shi
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Glasgow, Scotland
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Public Health Scotland, Glasgow, Scotland
| | - Rachael Wood
- Usher Institute, University of Edinburgh, Edinburgh, UK.
- Public Health Scotland, Glasgow, Scotland.
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5
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Stock SJ, Moore E, Calvert C, Carruthers J, Denny C, Donaghy J, Hillman S, Hopcroft LEM, Hopkins L, Goulding A, Lindsay L, McLaughlin T, Taylor B, Auyeung B, Katikireddi SV, McCowan C, Ritchie LD, Rudan I, Simpson CR, Robertson C, Sheikh A, Wood R. Pregnancy outcomes after SARS-CoV-2 infection in periods dominated by delta and omicron variants in Scotland: a population-based cohort study. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1129-1136. [PMID: 36216011 PMCID: PMC9708088 DOI: 10.1016/s2213-2600(22)00360-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/10/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Evidence suggests that the SARS-CoV-2 omicron (B.1·1.529) is associated with lower risks of adverse outcomes than the delta (B.1.617.2) variant among the general population. However, little is known about outcomes after omicron infection in pregnancy. We aimed to assess and compare short-term pregnancy outcomes after SARS-CoV-2 delta and omicron infection in pregnancy. METHODS We did a national population-based cohort study of women who had SARS-CoV-2 infection in pregnancy between May 17, 2021, and Jan 31, 2022. The primary maternal outcome was admission to critical care within 21 days of infection or death within 28 days of date of infection. Pregnancy outcomes were preterm birth and stillbirth within 28 days of infection. Neonatal outcomes were death within 28 days of birth, and low Apgar score (<7 of 10, for babies born at term) or neonatal SARS-CoV-2 infection in births occurring within 28 days of maternal infection. We used periods when variants were dominant in the general Scottish population, based on 50% or more of cases being S-gene positive (delta variant, from May 17 to Dec 14, 2021) or S-gene negative (omicron variant, from Dec 15, 2021, to Jan 31, 2022) as surrogates for variant infections. Analyses used logistic regression, adjusting for maternal age, deprivation quintile, ethnicity, weeks of gestation, and vaccination status. Sensitivity analyses included restricting the analysis to those with first confirmed SARS-CoV-2 infection and using periods when delta or omicron had 90% or more predominance. FINDINGS Between May 17, 2021, and Jan 31, 2022, there were 9923 SARS-CoV-2 infections in 9823 pregnancies, in 9817 women in Scotland. Compared with infections in the delta-dominant period, SARS-CoV-2 infections in pregnancy in the omicron-dominant period were associated with lower maternal critical care admission risk (0·3% [13 of 4968] vs 1·8% [89 of 4955]; adjusted odds ratio 0·25, 95% CI 0·14-0·44) and lower preterm birth within 28 days of infection (1·8% [37 of 2048] vs 4·2% [98 of 2338]; 0·57, 95% CI 0·38-0·87). There were no maternal deaths within 28 days of infection. Estimates of low Apgar scores were imprecise due to low numbers (5 [1·2%] of 423 with omicron vs 11 [2·1%] of 528 with delta, adjusted odds ratio 0·72, 0·23-2·32). There were fewer stillbirths in the omicron-dominant period than in the delta-dominant period (4·3 [2 of 462] per 1000 births vs 20·3 [13 of 639] per 1000) and no neonatal deaths during the omicron-dominant period (0 [0 of 460] per 1000 births vs 6·3 [4 of 626] per 1000 births), thus numbers were too small to support adjusted analyses. Rates of neonatal infection were low in births within 28 days of maternal SARS-CoV-2 infection, with 11 cases of neonatal SARS-CoV-2 in the delta-dominant period, and 1 case in the omicron-dominant period. Of the 15 stillbirths, 12 occurred in women who had not received two or more doses of COVID-19 vaccination at the time of SARS-CoV-2 infection in pregnancy. All 12 cases of neonatal SARS-CoV-2 infection occurred in women who had not received two or more doses of vaccine at the time of maternal infection. Findings in sensitivity analyses were similar to those in the main analyses. INTERPRETATION Pregnant women infected with SARS-CoV-2 were substantially less likely to have a preterm birth or maternal critical care admission during the omicron-dominant period than during the delta-dominant period. FUNDING Wellcome Trust, Tommy's charity, Medical Research Council, UK Research and Innovation, Health Data Research UK, National Core Studies-Data and Connectivity, Public Health Scotland, Scottish Government Health and Social Care, Scottish Government Chief Scientist Office, National Research Scotland.
