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Ciapponi A, Berrueta M, Argento FJ, Ballivian J, Bardach A, Brizuela ME, Castellana N, Comandé D, Gottlieb S, Kampmann B, Mazzoni A, Parker EPK, Sambade JM, Stegelmann K, Xiong X, Stergachis A, Buekens P. Safety and Effectiveness of COVID-19 Vaccines During Pregnancy: A Living Systematic Review and Meta-analysis. Drug Saf 2024:10.1007/s40264-024-01458-w. [PMID: 39009928 DOI: 10.1007/s40264-024-01458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Pregnant persons are susceptible to significant complications following COVID-19, even death. However, worldwide COVID-19 vaccination coverage during pregnancy remains suboptimal. OBJECTIVE This study assessed the safety and effectiveness of COVID-19 vaccines administered to pregnant persons and shared this evidence via an interactive online website. METHODS We followed Cochrane methods to conduct this living systematic review. We included studies assessing the effects of COVID-19 vaccines in pregnant persons. We conducted searches every other week for studies until October 2023, without restrictions on language or publication status, in ten databases, guidelines, preprint servers, and COVID-19 websites. The reference lists of eligible studies were hand searched to identify additional relevant studies. Pairs of review authors independently selected eligible studies using the web-based software COVIDENCE. Data extraction and risk of bias assessment were performed independently by pairs of authors. Disagreements were resolved by consensus. We performed random-effects meta-analyses of adjusted relative effects for relevant confounders of comparative studies and proportional meta-analyses to summarize frequencies from one-sample studies using R statistical software. We present the GRADE certainty of evidence from comparative studies. Findings are available on an interactive living systematic review webpage, including an updated evidence map and real-time meta-analyses customizable by subgroups and filters. RESULTS We included 177 studies involving 638,791 participants from 41 countries. Among the 11 types of COVID-19 vaccines identified, the most frequently used platforms were mRNA (154 studies), viral vector (51), and inactivated virus vaccines (17). Low to very low-certainty evidence suggests that vaccination may result in minimal to no important differences compared to no vaccination in all assessed maternal and infant safety outcomes from 26 fewer to 17 more events per 1000 pregnant persons, and 13 fewer to 9 more events per 1000 neonates, respectively. We found statistically significant reductions in emergency cesarean deliveries (9%) with mRNA vaccines, and in stillbirth (75-83%) with mRNA/viral vector vaccines. Low to very low-certainty evidence suggests that vaccination during pregnancy with mRNA vaccines may reduce severe cases or hospitalizations in pregnant persons with COVID-19 (72%; 95% confidence interval [CI] 42-86), symptomatic COVID-19 (78%; 95% CI 21-94), and virologically confirmed SARS-CoV-2 infection (82%; 95% CI 39-95). Reductions were lower with other vaccine types and during Omicron variant dominance than Alpha and Delta dominance. Infants also presented with fewer severe cases or hospitalizations due to COVID-19 and laboratory-confirmed SARS-CoV-2 infection (64%; 95% CI 37-80 and 66%; 95% CI 37-81, respectively). CONCLUSIONS We found a large body of evidence supporting the safety and effectiveness of COVID-19 vaccines during pregnancy. While the certainty of evidence is not high, it stands as the most reliable option available, given the current absence of pregnant individuals in clinical trials. Results are shared in near real time in an accessible and interactive format for scientists, decision makers, clinicians, and the general public. This living systematic review highlights the relevance of continuous vaccine safety and effectiveness monitoring, particularly in at-risk populations for COVID-19 impact such as pregnant persons, during the introduction of new vaccines. CLINICAL TRIAL REGISTRATION PROSPERO: CRD42021281290.
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Affiliation(s)
- Agustín Ciapponi
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina.
| | - Mabel Berrueta
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Fernando J Argento
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Jamile Ballivian
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Ariel Bardach
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Martin E Brizuela
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Noelia Castellana
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Daniel Comandé
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research World Health Organization, Geneva, Switzerland
| | - Beate Kampmann
- London School of Hygiene & Tropical Medicine, London, UK
- Charite Centre for Global Health, Charité, Universitätsmedizin, Vaccine Centre, Berlin, Germany
| | - Agustina Mazzoni
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Juan M Sambade
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Katharina Stegelmann
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Andy Stergachis
- Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, USA
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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2
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Wang J, Deng Y, Wang W. COVID-19 vaccination during pregnancy and adverse perinatal outcomes: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2024; 118:405-425. [PMID: 38291854 DOI: 10.1093/trstmh/trad093] [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: 07/06/2023] [Revised: 10/05/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024] Open
Abstract
We aimed to estimate the associations between coronavirus disease 2019 (COVID-19) vaccination during pregnancy and the risks of adverse perinatal outcomes. We performed a literature search in PubMed, Web of Science and Embase to identify eligible studies published up to 24 September 2023, yielding 39 included studies. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated with a random effects model. The pooled results showed that COVID-19 vaccination during pregnancy (any type or dose of COVID-19 vaccination during any trimester) was not associated with an increased risk of adverse perinatal outcomes. In particular, COVID-19 vaccination in the third trimester was associated with a decreased risk of preterm birth (<37 weeks) (RR 0.85 [95% CI 0.74 to 0.98]), 5-min Apgar <7 (RR 0.87 [95% CI 0.78 to 0.97]) and neonatal intensive care unit (NICU) admission (RR 0.90 [95% CI 0.86 to 0.95]). The inverse associations were also found in analysis of one-dose vaccination during pregnancy and the risk of miscarriage (RR 0.83 [95% CI 0.72 to 0.96]) and preterm birth (<37 weeks) (RR 0.90 [95% CI 0.80 to 1.00]) and two-dose vaccination during pregnancy and the risk of NICU admission (RR 0.86 [95% CI 0.76 to 0.96]). COVID-19 vaccination during pregnancy does not increase the risk of negative outcomes for the mother or baby.
