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Álvarez Aldeán J, José Álvarez García F, de la Calle Fernández-Miranda M, Figueras Falcón T, Iofrío de Arce A, López Rojano M, Rivero Calle I, Suy Franch A. Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO. An Pediatr (Barc) 2024; 100:268-274. [PMID: 38565447 DOI: 10.1016/j.anpede.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitis B, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated. Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines. The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines, and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6 months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36.
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Affiliation(s)
- Javier Álvarez Aldeán
- Servicio de Pediatría, Hospital Costa del Sol, Asociación Española de Pediatría (CAV-AEP), Marbella, Málaga, Spain
| | - Francisco José Álvarez García
- Centro de Salud de Llanera, Asturias Departamento de Medicina. Universidad de Oviedo. Asociación Española de Pediatría (CAV-AEP), Oviedo, Spain.
| | - Maria de la Calle Fernández-Miranda
- Sección de Obstetricia, Hospital Universitario la Paz, Facultad de Medicina, Universidad Autónoma de Madrid, Sociedad Española de Ginecología y Obstetricia, Madrid, Spain
| | - Tatiana Figueras Falcón
- Unidad Medicina Materno Fetal, Servicio de Obstetricia y Ginecologia, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas, Sociedad Española de Ginecología y Obstetricia, Las Palmas de Gran Canaria, Spain
| | - Antonio Iofrío de Arce
- Centro de Salud El Ranero, Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP), Murcia, Spain
| | - Marta López Rojano
- Servicio de Medicina Maternofetal, BCNatal-Centro de Medicina Maternofetal y Neonatal de Barcelona (Hospital Clínic de Barcelona y Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Sociedad Española de Ginecología y Obstetricia, Barcelona, Spain
| | - Irene Rivero Calle
- Sección de Pediatría Clínica, Infectológica y Traslacional, Hospital Clínico Universitario de Santiago de Compostela, Sociedad Española de Infectología Pediátrica (SEIP), Grupo Genética, Vacunas, Infecciones y Pediatría (GENVIP). Asociación Española de Pediatría (CAV-AEP), Santiago de Compostela, A Coruña, Spain
| | - Anna Suy Franch
- Sección de Obstetricia, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Sociedad Española de Ginecología y Obstetricia, Barcelona, Spain
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Quincer EM, Cranmer LM, Kamidani S. Prenatal Maternal Immunization for Infant Protection: A Review of the Vaccines Recommended, Infant Immunity and Future Research Directions. Pathogens 2024; 13:200. [PMID: 38535543 PMCID: PMC10975994 DOI: 10.3390/pathogens13030200] [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: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 04/01/2024] Open
Abstract
Prenatal maternal immunization is an effective tool to protect mothers and infants from poor health outcomes due to infectious diseases. We provide an overview of the rationale for the use of prenatal vaccines, discuss the immunologic environment of the maternal-fetal interface including the impact of maternal vaccines prenatally and subsequently on the infant's immune response, and review vaccines currently recommended in pregnancy and landscape for the future of maternal vaccination. This review aims to provide an understanding of the recent history and progress made in the field and highlight the importance of continued research and development into new vaccines for pregnant populations.
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Affiliation(s)
- Elizabeth M. Quincer
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Lisa M. Cranmer
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Satoshi Kamidani
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
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Colombo L, Hadigal S, Nauta J, Kondratenko A, Rogoll J, Van de Witte S. Influvac Tetra: clinical experience on safety, efficacy, and immunogenicity. Expert Rev Vaccines 2024; 23:88-101. [PMID: 38088157 DOI: 10.1080/14760584.2023.2293241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION This paper summarizes the safety and immunogenicity data of Influvac Tetra across all age groups starting from 6 months of age, obtained during its clinical development program. AREAS COVERED The article covers the clinical development program of Influvac Tetra based on five registration studies that included different age groups, different comparators, and participants from Europe and Asia. Safety and immunogenicity were assessed in all studies and in one study, the efficacy of Influvac Tetra was assessed. EXPERT OPINION Seasonal influenza is a vaccine-preventable disease that can cause serious complications. Several types of influenza vaccines are available, including egg-based (standard dose, high dose, and adjuvanted), cell-based, and recombinant. The COVID-19 pandemic has stimulated innovation in the development such as mRNA vaccines. However, these vaccines are still in development and the true value still has to be proven. Regardless of the type of vaccine, it is also important to increase overall vaccination coverage. ECDC recommends that EU Member States implement action plans and policies aimed at reaching 75% coverage in at-risk groups and healthcare workers. Even so, vaccine coverage is still far from recommended.