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Affiliation(s)
- Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh.
| | | | - Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Sam Hillman
- Usher Institute, University of Edinburgh, Edinburgh
| | - Lisa E M Hopcroft
- Public Health Scotland, Edinburgh, UK; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Bonnie Auyeung
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Edinburgh, UK; MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Igor Rudan
- Usher Institute, University of Edinburgh, Edinburgh
| | - Colin R Simpson
- Public Health Scotland, Edinburgh, UK; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Edinburgh, UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh
| | - Rachael Wood
- Usher Institute, University of Edinburgh, Edinburgh; Public Health Scotland, Edinburgh, UK
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6
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A population-based matched cohort study of early pregnancy outcomes following COVID-19 vaccination and SARS-CoV-2 infection. Nat Commun 2022; 13:6124. [PMID: 36253471 PMCID: PMC9574832 DOI: 10.1038/s41467-022-33937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
Data on the safety of COVID-19 vaccines in early pregnancy are limited. We conducted a national, population-based, matched cohort study assessing associations between COVID-19 vaccination and miscarriage prior to 20 weeks gestation and, separately, ectopic pregnancy. We identified women in Scotland vaccinated between 6 weeks preconception and 19 weeks 6 days gestation (for miscarriage; n = 18,780) or 2 weeks 6 days gestation (for ectopic; n = 10,570). Matched, unvaccinated women from the pre-pandemic and, separately, pandemic periods were used as controls. Here we show no association between vaccination and miscarriage (adjusted Odds Ratio [aOR], pre-pandemic controls = 1.02, 95% Confidence Interval [CI] = 0.96-1.09) or ectopic pregnancy (aOR = 1.13, 95% CI = 0.92-1.38). We undertook additional analyses examining confirmed SARS-CoV-2 infection as the exposure and similarly found no association with miscarriage or ectopic pregnancy. Our findings support current recommendations that vaccination remains the safest way for pregnant women to protect themselves and their babies from COVID-19.
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7
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Abstract
Pregnant women with covid-19 are at greater risk of severe disease than their non-pregnant peers, and yet they are frequently denied investigations or treatments because of unfounded concerns about risk to the fetus. The basic principles of diagnosing and managing covid-19 are the same as for non-pregnant patients, and a multidisciplinary, expert team approach is essential to ensure optimal care. During pregnancy, treatment with corticosteroids should be modified to use non-fluorinated glucocorticoids. Il-6 inhibitors and monoclonal antibodies, together with specific antiviral therapies, may also be considered. Prophylaxis against venous thromboembolism is important. Women may require respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position (either awake or during invasive ventilation), intubation and ventilation, and extracorporeal membrane oxygenation (ECMO). Pregnancy is not a contraindication for any of these supportive therapies, and the criteria for providing them are the same as in the general population. Decisions regarding timing, place, and mode of delivery should be taken with a multidisciplinary team including obstetricians, physicians, anesthetists, and intensivists experienced in the care of covid-19 in pregnancy. Ideally these decisions should take place in consultation with centers that have experience and expertise in all these specialties.
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Affiliation(s)
- Melanie Nana
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Kenneth Hodson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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8
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Stock SJ, Carruthers J, Calvert C, Denny C, Donaghy J, Goulding A, Hopcroft LEM, Hopkins L, McLaughlin T, Pan J, Shi T, Taylor B, Agrawal U, Auyeung B, Katikireddi SV, McCowan C, Murray J, Simpson CR, Robertson C, Vasileiou E, Sheikh A, Wood R. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland. Nat Med 2022; 28:504-512. [PMID: 35027756 PMCID: PMC8938271 DOI: 10.1038/s41591-021-01666-2] [Citation(s) in RCA: 145] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/20/2021] [Indexed: 02/05/2023]
Abstract
Population-level data on COVID-19 vaccine uptake in pregnancy and SARS-CoV-2 infection outcomes are lacking. We describe COVID-19 vaccine uptake and SARS-CoV-2 infection in pregnant women in Scotland, using whole-population data from a national, prospective cohort. Between the start of a COVID-19 vaccine program in Scotland, on 8 December 2020 and 31 October 2021, 25,917 COVID-19 vaccinations were given to 18,457 pregnant women. Vaccine coverage was substantially lower in pregnant women than in the general female population of 18-44 years; 32.3% of women giving birth in October 2021 had two doses of vaccine compared to 77.4% in all women. The extended perinatal mortality rate for women who gave birth within 28 d of a COVID-19 diagnosis was 22.6 per 1,000 births (95% CI 12.9-38.5; pandemic background rate 5.6 per 1,000 births; 452 out of 80,456; 95% CI 5.1-6.2). Overall, 77.4% (3,833 out of 4,950; 95% CI 76.2-78.6) of SARS-CoV-2 infections, 90.9% (748 out of 823; 95% CI 88.7-92.7) of SARS-CoV-2 associated with hospital admission and 98% (102 out of 104; 95% CI 92.5-99.7) of SARS-CoV-2 associated with critical care admission, as well as all baby deaths, occurred in pregnant women who were unvaccinated at the time of COVID-19 diagnosis. Addressing low vaccine uptake rates in pregnant women is imperative to protect the health of women and babies in the ongoing pandemic.
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Affiliation(s)
- Sarah J Stock
- University of Edinburgh Usher Institute, Edinburgh, UK.
- Public Health Scotland, Scotland, UK.
| | | | - Clara Calvert
- University of Edinburgh Usher Institute, Edinburgh, UK
| | | | | | | | - Lisa E M Hopcroft
- Public Health Scotland, Scotland, UK
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Ting Shi
- University of Edinburgh Usher Institute, Edinburgh, UK
| | | | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Bonnie Auyeung
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Scotland, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Colin R Simpson
- University of Edinburgh Usher Institute, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Scotland, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Aziz Sheikh
- University of Edinburgh Usher Institute, Edinburgh, UK
| | - Rachael Wood
- University of Edinburgh Usher Institute, Edinburgh, UK
- Public Health Scotland, Scotland, UK
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