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Affiliation(s)
- Jia Wang
- Public Health Department, Weihai Maternal and Child Health Hospital, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong, China
| | - Yuzhi Deng
- Public Health Department, Weihai Maternal and Child Health Hospital, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 308 Ningxia Road, Qingdao, Shandong, China
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Fernández-García S, Del Campo-Albendea L, Sambamoorthi D, Sheikh J, Lau K, Osei-Lah N, Ramkumar A, Naidu H, Stoney N, Sundaram P, Sengupta P, Mehta S, Attarde S, Maddock S, Manning M, Meherally Z, Ansari K, Lawson H, Yap M, Kew T, Punnoose A, Knight C, Sadeqa E, Cherian J, Ravi S, Chen W, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Gottlieb SL, Bonet M, Moss N, Zamora J, Allotey J, Thangaratinam S. Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e014247. [PMID: 38580375 PMCID: PMC11002410 DOI: 10.1136/bmjgh-2023-014247] [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: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Major databases between December 2019 and January 2023. STUDY SELECTION Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included. QUALITY ASSESSMENT, DATA EXTRACTION AND ANALYSIS Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs. RESULTS Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women). CONCLUSION COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women. PROSPERO REGISTRATION NUMBER CRD42020178076.
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Affiliation(s)
- Silvia Fernández-García
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Laura Del Campo-Albendea
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
| | | | - Jameela Sheikh
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Karen Lau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nana Osei-Lah
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Anoushka Ramkumar
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Harshitha Naidu
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicole Stoney
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Paul Sundaram
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Samay Mehta
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Shruti Attarde
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sophie Maddock
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Millie Manning
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | - Kehkashan Ansari
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Heidi Lawson
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Magnus Yap
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Tania Kew
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Andriya Punnoose
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Chloe Knight
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Eyna Sadeqa
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Jiya Cherian
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sangamithra Ravi
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Wentin Chen
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | - Madelon van Wely
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Elizabeth van Leeuwen
- Amsterdam UMC Location AMC Department of Obstetrics Gynecology, Amsterdam, The Netherlands
| | - Elena Kostova
- Amsterdam UMC Location AMC Center for Reproductive Medicine, Amsterdam, The Netherlands
| | - Heinke Kunst
- Queen Mary University of London Blizard Institute, London, UK
- Barts Health NHS Trust, London, UK
| | - Asma Khalil
- St George's University of London, London, UK
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Edna Kara
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Caron Rahn Kim
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Anna Thorson
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Olufemi T Oladapo
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Lynne Mofenson
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | | | - Javier Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Madrid, Spain
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Celik IH, Ozkaya Parlakay A, Canpolat FE. Management of neonates with maternal prenatal coronavirus infection and influencing factors. Pediatr Res 2024; 95:436-444. [PMID: 37857851 DOI: 10.1038/s41390-023-02855-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/09/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
The coronavirus disease 2019 (COVID-19) in pregnancy causes adverse outcomes for both the mother and the fetus. Neonates are at risk of vertical transmission and in-utero infection. Additionally, intensive care unit (ICU) admission and impairment in the organ systems of the mother are associated with neonatal outcomes, including impaired intrauterine growth, prematurity, and neonatal ICU admission. The management of neonates born from infected mothers has changed over the progress of the pandemic. At the beginning of the pandemic, cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoiding of skin-to-skin contact, breast milk, and breastfeeding were the main practices to reduce vertical and horizontal transmission risk in the era of insufficient knowledge. The effects of antenatal steroids and delayed cord clamping on COVID-19 were also not known. As the pandemic progressed, data showed that prenatal, delivery room, and postnatal care of neonates can be performed as pre-pandemic practices. Variants and vaccines that affect clinical course and outcomes have emerged during the pandemic. The severity of the disease and the timing of infection in pregnancy also influence maternal and neonatal outcomes. The knowledge and lessons from COVID-19 will be helpful for the next pandemic if it happens. IMPACT: Prenatal infection with COVID-19 is associated with adverse maternal and neonatal outcomes. Our review includes the management of neonates with prenatal COVID-19 infection exposure, maternal-fetal, delivery room, and postnatal care of neonates, clinical features, treatment of neonates, and influencing factors such as variants, vaccination, severity of maternal disease, and timing of infection during pregnancy. There is a growing body of data and evidence about the COVID-19 pandemic. The knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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Affiliation(s)
- Istemi Han Celik
- University of Health Sciences Turkey; Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye.