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Affiliation(s)
| | | | - Jos Nauta
- Innovation & Development, Abbott, Weesp, The Netherlands
| | | | - Jutta Rogoll
- Global Pharmacovigilance, Abbott, Hannover, Germany
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Moon S, Lee J, Yu JM, Choi H, Choi S, Park J, Choi K, Kim E, Kim H, Kim MJ, Park YJ. Association between environmental cadmium exposure and increased mortality in the U.S. National Health and Nutrition Examination Survey (1999-2018). JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:874-882. [PMID: 37161056 DOI: 10.1038/s41370-023-00556-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Cadmium (Cd) is toxic to human health and increases overall mortality. In this study, we investigated the association between Cd exposure and all-cause, cardiovascular (CVD), and cancer mortality in the general population and the mediating effect of smoking on these association. METHODS We used data from U.S. National Health and Nutrition Examination Survey for 1999-2018. To evaluate the hazard ratio (HR) for mortality, a multiple Cox regression analysis was conducted by adjusting for age, sex, race/ethnicity, body mass index, smoking, alcohol, hypertension, diabetes, hyperlipidemia, and history of CVD and cancer. A causal mediation analysis was performed to estimate the effects of smoking. RESULTS Among the 31,637 subjects, 5452 (12.3%) died. Blood Cd concentrations were significantly associated with all-cause (HR 1.473, 95% confidence interval [CI] 1.403-1.546, p < 0.001), CVD (HR 1.445, 95% CI 1.344-1.554, p < 0.001), and cancer (HR 1.496, 95% CI 1.406-1.592, p < 0.001) mortality. Urinary Cd concentrations were also significantly associated with them. Using feature selection via machine learning, the importance of Cd in all-cause and cancer mortality was second only to age. The association between Cd concentrations and all-cause mortality was significant in both ever-smokers and never-smokers. The mediating effect of smoking was estimated at 32%, whereas a large proportion (68%) remained a direct effect of Cd. In a subgroup analysis of subjects with cancer history, blood Cd concentrations were significantly associated with cancer-related deaths in those with a history of breast, gastrointestinal, and skin cancers. CONCLUSION High Cd exposure is an important risk factor for all-cause, CVD, and cancer mortality among the general population. Cd exposure increased the risk of death even in never-smokers, and its effects unrelated to smoking were substantial, suggesting the importance of regulating other sources of Cd exposure such as food and water. IMPACT STATEMENT Using national large-scale data, we found that low-level environmental exposure to cadmium significantly increased the risk of all-cause, cardiovascular, and cancer mortality in the general population even after adjusting for several risk factors. Although smoking is a major source of cadmium exposure, cadmium was nevertheless significantly associated with all-cause mortality in never-smokers, and the mediating effect of smoking on this association was only 32%. Hence, other sources of cadmium exposure such as food and water may be important.
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Affiliation(s)
- Shinje Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Junghoon Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jae Myung Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hoonsung Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sohyeon Choi
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Jeongim Park
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Kyungho Choi
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ejin Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Min Joo Kim
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
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Lopatynsky-Reyes EZ, Chacon-Cruz E, Greenberg M, Clemens R, Costa Clemens SA. Influenza Vaccination during Pregnancy: A Descriptive Study of the Knowledge, Beliefs, and Practices of Mexican Gynecologists and Family Physicians. Vaccines (Basel) 2023; 11:1383. [PMID: 37631951 PMCID: PMC10459716 DOI: 10.3390/vaccines11081383] [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: 06/30/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Influenza in pregnancy is associated with elevated morbidity and mortality. Influenza vaccines are safe and effective in pregnancy. There are no Mexican surveys of physicians on knowledge, beliefs, and practices towards influenza and influenza immunization during pregnancy. METHODS A 32-question descriptive survey was conducted, addressing the general knowledge of influenza as well as beliefs and practices regarding influenza vaccination during pregnancy among Mexican physicians responsible for prenatal care, traditionally Obstetricians (OBGYNs) and Family Physicians (FPs). RESULTS A total of 206 surveys were available, 98 (47.6%) from OBGYNs and 108 (52.4%) from FPs, representing an estimated 2472 daily pregnancy consultations. In total, 54 of the 206 respondents (26.2%) were not aware that influenza is more severe during pregnancy, 106 of the 206 respondents (51.5%) ignored the potential side effects of influenza infection on the fetus, and 56.8% did not know when to vaccinate pregnant women. Pregnancy as a risk factor for developing influenza complications was only known by 99 of the 206 respondents (48.1%), and 6.1% believed that vaccination does not confer protection to the fetus. CONCLUSIONS The current beliefs of Mexican OBGYNs and FPs for both influenza morbidity and mortality, and the importance of influenza vaccination during pregnancy are suboptimal. The drivers of these beliefs should be assessed to improve influenza vaccination recommendations, as knowledge alone is not sufficient.
