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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] [What about the content of this article? (0)] [Affiliation(s)] [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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