| | - Aslinur Ozkaya Parlakay
- Ankara Yildirim Beyazit University; Ankara Bilkent City Hospital, Department of Pediatrics, Pediatric Infectious Diseases Unit, Ankara, Türkiye
| | - Fuat Emre Canpolat
- University of Health Sciences Turkey, Ankara Bilkent City Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
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5
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Yussuph ZH, Alwy Al-Beity FM, August F, Anaeli A. COVID-19 vaccine hesitancy among pregnant women attending public antenatal clinics in Dar es Salaam, Tanzania. Hum Vaccin Immunother 2023; 19:2269777. [PMID: 37942618 PMCID: PMC10653711 DOI: 10.1080/21645515.2023.2269777] [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: 05/08/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
The COVID-19 pandemic has claimed over six million lives and caused significant morbidities globally. The development and use of COVID-19 vaccines is a key strategy in ending this. There is a general public hesitancy on vaccine uptake, including pregnant women who are at high risk of severe forms of the disease and death when infected with the virus. To determine the magnitude of hesitancy toward COVID-19 vaccines and the associated factors among pregnant women attending public antenatal clinics in Dar es Salaam. This was a cross-sectional analytical study conducted among 896 pregnant women attending antenatal clinics at public health facilities in Dar es Salaam. A structured interviewer-based questionnaire, in an electronic form, was used. The analysis was done by a multivariable linear regression model using STATA 16 to obtain factors associated with vaccine hesitancy, and P < .05 was considered significant. The proportion of pregnant women with vaccine hesitancy was 45%. Hesitancy was higher among unemployed pregnant women (AOR 2.16 (95% CI 1.36-3.42) and the self-employed group (AOR 1.62 (95% CI 1.07-2.44). It was also higher among pregnant women with poor attitudes to COVID-19 vaccines (AOR 2.44 (95% CI 1.75-3.39) and women who had low perceived benefits of the vaccines (AOR 2.57 (95% CI 1.83-3.60). COVID-19 vaccine-targeted interventions should aim at the provision of knowledge on COVID-19 and the COVID-19 vaccine and address poor attitudes and perceptions that pregnant women have on these vaccines.
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Affiliation(s)
- Zainab Hassan Yussuph
- Department of Obstetrics and Gynecology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Fadhlun M. Alwy Al-Beity
- Department of Obstetrics and Gynecology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Furaha August
- Department of Obstetrics and Gynecology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Amani Anaeli
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Ramasauskaite D, Grinciute D. Review of short-term and long-term adverse effects of covid-19 vaccination during pregnancy. Travel Med Infect Dis 2023; 56:102667. [PMID: 37951411 DOI: 10.1016/j.tmaid.2023.102667] [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: 05/31/2023] [Revised: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The covid-19 pandemic sparked a debate about the safety of vaccines during pregnancy. However, pregnant women were excluded from the Pfizer-BioNTech vaccine phase 3 trials. As two years have passed since the first Covid-19 vaccine and more studies have been conducted, we want to evaluate the scientific literature to determine any actual risks in taking the vaccine during pregnancy. METHODS We conducted literature research using PubMed and Google Scholar databases from January to April 2023. As the review considers short- and long-term adverse effects it was divided into two parts. The first part was conducted as a systematic review. The second concerning long-term negative effects due to lack of research is a literature review. The inclusion criteria for the systematic review part were singleton pregnancies, women vaccinated during pregnancy, and studies from 2020 and later. The most common short-term pregnancy adverse effects were included in the search: preterm delivery, small gestation age, intrauterine death, congenital defects, stillborn, fetal growth retardation, spontaneous abortion. Maternal immune activation was the primary concern for the long-term adverse effects and whether vaccination could cause it. The search terms included maternal immune activation, fetal neurodevelopment, neuropsychiatric disorders and the studies used were from 2019. RESULTS Most studies showed no significant difference in short-term adverse effects between vaccinated and non-vaccinated women and their fetuses. However, the literature is insufficient to evaluate possible long-term adverse effects. CONCLUSION Available evidence supports the safety of administering SARS-CoV-2 vaccines to pregnant women, but further systematic reviews and meta-analyses are essential. Maternal immune activation caused by vaccination may impact a child's neurodevelopment and should be a concern for future studies.