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Affiliation(s)
| | - Enrique Chacon-Cruz
- Institute for Global Health, University of Siena, 53100 Siena, Italy; (E.C.-C.); (S.A.C.C.)
- Think Vaccines LLC, Houston, TX 77005, USA
| | | | - Ralf Clemens
- International Vaccine Institute (IVI), Seoul 08826, Republic of Korea;
| | - Sue Ann Costa Clemens
- Institute for Global Health, University of Siena, 53100 Siena, Italy; (E.C.-C.); (S.A.C.C.)
- Department of Pediatrics, University of Oxford, Oxford OX1 2JD, UK
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Daley MF, Reifler LM, Glanz JM, Hambidge SJ, Getahun D, Irving SA, Nordin JD, McClure DL, Klein NP, Jackson ML, Kamidani S, Duffy J, DeStefano F. Association Between Aluminum Exposure From Vaccines Before Age 24 Months and Persistent Asthma at Age 24 to 59 Months. Acad Pediatr 2023; 23:37-46. [PMID: 36180331 PMCID: PMC10109516 DOI: 10.1016/j.acap.2022.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the association between cumulative aluminum exposure from vaccines before age 24 months and persistent asthma at age 24 to 59 months. METHODS A retrospective cohort study was conducted in the Vaccine Safety Datalink (VSD). Vaccination histories were used to calculate cumulative vaccine-associated aluminum in milligrams (mg). The persistent asthma definition required one inpatient or 2 outpatient asthma encounters, and ≥2 long-term asthma control medication dispenses. Cox proportional hazard models were used to evaluate the association between aluminum exposure and asthma incidence, stratified by eczema presence/absence. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) per 1 mg increase in aluminum exposure were calculated, adjusted for birth month/year, sex, race/ethnicity, VSD site, prematurity, medical complexity, food allergy, severe bronchiolitis, and health care utilization. RESULTS The cohort comprised 326,991 children, among whom 14,337 (4.4%) had eczema. For children with and without eczema, the mean (standard deviation [SD]) vaccine-associated aluminum exposure was 4.07 mg (SD 0.60) and 3.98 mg (SD 0.72), respectively. Among children with and without eczema, 6.0% and 2.1%, respectively, developed persistent asthma. Among children with eczema, vaccine-associated aluminum was positively associated with persistent asthma (aHR 1.26 per 1 mg increase in aluminum, 95% CI 1.07, 1.49); a positive association was also detected among children without eczema (aHR 1.19, 95% CI 1.14, 1.25). CONCLUSION In a large observational study, a positive association was found between vaccine-related aluminum exposure and persistent asthma. While recognizing the small effect sizes identified and the potential for residual confounding, additional investigation of this hypothesis appears warranted.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley, LM Reifler, and JM Glanz), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (MF Daley and SJ Hambidge), Aurora, Colo.
