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Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy.
Am J Obstet Gynecol MFM. 2021 11; 3(6):100467.AJ

Abstract

BACKGROUND

SARS-CoV-2 infection during pregnancy is associated with significant maternal morbidity and increased rates of preterm birth. For this reason, COVID-19 vaccination in pregnancy has been endorsed by multiple professional societies, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, despite the exclusion of pregnant women from initial clinical trials of vaccine safety and efficacy. However, to date, little data exist regarding the outcomes of pregnant patients after COVID-19 vaccination.

OBJECTIVE

To assess the safety and efficacy of COVID-19 vaccines in pregnant patients.

STUDY DESIGN

A comprehensive vaccine registry was combined with a delivery database for an integrated healthcare system to create a delivery cohort that included vaccinated patients. Maternal sociodemographic data were examined to identify factors associated with COVID-19 vaccination. Pregnancy and birth outcomes were analyzed, including a composite measure of maternal and neonatal pregnancy complications, the Adverse Outcome Index.

RESULTS

Of 2002 patients in the delivery cohort, 140 (7.0%) received a COVID-19 vaccine during pregnancy, and 212 (10.6%) experienced a COVID-19 infection during pregnancy. The median gestational age at first vaccination was 32 weeks (range, 13 6/7-40 4/7 weeks), and patients vaccinated during pregnancy were less likely than unvaccinated patients to experience COVID-19 infection before delivery (2/140 [1.4%] vs 210/1862 [11.3%]; P<.001). No maternal COVID-19 infection occurred after the vaccination of pregnant patients. Factors significantly associated with increased likelihood of vaccination in a multivariable logistic regression model included older age, higher level of maternal education, being a nonsmoker, use of infertility treatment for the current pregnancy, and lower gravidity. Compared with unvaccinated patients, no significant difference in the composite adverse outcome (7/140 [5.0%] vs 91/1862 [4.9%]; P=.95) or other maternal or neonatal complications, including thromboembolic events and preterm birth, was observed in vaccinated patients.

CONCLUSION

In this birth cohort, vaccinated pregnant women were less likely than unvaccinated pregnant patients to experience COVID-19 infection, and COVID-19 vaccination during pregnancy was not associated with increased pregnancy or delivery complications. The cohort was skewed toward late pregnancy vaccination, and thus, findings may not be generalizable to vaccination during early pregnancy.

Links

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Authors+Show Affiliations

Theiler RN
From the Division of Obstetrics, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN (Drs Theiler and Wick). Electronic address: Theiler.Regan@Mayo.edu.
Wick M
From the Division of Obstetrics, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN (Drs Theiler and Wick).
Mehta R
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (Ms Mehta and Weaver).
Weaver AL
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (Ms Mehta and Weaver).
Virk A
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (Dr Virk).
Swift M
Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN (Dr Swift).

MeSH

AgedCOVID-19COVID-19 VaccinesFemaleHumansInfant, NewbornPregnancyPregnancy Complications, InfectiousPregnancy OutcomePremature BirthSARS-CoV-2Vaccination

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

34425297

Citation

Theiler, Regan N., et al. "Pregnancy and Birth Outcomes After SARS-CoV-2 Vaccination in Pregnancy." American Journal of Obstetrics & Gynecology MFM, vol. 3, no. 6, 2021, p. 100467.
Theiler RN, Wick M, Mehta R, et al. Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy. Am J Obstet Gynecol MFM. 2021;3(6):100467.
Theiler, R. N., Wick, M., Mehta, R., Weaver, A. L., Virk, A., & Swift, M. (2021). Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy. American Journal of Obstetrics & Gynecology MFM, 3(6), 100467. https://doi.org/10.1016/j.ajogmf.2021.100467
Theiler RN, et al. Pregnancy and Birth Outcomes After SARS-CoV-2 Vaccination in Pregnancy. Am J Obstet Gynecol MFM. 2021;3(6):100467. PubMed PMID: 34425297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy. AU - Theiler,Regan N, AU - Wick,Myra, AU - Mehta,Ramila, AU - Weaver,Amy L, AU - Virk,Abinash, AU - Swift,Melanie, Y1 - 2021/08/20/ PY - 2021/06/10/received PY - 2021/08/16/revised PY - 2021/08/16/accepted PY - 2021/8/24/pubmed PY - 2021/11/20/medline PY - 2021/8/23/entrez KW - Adverse Outcomes Index KW - COVID-19 KW - SARS-CoV-2 KW - birth KW - gestation KW - immunity KW - mRNA vaccine KW - pregnancy KW - teratogenicity KW - vaccination SP - 100467 EP - 100467 JF - American journal of obstetrics & gynecology MFM JO - Am J Obstet Gynecol MFM VL - 3 IS - 6 N2 - BACKGROUND: SARS-CoV-2 infection during pregnancy is associated with significant maternal morbidity and increased rates of preterm birth. For this reason, COVID-19 vaccination in pregnancy has been endorsed by multiple professional societies, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, despite the exclusion of pregnant women from initial clinical trials of vaccine safety and efficacy. However, to date, little data exist regarding the outcomes of pregnant patients after COVID-19 vaccination. OBJECTIVE: To assess the safety and efficacy of COVID-19 vaccines in pregnant patients. STUDY DESIGN: A comprehensive vaccine registry was combined with a delivery database for an integrated healthcare system to create a delivery cohort that included vaccinated patients. Maternal sociodemographic data were examined to identify factors associated with COVID-19 vaccination. Pregnancy and birth outcomes were analyzed, including a composite measure of maternal and neonatal pregnancy complications, the Adverse Outcome Index. RESULTS: Of 2002 patients in the delivery cohort, 140 (7.0%) received a COVID-19 vaccine during pregnancy, and 212 (10.6%) experienced a COVID-19 infection during pregnancy. The median gestational age at first vaccination was 32 weeks (range, 13 6/7-40 4/7 weeks), and patients vaccinated during pregnancy were less likely than unvaccinated patients to experience COVID-19 infection before delivery (2/140 [1.4%] vs 210/1862 [11.3%]; P<.001). No maternal COVID-19 infection occurred after the vaccination of pregnant patients. Factors significantly associated with increased likelihood of vaccination in a multivariable logistic regression model included older age, higher level of maternal education, being a nonsmoker, use of infertility treatment for the current pregnancy, and lower gravidity. Compared with unvaccinated patients, no significant difference in the composite adverse outcome (7/140 [5.0%] vs 91/1862 [4.9%]; P=.95) or other maternal or neonatal complications, including thromboembolic events and preterm birth, was observed in vaccinated patients. CONCLUSION: In this birth cohort, vaccinated pregnant women were less likely than unvaccinated pregnant patients to experience COVID-19 infection, and COVID-19 vaccination during pregnancy was not associated with increased pregnancy or delivery complications. The cohort was skewed toward late pregnancy vaccination, and thus, findings may not be generalizable to vaccination during early pregnancy. SN - 2589-9333 UR - https://www.unboundmedicine.com/medline/citation/34425297/Pregnancy_and_birth_outcomes_after_SARS_CoV_2_vaccination_in_pregnancy_ DB - PRIME DP - Unbound Medicine ER -