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Affiliation(s)
- Diana Ramasauskaite
- Center of Obstetrics and Gynaecology, Vilnius University Faculty of Medicine, PO: Santariškių 2, Vilnius, LT08661, Lithuania.
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Tripathy GS, Rath TS, Behera S, Lekha KS, Kar D, Pendyala S. Effects of Covid-19 Vaccination during Pregnancy on the Obstetric and Neonatal Outcomes in a Tertiary Health Care Center. JOURNAL OF MOTHER AND CHILD 2023; 27:72-78. [PMID: 37409659 PMCID: PMC10323967 DOI: 10.34763/jmotherandchild.20232701.d-22-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pregnancy is an immuno-compromised state, and pregnant women with COVID-19 are at an increased risk for adverse pregnancy outcomes. Thus, the Center for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization (ACIP) have advocated for COVID-19 vaccination in pregnant women. COVAXIN and COVISHIELD were the vaccines being used in India in the first phase of vaccination, but limited data exist on pregnancy outcomes regarding SARS-CoV-2 vaccines and pregnancy and lactation. MATERIAL AND METHODS A retrospective study was conducted which included only women who delivered after 24 weeks gestation. Women with an unknown vaccination status or with past or active COVID-19 infection were excluded. Demographic characteristics, maternal and obstetric outcomes, and fetal and neonatal outcomes were compared between the unvaccinated and vaccinated groups. Statistical analysis was done with Chi-square testing and the Fisher exact test using SPSS-26 software. RESULTS Deliveries before a gestation of 37 weeks were significantly higher in the unvaccinated group compared to the vaccinated group. Rates of vaginal deliveries and preterm deliveries were found to be higher in the unvaccinated population. Women who had taken COVAXIN had a higher rate of adverse events compared to those who had taken COVISHIELD. CONCLUSION There were no significant differences in adverse obstetric outcomes attributed to vaccine administration between the vaccinated and unvaccinated pregnant women. The beneficial effects of the vaccines in protecting against COVID-19 infection, particularly in pregnancy, outweigh the minor adverse events associated with vaccine administration.
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Affiliation(s)
- Gargee Suman Tripathy
- Department of Obstetrics and Gynaecology, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
| | - Tanushree Sandipta Rath
- Department of Obstetrics and Gynaecology, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
| | - Saujanya Behera
- Department of Paediatrics, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - K Shruti Lekha
- AIPH (Asian Institute of Public Health) University, Bhubaneswar, Odisha, India
| | - Dattatreya Kar
- Department of Medical Research, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
| | - Sujata Pendyala
- Department of Obstetrics and Gynaecology, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
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8
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Juliá-Burchés C, Martínez-Varea A. An Update on COVID-19 Vaccination and Pregnancy. J Pers Med 2023; 13:jpm13050797. [PMID: 37240967 DOI: 10.3390/jpm13050797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Pregnant women are more prone to experience severe COVID-19 disease, including intensive care unit (ICU) admission, use of invasive ventilation, extracorporeal membrane oxygenation (ECMO), and mortality compared to non-pregnant individuals. Additionally, research suggests that SARS-CoV-2 infection during pregnancy is linked to adverse pregnancy outcomes, such as preterm birth, preeclampsia, and stillbirth, as well as adverse neonatal outcomes, including hospitalization and admission to the neonatal intensive care unit. This review assessed the available literature from November 2021 to 19 March 2023, concerning the safety and effectiveness of COVID-19 vaccination during pregnancy. COVID-19 vaccination administered during pregnancy is not linked to significant adverse events related to the vaccine or negative obstetric, fetal, or neonatal outcomes. Moreover, the vaccine has the same effectiveness in preventing severe COVID-19 disease in pregnant individuals as in the general population. Additionally, COVID-19 vaccination is the safest and most effective method for pregnant women to protect themselves and their newborns from severe COVID-19 disease, hospitalization, and ICU admission. Thus, vaccination should be recommended for pregnant patients. While the immunogenicity of vaccination in pregnancy appears to be similar to that in the general population, more research is needed to determine the optimal timing of vaccination during pregnancy for the benefit of the neonate.