| | - Liza M Reifler
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley, LM Reifler, and JM Glanz), Aurora, Colo
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley, LM Reifler, and JM Glanz), Aurora, Colo; Colorado School of Public Health (JM Glanz), Aurora, Colo
| | - Simon J Hambidge
- Department of Pediatrics, University of Colorado School of Medicine (MF Daley and SJ Hambidge), Aurora, Colo; Community Health Services, Denver Health (SJ Hambidge), Denver, Colo
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California (D Getahun), Pasadena, Calif; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine (D Getahun), Pasadena, Calif
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest (SA Irving), Portland, Ore
| | | | - David L McClure
- Marshfield Clinic Research Institute (DL McClure), Marshfield, Wis
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California (NP Klein), Oakland, Calif
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute (ML Jackson), Seattle, Wash
| | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University School of Medicine (S Kamidani), Atlanta, Ga; Immunization Safety Office, Centers for Disease Control and Prevention (S Kamidani, J Duffy, and F DeStefano), Atlanta, Ga
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention (S Kamidani, J Duffy, and F DeStefano), Atlanta, Ga
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention (S Kamidani, J Duffy, and F DeStefano), Atlanta, Ga
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Ramlawi S, Muldoon KA, Dunn SI, Murphy MSQ, Dingwall-Harvey ALJ, Rennicks White R, Fakhraei R, Wen SW, Walker MC, Fell DB, Bogler T, El-Chaâr D. Worries, beliefs and factors influencing perinatal COVID-19 vaccination: a cross-sectional survey of preconception, pregnant and lactating individuals. BMC Public Health 2022; 22:2418. [PMID: 36550543 PMCID: PMC9780097 DOI: 10.1186/s12889-022-14617-4] [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: 08/11/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND COVID-19 vaccines are recommended for pregnant and lactating individuals, and there is substantial evidence for their safety and effectiveness. As the pandemic continues, information on worries and beliefs surrounding perinatal COVID-19 vaccination remains important to inform efforts aimed at improving vaccine uptake. Our objectives were to assess factors associated with COVID-19 vaccination among perinatal individuals; and to explore motivational factors associated with willingness to be vaccinated among unvaccinated perinatal individuals. METHODS This was a cross-sectional web-based survey of preconception, pregnant, and lactating individuals in Canada. The outcomes of interest were vaccination with at least one dose of any COVID-19 vaccine and willingness to be vaccinated among unvaccinated individuals. Sample characteristics were summarized using frequencies and percentages. The association between eight prespecified risk factors and two outcomes (vaccination status and willingness to be vaccinated) was assessed by logistic regression. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the total sample, and across perinatal sub-groups. RESULTS Among 3446 survey respondents, there were 447 (13.0%) preconception, 1832 (53.2%) pregnant, and 1167 (42.4%) lactating. There were 1460 (42.4%) and 1982 (57.5%) who were vaccinated and unvaccinated, respectively. Factors positively associated with COVID-19 vaccine status were speaking to a healthcare provider about vaccination during the perinatal period (aOR:2.35, 95% CI:1.97-2.80) and believing that the COVID-19 vaccine is effective (aOR:1.91, 95% CI:1.46-2.48). Factors negatively associated with vaccine status included worries about fetal growth and development (aOR:0.55, 95% CI:0.43-0.70) and future child behavioral/neurodevelopmental problems (aOR:0.59, 95% CI:0.46-0.75). Among unvaccinated individuals specifically, characteristics positively associated with willingness to vaccinate were speaking to a healthcare provider (aOR:1.67, 95% CI:1.32-2.12) and believing the COVID-19 vaccine is effective (aOR:3.56, 95% CI:2.70-4.69). Factors negatively associated with willingness were concerns over infertility (aOR:0.66, 95% CI:0.49-0.88), fetal growth and development (aOR:0.33, 95% CI:0.24-0.46), and future child behavioral/neurodevelopmental problems (aOR:0.64, 95% CI:0.48-0.84). CONCLUSIONS In this Canadian perinatal population, approximately 42% reported COVID-19 vaccination. Among unvaccinated individuals, willingness to receive vaccination was high (73%). Factors enhancing vaccine willingness included discussions with healthcare providers and believing the vaccine was effective. Concerns regarding vaccine safety, particularly with respect to fetal/child development, were the greatest barriers to vaccine uptake.
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Affiliation(s)
- Serine Ramlawi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katherine A Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sandra I Dunn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada
| | - Romina Fakhraei
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Tali Bogler
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Darine El-Chaâr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- The Ottawa Hospital, General Campus, CPCR, 501 Smyth Rd, Box 241, Ottawa, ON, K1H 8L6, Canada.
