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Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study.
BMJ. 2022 08 17; 378:e071416.BMJ

Abstract

OBJECTIVE

To assess the risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy.

DESIGN

Population based retrospective cohort study.

SETTING

Ontario, Canada, 1 May to 31 December 2021.

PARTICIPANTS

All liveborn and stillborn infants from pregnancies conceived at least 42 weeks before the end of the study period and with gestational age ≥20 weeks or birth weight ≥500 g.

MAIN OUTCOME MEASURES

Using Cox regression, hazard ratios and 95% confidence intervals were estimated for preterm birth before 37 weeks (overall and spontaneous preterm birth), very preterm birth (<32 weeks), small for gestational age at birth (<10th centile), and stillbirth. Vaccination against covid-19 was treated as a time varying exposure in the outcome specific risk window, and propensity score weighting was used to adjust hazard ratios for potential confounding.

RESULTS

Among 85 162 births, 43 099 (50.6%) occurred in individuals who received one dose or more of a covid-19 vaccine during pregnancy-42 979 (99.7%) received an mRNA vaccine. Vaccination during pregnancy was not associated with any increased risk of overall preterm birth (6.5% among vaccinated v 6.9% among unvaccinated; adjusted hazard ratio 1.02, 95% confidence interval 0.96 to 1.08), spontaneous preterm birth (3.7% v 4.4%; 0.96, 0.90 to 1.03), or very preterm birth (0.59% v 0.89%; 0.80, 0.67 to 0.95). No increase was found in risk of small for gestational age at birth (9.1% v 9.2%; 0.98, 0.93 to 1.03) or stillbirth (0.25% v 0.44%; 0.65, 0.51 to 0.84). Findings were similar by trimester of vaccination, mRNA vaccine product, and number of doses received during pregnancy.

CONCLUSION

The findings suggest that vaccination against covid-19 during pregnancy is not associated with a higher risk of preterm birth, small for gestational age at birth, or stillbirth.

Links

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Authors+Show Affiliations

Fell DB
Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada dfell@cheo.on.ca. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Dimanlig-Cruz S
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.
Regan AK
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.
Håberg SE
Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
Gravel CA
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
Oakley L
Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway. Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Alton GD
Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada. Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.
Török E
Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada. Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.
Dhinsa T
Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.
Shah PS
Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada. Department of Paediatrics, University of Toronto, Toronto, ON, Canada. Maternal-infant Care Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
Wilson K
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.
Sprague AE
Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada. Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.
El-Chaâr D
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 Gynaecology, University of Ottawa, Ottawa, ON, Canada.
Walker MC
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 and Network (BORN) Ontario, Ottawa, ON, Canada. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada.
Barrett J
Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada.
Okun N
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
Buchan SA
Public Health Ontario, Toronto, ON, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Kwong JC
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.
Wilson SE
Public Health Ontario, Toronto, ON, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Dunn SI
Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada. School of Nursing, University of Ottawa, Ottawa, ON, Canada.
MacDonald SE
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. School of Public Health, University of Alberta, Edmonton, AB, Canada. Department of Paediatrics, University of Calgary, Calgary, AB, Canada.
Dougan SD
Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada. Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.

MeSH

COVID-19COVID-19 VaccinesCohort StudiesFemaleFetal Growth RetardationGestational AgeHumansInfantInfant, NewbornInfant, Small for Gestational AgeOntarioPregnancyPregnancy OutcomePremature BirthRetrospective StudiesStillbirthVaccinationVaccines, SyntheticmRNA Vaccines