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Affiliation(s)
- Cristina Juliá-Burchés
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
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Rahmati M, Yon DK, Lee SW, Butler L, Koyanagi A, Jacob L, Shin JI, Smith L. Effects of COVID-19 vaccination during pregnancy on SARS-CoV-2 infection and maternal and neonatal outcomes: A systematic review and meta-analysis. Rev Med Virol 2023; 33:e2434. [PMID: 36896895 DOI: 10.1002/rmv.2434] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 03/11/2023]
Abstract
SARS-CoV-2 infection during pregnancy is associated with adverse maternal and neonatal outcomes, but no systematic synthesis of evidence on COVID-19 vaccination during pregnancy against these outcomes has been undertaken. Thus, we aimed to assess the collective evidence on the effects of COVID-19 vaccination during pregnancy on maternal and neonatal outcomes. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to 1 November 2022. A systematic review and meta-analysis were performed to calculate pooled effects size and 95% confidence interval (CI). We evaluated 30 studies involving 862,272 individuals (308,428 vaccinated and 553,844 unvaccinated). Overall pooled analyses in pregnant women during pregnancy showed reduced risks of SARS-CoV-2 infection by 60% (41%-73%), COVID-19 hospitalisation during pregnancy by 53% (31%-69%), and COVID-19 intensive care unit (ICU) admission by 82% (12%-99%). Neonates of vaccinated women were 1.78 folds more likely to acquire SARS-CoV-2 infection during the first 2, 4 and 6 months of life during the Omicron period. The risk of stillbirth was reduced by 45% (17%-63%) in association with vaccination (vs. no vaccination) in pregnancy. A decrease of 15% (3%-25%), 33% (14%-48%), and 33% (17%-46%) in the odds of preterm births before 37, 32 and 28 weeks' gestation were associated with vaccination (vs. no vaccination) in pregnancy, respectively. The risk of neonatal ICU admission was significantly lower by 20% following COVID-19 vaccination in pregnancy (16%-24%). There was no evidence of a higher risk of adverse outcomes including miscarriage, gestational diabetes, gestational hypertension, cardiac problems, oligohydramnios, polyhydramnios, unassisted vaginal delivery, cesarean delivery, postpartum haemorrhage, gestational age at delivery, placental abruption, Apgar score at 5 min below 7, low birthweight (<2500 g), very low birthweight (<1500 g), small for gestational age, and neonatal foetal abnormalities. COVID-19 vaccination during pregnancy is safe and highly effective in preventing maternal SARS-CoV-2 infection in pregnancy, without increasing the risk of adverse maternal and neonatal outcomes, and is associated with a reduction in stillbirth, preterm births, and neonatal ICU admission. Importantly, maternal vaccination did not reduce the risk of neonatal SARS-CoV-2 infection during the first 6 months of life during the Omicron period.
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Affiliation(s)
- Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
- School of Medicine, Sungkyunkwan University, Suwon, Republic of Korea
| | - Laurie Butler
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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10
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Saadedine M, El Sabeh M, Borahay MA, Daoud G. The influence of COVID-19 infection-associated immune response on the female reproductive system†. Biol Reprod 2023; 108:172-182. [PMID: 36173920 PMCID: PMC9620712 DOI: 10.1093/biolre/ioac187] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a multi-system disease that has led to a pandemic with unprecedented ramifications. The pandemic has challenged scientists for the past 2 years and brought back previously abandoned research topics. COVID-19 infection causes a myriad of symptoms ranging from mild flu-like symptoms to severe illness requiring hospitalization. Case reports showed multiple systemic effects of COVID-19 infection, including acute respiratory distress syndrome, fibrosis, colitis, thyroiditis, demyelinating syndromes, and mania, indicating that COVID-19 can affect most human body systems. Unsurprisingly, a major concern for women all over the globe is whether a COVID-19 infection has any long-term effects on their menstrual cycle, fertility, or pregnancy. Published data have suggested an effect on the reproductive health, and we hypothesize that the reported reproductive adverse effects are due to the robust immune reaction against COVID-19 and the associated cytokine storm. While the COVID-19 receptor (angiotensin converting enzyme, ACE2) is expressed in the ovaries, uterus, vagina, and placenta, we hypothesize that it plays a less important role in the adverse effects on the reproductive system. Cytokines and glucocorticoids act on the hypothalamo-pituitary gonadal axis, arachidonic acid pathways, and the uterus, which leads to menstrual disturbances and pregnancy-related adverse events such as preterm labor and miscarriages. This hypothesis is further supported by the apparent lack of long-term effects on the reproductive health in females, indicating that when the cytokine storm and its effects are dampened, the reproductive health of women is no longer affected.