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Goldshtein I, Steinberg DM, Kuint J, Chodick G, Segal Y, Shapiro Ben David S, Ben-Tov A. Association of BNT162b2 COVID-19 Vaccination During Pregnancy With Neonatal and Early Infant Outcomes. JAMA Pediatr 2022; 176:470-477. [PMID: 35142809 PMCID: PMC8832306 DOI: 10.1001/jamapediatrics.2022.0001] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Pregnant women were excluded from the BNT162b2 messenger RNA (mRNA) COVID-19 vaccine (Pfizer-BioNTech) preauthorization trial. Therefore, observational data on vaccine safety for prenatally exposed newborns are critical to inform recommendations on maternal immunization. OBJECTIVE To examine whether BNT162b2 mRNA vaccination during pregnancy is associated with adverse neonatal and early infant outcomes among the newborns. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study comprising all singleton live births in March through September 2021, within a large state-mandated health care organization in Israel, followed up until October 31, 2021. EXPOSURE Maternal BNT162b2 mRNA vaccination during pregnancy. MAIN OUTCOMES AND MEASURES Risk ratios (RR) of preterm birth, small birth weight for gestational age (SGA), congenital malformations, all-cause hospitalizations, and infant death. Stabilized inverse probability weighting was used to adjust for maternal age, timing of conception, parity, socioeconomic status, population subgroup, and maternal influenza immunization status. RESULTS The cohort included 24 288 eligible newborns (49% female, 96% born at ≥37 weeks' gestation), of whom 16 697 were exposed (n = 2134 and n = 9364 in the first and second trimesters, respectively) to maternal vaccination in utero. Median (IQR) follow-up after birth was 126 days (76-179) among exposed and 152 days (88-209) among unexposed newborns. No substantial differences were observed in preterm birth rates between exposed and unexposed newborns (RR = 0.95; 95% CI, 0.83-1.10) or SGA (RR = 0.97; 95% CI, 0.87-1.08). No significant differences were observed in the incidence of all-cause neonatal hospitalizations (RR = 0.99; 95% CI, 0.88-1.12), postneonatal hospitalizations after birth (RR = 0.95; 95% CI, 0.84-1.07), congenital anomalies (RR = 0.69; 95% CI, 0.44-1.04), or infant mortality over the study period (RR = 0.84; 95% CI, 0.43-1.72). CONCLUSIONS AND RELEVANCE This large population-based study found no evident differences between newborns of women who received BNT162b2 mRNA vaccination during pregnancy, vs those of women who were not vaccinated, and contributes to current evidence in establishing the safety of prenatal vaccine exposure to the newborns. Interpretation of study findings is limited by the observational design.
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Affiliation(s)
- Inbal Goldshtein
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel,Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - David M. Steinberg
- Department of Statistics and Operations Research, Tel Aviv University, Tel-Aviv, Israel
| | - Jacob Kuint
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Gabriel Chodick
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel,Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yaakov Segal
- Health Division, Maccabi Healthcare Services, Tel-Aviv, Israel
| | | | - Amir Ben-Tov
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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O'Connor TG, Ciesla AA, Sefair AV, Thornburg LL, Brown AS, Glover V, O'Donnell KJ. Maternal prenatal infection and anxiety predict neurodevelopmental outcomes in middle childhood. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:422-434. [PMID: 35238594 PMCID: PMC9069845 DOI: 10.1037/abn0000746] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
Prenatal maternal infection and anxiety have been linked, in separate lines of study, with child neurodevelopment. We extend and integrate these lines of study in a large prospective longitudinal cohort study of child neurodevelopment. Data are based on the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort; prenatal maternal anxiety was assessed from self-report questionnaire; prenatal infection was derived from reports of several conditions in pregnancy (n = 7,042). Child neurodevelopment at approximately 8 years of age was assessed by in-person testing, reports of social and communication problems associated with autism, and psychiatric evaluation. Covariates included psychosocial, demographic, and perinatal/obstetric risks. Prenatal infection was associated with increased likelihood of co-occurring prenatal risk, including anxiety. Regression analyses indicated that both prenatal infection and prenatal anxiety predicted child social and communication problems; the predictions were largely independent of each other. Comparable effects were also found for the prediction of symptoms of attention problems and anxiety symptoms. These results provide the first evidence for the independent effects of prenatal infection and anxiety on a broad set of neurodevelopmental and behavioral and emotional symptoms in children, suggesting the involvement of multiple mechanisms in the prenatal programming of child neurodevelopment. The results further underscore the importance of promoting prenatal physical and mental health for child health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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10