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35977737

Citation

Fell, Deshayne B., et al. "Risk of Preterm Birth, Small for Gestational Age at Birth, and Stillbirth After Covid-19 Vaccination During Pregnancy: Population Based Retrospective Cohort Study." BMJ (Clinical Research Ed.), vol. 378, 2022, pp. e071416.
Fell DB, Dimanlig-Cruz S, Regan AK, et al. Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study. BMJ. 2022;378:e071416.
Fell, D. B., Dimanlig-Cruz, S., Regan, A. K., Håberg, S. E., Gravel, C. A., Oakley, L., Alton, G. D., Török, E., Dhinsa, T., Shah, P. S., Wilson, K., Sprague, A. E., El-Chaâr, D., Walker, M. C., Barrett, J., Okun, N., Buchan, S. A., Kwong, J. C., Wilson, S. E., ... Dougan, S. D. (2022). Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study. BMJ (Clinical Research Ed.), 378, e071416. https://doi.org/10.1136/bmj-2022-071416
Fell DB, et al. Risk of Preterm Birth, Small for Gestational Age at Birth, and Stillbirth After Covid-19 Vaccination During Pregnancy: Population Based Retrospective Cohort Study. BMJ. 2022 08 17;378:e071416. PubMed PMID: 35977737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study. AU - Fell,Deshayne B, AU - Dimanlig-Cruz,Sheryll, AU - Regan,Annette K, AU - Håberg,Siri E, AU - Gravel,Christopher A, AU - Oakley,Laura, AU - Alton,Gillian D, AU - Török,Eszter, AU - Dhinsa,Tavleen, AU - Shah,Prakesh S, AU - Wilson,Kumanan, AU - Sprague,Ann E, AU - El-Chaâr,Darine, AU - Walker,Mark C, AU - Barrett,Jon, AU - Okun,Nannette, AU - Buchan,Sarah A, AU - Kwong,Jeffrey C, AU - Wilson,Sarah E, AU - Dunn,Sandra I, AU - MacDonald,Shannon E, AU - Dougan,Shelley D, Y1 - 2022/08/17/ PY - 2022/8/17/entrez PY - 2022/8/18/pubmed PY - 2022/8/20/medline SP - e071416 EP - e071416 JF - BMJ (Clinical research ed.) JO - BMJ VL - 378 N2 - OBJECTIVE: To assess the risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy. DESIGN: Population based retrospective cohort study. SETTING: Ontario, Canada, 1 May to 31 December 2021. PARTICIPANTS: All liveborn and stillborn infants from pregnancies conceived at least 42 weeks before the end of the study period and with gestational age ≥20 weeks or birth weight ≥500 g. MAIN OUTCOME MEASURES: Using Cox regression, hazard ratios and 95% confidence intervals were estimated for preterm birth before 37 weeks (overall and spontaneous preterm birth), very preterm birth (<32 weeks), small for gestational age at birth (<10th centile), and stillbirth. Vaccination against covid-19 was treated as a time varying exposure in the outcome specific risk window, and propensity score weighting was used to adjust hazard ratios for potential confounding. RESULTS: Among 85 162 births, 43 099 (50.6%) occurred in individuals who received one dose or more of a covid-19 vaccine during pregnancy-42 979 (99.7%) received an mRNA vaccine. Vaccination during pregnancy was not associated with any increased risk of overall preterm birth (6.5% among vaccinated v 6.9% among unvaccinated; adjusted hazard ratio 1.02, 95% confidence interval 0.96 to 1.08), spontaneous preterm birth (3.7% v 4.4%; 0.96, 0.90 to 1.03), or very preterm birth (0.59% v 0.89%; 0.80, 0.67 to 0.95). No increase was found in risk of small for gestational age at birth (9.1% v 9.2%; 0.98, 0.93 to 1.03) or stillbirth (0.25% v 0.44%; 0.65, 0.51 to 0.84). Findings were similar by trimester of vaccination, mRNA vaccine product, and number of doses received during pregnancy. CONCLUSION: The findings suggest that vaccination against covid-19 during pregnancy is not associated with a higher risk of preterm birth, small for gestational age at birth, or stillbirth. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/35977737/Risk_of_preterm_birth_small_for_gestational_age_at_birth_and_stillbirth_after_covid_19_vaccination_during_pregnancy:_population_based_retrospective_cohort_study_ DB - PRIME DP - Unbound Medicine ER -