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Affiliation(s)
- Mariam Saadedine
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Malak El Sabeh
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Georges Daoud
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
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11
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Ding C, Liu Y, Pang W, Zhang D, Wang K, Chen Y. Associations of COVID-19 vaccination during pregnancy with adverse neonatal and maternal outcomes: A systematic review and meta-analysis. Front Public Health 2023; 11:1044031. [PMID: 36794075 PMCID: PMC9922836 DOI: 10.3389/fpubh.2023.1044031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023] Open
Abstract
Objectives The low COVID-19 vaccine uptake rate among pregnant women is mainly due to safety concerns about COVID-19 vaccines due to limited safety evidence. Our goal was to evaluate the safety of COVID-19 vaccination during pregnancy with up-to-date evidence. Methods A comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and clinicaltrials.gov was performed on April 5th, 2022, and updated on May 25th, 2022. Studies evaluating the association of COVID-19 vaccination during pregnancy with adverse maternal and neonatal outcomes were included. Two reviewers independently performed the risk of bias assessment and data extraction. Inverse variance random effect meta-analyses were performed to pool outcome data. Results Forty-three observational studies were included. COVID-19 vaccination [96,384 (73.9%) BNT162b2, 30,889 (23.7%) mRNA-1273, and 3,172 (2.4%) other types] during pregnancy [23,721 (18.3%) in the first trimester, 52,778 (40.5%) in the second trimester, and 53,886 (41.2%) in the third trimester].was associated with reduced risks of stillbirth or neonatal death (OR, 0.74; 95% CI, 0.60-0.92). Sensitivity analysis restricted to studies in participants without COVID-19 showed that the pooled effect was not robust. COVID-19 vaccination during pregnancy was not associated with congenital anomalies (OR, 0.83; 95% CI, 0.63-1.08), preterm birth (OR, 0.98; 95% CI, 0.90-1.06), NICU admission or hospitalization (OR, 0.94; 95% CI, 0.84-1.04), an Apgar score at 5 min <7 (OR, 0.93; 95% CI, 0.86-1.01), low birth weight (OR, 1.00; 95% CI, 0.88-1.14), miscarriage (OR, 0.99; 95% CI, 0.88-1.11), cesarean delivery (OR, 1.07; 95% CI, 0.96-1.19), or postpartum hemorrhage (OR, 0.91; 95% CI, 0.81-1.01). Conclusions COVID-19 vaccination during pregnancy was not associated with any of the adverse neonatal or maternal outcomes studied. Interpretation of study findings is limited by the types and timing of vaccination. The vaccinations in our study received during pregnancy were primarily mRNA vaccines administered in the second and third trimester. Future RCTs and meta-analysis are warranted to evaluate the efficacy and long-term effects of the COVID-19 vaccines. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022322525, identifier: PROSPERO, CRD42022322525.
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12
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Zhang D, Huang T, Chen Z, Zhang L, Gao Q, Liu G, Zheng J, Ding F. Systematic review and meta-analysis of neonatal outcomes of COVID-19 vaccination in pregnancy. Pediatr Res 2023:10.1038/s41390-022-02421-0. [PMID: 36596943 PMCID: PMC9808682 DOI: 10.1038/s41390-022-02421-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The safety of coronavirus disease 2019 (COVID-19) vaccines during pregnancy is a particular concern. Here, we addressed the neonatal outcomes after maternal vaccination of COVID-19 during pregnancy. METHODS We systematically searched PubMed, EMBASE, and the WHO COVID-19 Database for studies on neonatal outcomes after maternal COVID-19 vaccination from inception to 3 July 2022. Main neonatal outcomes were related to preterm, small for gestation (SGA), NICU admission, low Apgar score at 5 min (<7), and additional neonatal outcomes such as gestation <34 weeks, low birth weight and some neonatal morbidity were all also analyzed. RESULTS A total of 15 studies were included. We found that maternal vaccination during pregnancy was related to the reduction rates of Preterm, SGA, Low Apgar score at 5 min (<7). In addition, there was no evidence of a higher risk of adverse neonatal outcomes after maternal vaccination of COVID-19 during pregnancy, including NICU admission, preterm birth with gestation <34 weeks, low birth weight, very low birth weight, congenital anomalies, and so on. CONCLUSIONS COVID-19 vaccination in pregnant women does not raise significant adverse effects on neonatal outcomes and is related to a protective effect on some neonatal outcomes. IMPACT Present study has addressed the neonatal outcomes after maternal vaccination of COVID-19 during pregnancy. COVID-19 vaccination in pregnant women does not raise significant adverse effects on neonatal outcomes and is related to a protective effect on some neonatal outcomes. The present study could encourage pregnant women to be vaccinated against COVID-19.
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Affiliation(s)
- Dingning Zhang
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000 Tianjin, China ,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000 Tianjin, China ,grid.216938.70000 0000 9878 7032Department of Neonatology, Nankai University Maternity Hospital, 300000 Tianjin, China
| | - Tingting Huang
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000 Tianjin, China ,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000 Tianjin, China ,grid.216938.70000 0000 9878 7032Department of Neonatology, Nankai University Maternity Hospital, 300000 Tianjin, China
| | - Zhihui Chen
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000 Tianjin, China ,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000 Tianjin, China ,grid.216938.70000 0000 9878 7032Department of Neonatology, Nankai University Maternity Hospital, 300000 Tianjin, China
| | - Lulu Zhang
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000 Tianjin, China ,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000 Tianjin, China ,grid.216938.70000 0000 9878 7032Department of Neonatology, Nankai University Maternity Hospital, 300000 Tianjin, China
| | - Qi Gao
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000 Tianjin, China ,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000 Tianjin, China ,grid.216938.70000 0000 9878 7032Department of Neonatology, Nankai University Maternity Hospital, 300000 Tianjin, China
| | - Ge Liu
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000 Tianjin, China ,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000 Tianjin, China ,grid.216938.70000 0000 9878 7032Department of Neonatology, Nankai University Maternity Hospital, 300000 Tianjin, China
| | - Jun Zheng
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000, Tianjin, China. .,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000, Tianjin, China. .,Department of Neonatology, Nankai University Maternity Hospital, 300000, Tianjin, China.
| | - Fangrui Ding
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, 300000, Tianjin, China. .,Tianjin Key Laboratory of Human Development and Reproductive Regulation, 300000, Tianjin, China. .,Department of Neonatology, Nankai University Maternity Hospital, 300000, Tianjin, China.