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Prenatal influenza vaccination and allergic and autoimmune diseases in childhood: A longitudinal, population-based linked cohort study. PLoS Med 2022; 19:e1003963. [PMID: 35381006 PMCID: PMC9017895 DOI: 10.1371/journal.pmed.1003963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/19/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have evaluated the effect of maternal influenza vaccination on the development of allergic and autoimmune diseases in children beyond 6 months of age. We aimed to investigate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and subsequent diagnosis of allergic and autoimmune diseases. METHODS AND FINDINGS This longitudinal, population-based linked cohort study included 124,760 singleton, live-born children from 106,206 mothers in Western Australia (WA) born between April 2012 and July 2016, with up to 5 years of follow-up from birth. In our study cohort, 64,169 (51.4%) were male, 6,566 (5.3%) were Aboriginal and/or Torres Strait Islander children, and the mean age at the end of follow-up was 3.0 (standard deviation, 1.3) years. The exposure was receipt of seasonal IIV during pregnancy. The outcomes were diagnosis of an allergic or autoimmune disease, including asthma and anaphylaxis, identified from hospital and/or emergency department (ED) records. Inverse probability of treatment weights (IPTWs) accounted for baseline probability of vaccination by maternal age, Aboriginal and/or Torres Strait Islander status, socioeconomic status, body mass index, parity, medical conditions, pregnancy complications, prenatal smoking, and prenatal care. The models additionally adjusted for the Aboriginal and/or Torres Strait Islander status of the child. There were 14,396 (11.5%) maternally vaccinated children; 913 (6.3%) maternally vaccinated and 7,655 (6.9%) maternally unvaccinated children had a diagnosis of allergic or autoimmune disease, respectively. Overall, maternal influenza vaccination was not associated with diagnosis of an allergic or autoimmune disease (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.95 to 1.09). In trimester-specific analyses, we identified a negative association between third trimester influenza vaccination and the diagnosis of asthma (n = 40; aHR, 0.70; 95% CI, 0.50 to 0.97) and anaphylaxis (n = 36; aHR, 0.67; 95% CI, 0.47 to 0.95).We did not capture outcomes diagnosed in a primary care setting; therefore, our findings are only generalizable to more severe events requiring hospitalization or presentation to the ED. Due to small cell sizes (i.e., <5), estimates could not be determined for all outcomes after stratification. CONCLUSIONS In this study, we observed no association between in utero exposure to influenza vaccine and diagnosis of allergic or autoimmune diseases. Although we identified a negative association of asthma and anaphylaxis diagnosis when seasonal IIV was administered later in pregnancy, additional studies are needed to confirm this. Overall, our findings support the safety of seasonal inactivated influenza vaccine during pregnancy in relation to allergic and autoimmune diseases in early childhood and support the continuation of current global maternal vaccine programs and policies.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C. Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K. Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States of America
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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11
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Becerra-Culqui TA, Getahun D, Chiu V, Sy LS, Tseng HF. Prenatal influenza vaccination or influenza infection and autism spectrum disorder in offspring. Clin Infect Dis 2022; 75:1140-1148. [PMID: 35174388 DOI: 10.1093/cid/ciac101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As prenatal vaccinations continue to be given more frequently, it is important to assess long-term safety events. This study investigates the association between prenatal influenza vaccination or infection and autism spectrum disorder (ASD) risk in offspring. METHODS Retrospective cohort study of mother-child pairs with deliveries 1/1/2011-12/31/2014 at Kaiser Permanente Southern California was performed. Children >1 year were followed through 12/31/2018. Maternal influenza vaccination or infection during pregnancy was obtained from electronic health records. ASD was defined by International Classification of Diseases, 9th/10th Revision codes after age 1 year. Cox proportional hazards models estimated the crude and inverse probability of treatment weighted (IPTW) hazard ratios (HR) for the association between maternal influenza vaccination or infection and ASD. RESULTS There were 84,739 mother-child pairs included in the final analytic sample. Maternal vaccination coverage increased slightly over time, from 52.7% for 2011 births to 59.6% for 2014 births. Of the 46,257 women vaccinated, 32.4% were vaccinated during the 1 st trimester, 41.8% during the 2 nd trimester, and 25.8% during the 3 rd trimester. ASD was diagnosed in 1,930 (2.3%) children. The IPTW analyses showed no association between prenatal influenza vaccination or infection and ASD in offspring (HR: 1.04, 95% confidence interval [CI]: 0.95, 1.13; HR: 1.12, 95% CI: 0.66, 1.89, respectively). CONCLUSIONS Prenatal influenza vaccination or infection was not associated with ASD risk in offspring. The findings support recommendations to vaccinate pregnant women to protect themselves and their infants, both of whom are vulnerable to severe morbidity following infection.