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13
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Muacevic A, Adler JR, Alsuwaidan S, Sufyani R, AlSalem S, Alghamdi J. COVID-19 Vaccine During Pregnancy and Perinatal Outcomes. Cureus 2023; 15:e33240. [PMID: 36606110 PMCID: PMC9807835 DOI: 10.7759/cureus.33240] [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] [Accepted: 12/24/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction When COVID-19 vaccination started, there was little data on the safety of immunization against COVID-19 infection in pregnant women. Previous studies revealed no safety concerns for pregnant women or newborns who received a messenger ribonucleic acid (mRNA) COVID-19 vaccine during pregnancy. This study aimed to investigate the effects of COVID-19 vaccination on pregnant women and on perinatal outcomes. Methods This cross-sectional study was conducted in a maternity hospital in King Saud Medical City. It started in January 2022 and ended in June 2022. The questionnaire was developed and validated by experts. This study included all women admitted to the postpartum ward who were more than 18 years old and had received the COVID-19 vaccine. The study excluded women who had no proof of their vaccination status or who could not complete the questionnaire. The primary outcome was the effect of COVID-19 vaccination on gestational age and birth weight. The secondary outcomes included the development of polyhydramnios, oligohydramnios, mode of delivery, Apgar score, postpartum hemorrhage, and neonatal intensive care unit admission. Results A total of 365 pregnant women participated in this study. The mean gestational age of the unvaccinated women was 38.83 ± 1.62 weeks, which was significantly (p < 0.001) higher than that of vaccinated women (37.69 ± 2.9 weeks). In addition, the average birth weight for the unvaccinated women was 2.96 ± 0.4 kg, which did not differ significantly (p = 0.89) from that of vaccinated women (2.97 ± 0.66 kg). Conclusion COVID-19 vaccination, regardless of the type of vaccine received before, during, or after pregnancy, is not associated with any unfavorable perinatal outcomes for pregnant women or neonates.
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14
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The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes. Reprod Toxicol 2022; 114:33-43. [PMID: 36283657 PMCID: PMC9595355 DOI: 10.1016/j.reprotox.2022.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/24/2022] [Accepted: 10/17/2022] [Indexed: 12/22/2022]
Abstract
The rapidly evolving COVID-19 pandemic has resulted in an upsurge of scientific productivity to help address the global health crisis. One area of active research is the impact of COVID-19 on pregnancy. Here, we provide an epidemiological overview about what is known about the effects of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes, and identify gaps in knowledge. Pregnant people are at increased risk for severe COVID-19, and maternal SARS-CoV-2 infection increases the risk of negative maternal-fetal outcomes. Despite this elevated risk, there have been high rates of vaccine hesitancy, heightened by the initial lack of safety and efficacy data for COVID-19 vaccination in pregnancy. In response, retrospective cohort studies were performed to examine the impact of COVID-19 vaccination during pregnancy. Here, we report the vaccine's efficacy during pregnancy and its impact on maternal-fetal outcomes, as well as an overview of initial studies on booster shots in pregnancy. We found that pregnant people are at risk for more severe COVID-19 outcomes, maternal SARS-CoV-2 infection is associated with worse birth outcomes, COVID-19 vaccine hesitancy remains prevalent in the pregnant population, and COVID-19 vaccination and boosters promote better maternal-fetal outcomes. The results should help reduce vaccine hesitancy by alleviating concerns about the safety and efficacy of administering the COVID-19 vaccine during pregnancy. Overall, this review provides an introduction to COVID-19 during pregnancy. It is expected to help consolidate current knowledge, accelerate research of COVID-19 during pregnancy and inform clinical, policy, and research decisions regarding COVID-19 vaccination in pregnant people.
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15
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Toussia-Cohen S, Nir O, Peretz-Machluf R, Bookstein-Peretz S, Segal O, Asraf K, Doolman R, Regev-Yochay G, Yinon Y. Maternal and Neonatal Immune Responses Following COVID-19 Infection and Vaccinations in Pregnancy. Vaccines (Basel) 2022; 10:vaccines10122019. [PMID: 36560429 PMCID: PMC9782019 DOI: 10.3390/vaccines10122019] [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: 10/30/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The objective of the study was to compare the maternal and neonatal humoral immune responses among different groups of women, namely those vaccinated by the BNT162b2 vaccine, not vaccinated, and COVID-19-recovered parturient women at the time of delivery. This is a prospective cohort study of pregnant women, divided into four groups: Group A "Recovered"-recovered and not vaccinated. Group B "Second Vaccination"-first and second doses only. Group C "Third Vaccination"-third dose. Group D "No Third Vaccination"-women eligible for the third dose of the vaccine but did not receive it. Maternal and umbilical cord blood were sampled and tested for SARS-CoV-2 IgG antibodies on admittance to labor and immediately postpartum, respectively. Maternal serum SARS-CoV-2 IgG levels were significantly higher among Group C compared to Group B (741.6 (514.5-1069) vs. 333.5 (327-340.2), respectively). Both groups had higher antibody levels compared to Groups A and D (113.5 (61.62-209.1) and 57.99 (32.93-102.1), respectively). Similarly, umbilical cord blood SARS-CoV-2 IgG levels were also highest among Group C compared to the other three groups (1269 (953.4-1690) vs. Group B, 322.6 (305.6-340.5), Group A, 109 (49.01-242.6), and Group D, 103.9 (48.59-222), respectively). In conclusion, pregnant women who were fully vaccinated with three dosages before delivery generated the highest levels of maternal and neonatal SARS-CoV-2 IgG antibodies.
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Affiliation(s)
- Shlomi Toussia-Cohen
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Correspondence: ; Tel.: +972-546-308521
| | - Omer Nir
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Ravit Peretz-Machluf
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Shiran Bookstein-Peretz
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Omri Segal
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
| | - Ram Doolman
- The Dworman Automated-Mega Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
| | - Gili Regev-Yochay
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Infection Prevention & Control Unit, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
| | - Yoav Yinon
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
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16
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SeyedAlinaghi S, MohsseniPour M, Saeidi S, Habibi P, Dashti M, Nazarian N, Noori T, Pashaei Z, Bagheri A, Ghasemzadeh A, Afsahi AM, Aghaie N, Mojdeganlou P, Arjmand G, Zargari G, Modiri R, Mojdeganlou H, Razi A, Mehraeen E, Dadras O. Complications of COVID-19 Vaccines during Pregnancy; a Systematic Review. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e76. [PMID: 36426163 PMCID: PMC9676695 DOI: 10.22037/aaem.v10i1.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rare serious complications have been documented after COVID-19 vaccination as clinical research proceeded and new target populations, such as children and pregnant women, were included. In this study, we attempted to review the literature relevant to pregnancy complications and maternal outcomes of COVID-19 immunization in pregnant women. . METHODS We searched the databases of PubMed, Scopus, Cochrane, and Web of Science on 31 August 2022. The records were downloaded and underwent a two-step screening; 1) title/abstract and then 2) full-text screening to identify the eligible studies. We included English original studies that evaluated the adverse effects of COVID-19 vaccines during pregnancy. Information such as the type of study, geographical location, type of vaccine injected, gestational age, maternal underlying diseases, and complications following the vaccination were extracted into pre-designed tables. RESULTS According to the findings of included studies, in most of them vaccination had a positive impact and no negative effects were observed. Also, no medical history was reported in 11 articles, and pregnant women had no underlying diseases. Some serious adverse events were reported after vaccination, including miscarriage, paresthesia, uterine contraction, vaginal bleeding, preterm birth, major congenital anomalies, intrauterine growth restriction, and seizure. . CONCLUSION Because of limited data availability and the cross-sectional design of most studies, we could neither infer causation between vaccines and incidence of adverse effects nor comment with certainty about any possible adverse outcome of COVID-19 vaccines in vaccinated pregnant women. Consequently, more longitudinal and experimental studies are needed to define the exact adverse effects of COVID-19 vaccines in pregnant women.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrzad MohsseniPour
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Solmaz Saeidi
- Department of Nursing, Khalkhal University of Medical Sciences; Khalkhal, Iran
| | - Pedram Habibi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Dashti
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Tayebeh Noori
- Department of Health Information Technology, Zabol University of Medical Sciences, Zabol, Iran
| | - Zahra Pashaei
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - AmirBehzad Bagheri
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsaneh Ghasemzadeh
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Masoud Afsahi
- Department of Radiology, School of Medicine, University of California, San Diego (UCSD), California, USA
| | - Narjes Aghaie
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ghazal Arjmand
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Zargari
- School of Medicine, Iran University of Medical Sciences. Tehran, Iran
| | - Roshanak Modiri
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Armin Razi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mehraeen
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. ,Corresponding Author: Esmaeil Mehraeen, Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran. Postal Code: 5681761351, Tel: +98-45-32426801, Fax: +98-45-32422305, E-mail:
| | - Omid Dadras
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. ,Department of Global Public Health and Primary Care, Graduate School of Medicine, University of Bergen, Bergen, Norway
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