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Affiliation(s)
- Tracy A Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.,Department of Occupational Therapy, California State University, Dominguez Hills, Carson CA, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine School of Medicine, Pasadena, CA, USA
| | - Vicki Chiu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Hung Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine School of Medicine, Pasadena, CA, USA
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12
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Holstein R, Dawood FS, O'Halloran A, Cummings C, Ujamaa D, Daily Kirley P, Yousey-Hindes K, Fawcett E, Monroe ML, Kim S, Lynfield R, McMullen C, Muse A, Bennett NM, Billing LM, Sutton M, Thomas A, Talbot HK, Schaffner W, Risk I, Reed C, Garg S. Characteristics and Outcomes of Hospitalized Pregnant Women With Influenza, 2010 to 2019 : A Repeated Cross-Sectional Study. Ann Intern Med 2022; 175:149-158. [PMID: 34958603 DOI: 10.7326/m21-3668] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pregnant women may be at increased risk for severe influenza-associated outcomes. OBJECTIVE To describe characteristics and outcomes of hospitalized pregnant women with influenza. DESIGN Repeated cross-sectional study. SETTING The population-based U.S. Influenza Hospitalization Surveillance Network during the 2010-2011 through 2018-2019 influenza seasons. PATIENTS Pregnant women (aged 15 to 44 years) hospitalized with laboratory-confirmed influenza identified through provider-initiated or facility-based testing practices. MEASUREMENTS Clinical characteristics, interventions, and in-hospital maternal and fetal outcomes were obtained through medical chart abstraction. Multivariable logistic regression was used to evaluate the association between influenza A subtype and severe maternal influenza-associated outcomes, including intensive care unit (ICU) admission, mechanical ventilation, extracorporeal membrane oxygenation, or in-hospital death. RESULTS Of 9652 women aged 15 to 44 years and hospitalized with influenza, 2690 (27.9%) were pregnant. Among the 2690 pregnant women, the median age was 28 years, 62% were in their third trimester, and 42% had at least 1 underlying condition. Overall, 32% were vaccinated against influenza and 88% received antiviral treatment. Five percent required ICU admission, 2% required mechanical ventilation, and 0.3% (n = 8) died. Pregnant women with influenza A H1N1 were more likely to have severe outcomes than those with influenza A H3N2 (adjusted risk ratio, 1.9 [95% CI, 1.3 to 2.8]). Most women (71%) were still pregnant at hospital discharge. Among 754 women who were no longer pregnant at discharge, 96% had a pregnancy resulting in live birth, and 3% experienced fetal loss. LIMITATION Maternal and fetal outcomes that occurred after hospital discharge were not captured. CONCLUSION Over 9 influenza seasons, one third of reproductive-aged women hospitalized with influenza were pregnant. Influenza A H1N1 was associated with more severe maternal outcomes. Pregnant women remain a high-priority target group for vaccination. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Rachel Holstein
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Fatimah S Dawood
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Charisse Cummings
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Dawud Ujamaa
- Centers for Disease Control and Prevention, Atlanta, Georgia, and General Dynamics Information Technology, Falls Church, Virginia (D.U.)
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California (P.D.K.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y.)
| | - Emily Fawcett
- Emerging Infections Program, Georgia Department of Health, and Veterans Affairs Medical Center, Atlanta, Georgia, and Foundation for Atlanta Veterans Education and Research, Decatur, Georgia (E.F.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (M.L.M.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (S.K.)
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota (R.L.)
| | | | - Alison Muse
- New York State Department of Health, Albany, New York (A.M.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B.)
| | | | | | - Ann Thomas
- Oregon Health Authority, Portland, Oregon (M.S., A.T.)
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Ilene Risk
- Salt Lake County Health Department, Salt Lake City, Utah (I.R.)
| | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
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O'Connor TG, Ciesla AA. Maternal Immune Activation Hypotheses for Human Neurodevelopment: Some Outstanding Questions. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:471-479. [PMID: 34688920 PMCID: PMC9021321 DOI: 10.1016/j.bpsc.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 12/17/2022]
Abstract
The Maternal Immune Activation (MIA) hypothesis is a leading model for understanding prenatal influences on individual differences in, and clinical syndromes of, neurodevelopment. Experimental animal and human research has proliferated in recent years, and there is now a sizable research base. Several meta-analyses demonstrate general support for an association between prenatal immune activation and neurodevelopment in human research. However, questions remain about the nature of the immune activation, the network of underlying mechanisms involved, and the breadth of impact across behavioral phenotypes. Complementing recent reviews of results, the current review places particular emphasis on how advances in understanding mechanisms may be improved with greater attention to addressing the methodological variation and limitations of existing studies, and identifies areas for further clinical research.
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Affiliation(s)
- Thomas G O'Connor
- Department of Psychiatry, University of Rochester; Department of Psycholog, University of Rochestery; Department of Neuroscience, University of Rochester; Department of Obstetrics and Gynecology, University of Rochester; Wynne Center for Family Research, University of Rochester.
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14
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Influenzaimpfung in der Schwangerschaft: Kein Risiko für die
Kinder. Z Geburtshilfe Neonatol 2021. [DOI: 10.1055/a-1556-2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Schwangere haben ein hohes Risiko für einen schweren Influenzaverlauf und
die damit einhergehenden Komplikationen. Trotz des nachweislichen Nutzens der
Impfung sowohl für die Mutter als auch für das Neugeborene
nehmen nur relativ wenige Frauen – häufig aus Angst vor
gesundheitlichen Nachteilen für das Kind – das Impfangebot in
Anspruch. Ob diese Sicherheitsbedenken begründet sind, untersuchte nun
ein kanadisches Forscherteam.
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15
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Wang PH, Lee WL, Yang ST, Tsui KH, Chang CC, Lee FK. The impact of COVID-19 in pregnancy: Part II. Vaccination to pregnant women. J Chin Med Assoc 2021; 84:903-910. [PMID: 34433191 DOI: 10.1097/jcma.0000000000000612] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Effective strategies are urgently needed to decrease the risk of untoward outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) infection. Pregnant women are a vulnerable population to infectious disease pandemics with dramatically increased infectious diseases-related serious complications, such as the need of hospitalizations, the need of admission to intensive care unit, and the final disease-related death compared with those nonpregnant counterparts or those pregnant women without infection. Several studies have shown that vaccinations in pregnancy are a safe and highly effective strategy, not only for pregnant women but also for fetus and/or newborn because of the passive transplacental transfer of antibodies to the offspring. Active and passive prevention of infectious diseases is approved as effective strategies for women who attempt to become pregnant or during pregnancy. Despite the large and proven scientific evidence, pregnant women still puzzle over whether they should get vaccinated. The question therefore arises: Why are pregnant women so reluctant to receive vaccination? The explanation is more likely in the way that the benefits of vaccination have been communicated "confusedly." In fact, like virtually all clinical trials, all the COVID-19 vaccine trials have excluded pregnant and lactating women from participating, contributing to uncertainty of safety and efficacy in COVID-19 vaccines that have been well prepared and available for the general adult population worldwide. Moreover, messenger RNA vaccine is a relatively brand-new vaccine, and experience with this type of vaccine is still scarce. It is hard to overcome this innovation deadlock. The knowledge and awareness of pregnant women who are at risk, and full information on the knowledge of vaccines and related preventable diseases in pregnant women may avoid hesitancy and increase vaccine acceptance. The current review is a part two addressing the impact of COVID-19 on pregnant women. We focus on the up-to-date information about the application of vaccination on pregnant women, especially during this COVID-19 pandemic.
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Affiliation(s)
- Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuan-Hao Tsui
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynaecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Institute of BioPharmaceutical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan, ROC
- Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan, ROC
| | - Cheng-Chang Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Fa-Kung Lee
- Department of Obstetrics and Gynecology, Cathy General Hospital, Taipei, Taiwan, ROC
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