The risk of miscarriage after COVID-19 vaccination before and during pregnancy

PURPOSE

Pregnant women are at higher risk of severe illness and adverse pregnancy outcomes due to a SARS-CoV-2 infection, which can be prevented by vaccination. Observational studies are needed to ascertain the safety of COVID-19 vaccination during pregnancy. We aimed to determine whether COVID-19 vaccination before and during pregnancy is associated with the risk of miscarriage.

METHODS

In this cohort study, we included 4640 pregnant women (mean age: 32.8 ± 3.7 years) from the Dutch Pregnancy Drug Register between February 2021 and August 2022. Information on COVID-19 vaccinations, miscarriage, and confounders was self-reported, using web-based questionnaires. The hazard ratio (HR) of miscarriage (in gestational weeks 6-20) after a COVID-19 vaccination, was estimated using the survival analyses. A COVID-19 vaccination during pregnancy (≥1 COVID-19 vaccination between week 2 and 20 of pregnancy) was included as a time-dependent exposure and vaccination prior to pregnancy was included as a binary exposure.

RESULTS

A total of 3202 pregnant women (69%) received ≥1 COVID-19 vaccine in gestational week 2-20. We observed no association of vaccination during pregnancy with the risk of miscarriage (adjusted HR = 1.29, 95% CI = 0.93-1.74). Vaccination prior to pregnancy, however, was associated with a decreased risk of miscarriage (adjusted HR = 0.69, 95% CI = 0.48-0.99).

CONCLUSIONS

We demonstrated that COVID-19 vaccination during pregnancy is not associated with an increased risk of miscarriage in gestational weeks 6-20. This study adds to the growing body of evidence demonstrating the safety of COVID-19 vaccination during pregnancy.

Maternal first trimester COVID-19 vaccination and risk of major non-genetic congenital anomalies

BACKGROUND

Information regarding the risk of early pregnancy COVID-19 vaccination on the development of major congenital anomalies in the offspring is still limited. Here, we study the association between any COVID-19 vaccination during the 1st trimester and at least one major non-genetic congenital anomaly in the offspring.

METHODS

We used data from the Dutch Pregnancy Drug Register, an ongoing cohort study. We selected participants with a pregnancy that ended after at least 20 weeks gestation. Pregnant participants self-reported their COVID-19 vaccination status and the presence of congenital anomalies in the offspring. We used logistic regression analyses to study the association between 1st trimester COVID-19 vaccination (gestational week 2 + 0 to 12 + 6) and the risk of at least one major non-genetic congenital anomaly in the offspring. Clustering of anomalies on the ICD10 level by 1st trimester COVID-19 vaccination status was explored using Fisher exact tests.

RESULTS

We included 3721 participants of whom 795 (21.4%) were COVID-19 vaccinated during the 1st trimester. The percentage of participants who gave birth to a child with at least one major non-genetic congenital anomaly was comparable between participants who were 1st trimester vaccinated (1.1%) and participants who were not (1.2%) (adjusted odd ratio 0.78 [95% confidence interval 0.35-1.71]). We found no clustering of major non-genetic congenital anomalies by 1st trimester COVID-19 vaccination status (p > .05).

CONCLUSIONS

There were no indications of an increased risk of major non-genetic congenital anomalies in the offspring after maternal 1st trimester COVID-19 vaccination. Our findings suggest COVID-19 vaccines are safe during early pregnancy.

[Thrombosis and embolism during Diane-35 use: analysis of reports made to the Netherlands Pharmacovigilance Centre Lareb]

After media attention on the possible risks of thromboembolic complications associated with the use of cyproterone/ethinylestradiol (Diane-35 and generics), the Netherlands Pharmacovigilance Centre Lareb received a large number of reports over a short period of time. We describe in detail the reports of serious undesirable effects, also taking into account the indication, time to onset and risk factors, identification of the complication, treatment and course. The reports Lareb received give an insight into the nature and impact of the occurrence of these adverse drug reactions in daily practice. It was mentioned that cyproterone/ethinylestradiol was often used as a contraceptive drug. Some reports mentioned the fact that thrombosis and embolism were not always recognised at an early stage by users.

[Reported adverse events following influenza vaccination]

OBJECTIVE

Review of case reports of possible adverse events following immunization (AEFI) after vaccination with an influenza vaccine in the past three years.

DESIGN

Descriptive, retrospective.

METHOD

Lareb (Netherlands Pharmacovigilance Centre) investigated and reviewed reports of possible AEFI after vaccination with an influenza vaccine over seasons 2010-2011, 2011-2012 and 2012-2013.

RESULTS

Over the three seasons we received a total of 531 reports after administration of seasonal influenza vaccination. Each year the number of reports increased, especially the reports directly from vaccinees. In 32 cases (6%) the report was considered 'serious', in most cases it was associated with hospitalization. Two reports mentioned that the patient died but a causal relationship with the vaccination was considered unlikely. There were three reports of acute severe reactions, with anaphylaxis, angio-oedema and cardiac arrest. A total of 961 possible AEFI were reported. In 256 (over 25%) AEFI inflammatory symptoms occurred at the injection site. Besides the injection site reactions, headache (101), myalgia (90) and pyrexia (86) were the most reported AEFI. Notably, there were 26 reports of extensive limb swelling, in which injection site inflammation extends beyond shoulder or elbow or around the upper arm. The clinical picture resembles cellulitis or an allergic reaction and usually disappears with symptomatic treatment. Its aetiology is unknown.

CONCLUSION

Apart from extensive swelling of the limb, we did not find signs of unknown side effects of influenza vaccination. Based on the reported AEFI, influenza vaccines seem to be safe.

The effect of the family physician on improving follow-up after an abnormal PAP smear

OBJECTIVE

The aim of this study was to assess the effect of the family physician on improving compliance with follow-up of abnormal smears in cervical cancer screening.

DESIGN

Observational study.

SETTING

Two Regional Health Authority districts in the east of The Netherlands.

STUDY PARTICIPANTS

Family practices with a national call system for cervical cancer screening and family practices with a family-practice-based call system. In a number of practices the family physicians had introduced a fail-safe system for follow-up.

MAIN OUTCOME MEASURES

Follow-up of women who participated in the first screening round and in whom a cytological abnormality had been diagnosed in the first smear. Criteria for adequate follow-up were defined with regard to the severity of the cytological abnormality.

RESULTS

The overall compliance with follow-up in the study-group was 88%. The study showed a strong relationship between involvement of the family physician and compliance with follow-up. The compliance in practices that had a fail-safe system for follow-up was 93% compared to 82% in the practices without a fail-safe system. The highest follow-up was found in practices involved in the family-practice-based system.

General practitioner based screening for cervical cancer: higher participation of women with a higher risk?

OBJECTIVE

To test the hypothesis that a personal invitation for cervical screening by a woman's own general practitioner (GP) achieves a higher attendance of women with an increased risk for cervical cancer.

SETTING

Two general practices and the local health authority screening programme for cervical cancer, Nijmegen, The Netherlands.

METHODS

Attendance rates of women with an increased risk of cervical cancer were compared for two invitation strategies: (a) invitation by the woman's own GP, and (b) invitation by a national call system through the local health authority. Data on risk profiles were gathered by questionnaire. Two hundred and thirty eight women eligible for screening were invited by their GPs (GP group), and 235 women by the local health authority (control group) in 1992.

RESULTS

The personal invitation by the GP resulted in an 18% higher overall attendance, and a 28% higher attendance of women with greater risk because of sexual behaviour and smoking.

CONCLUSION

Greater involvement of the GP in inviting women for cervical cancer screening results in a higher attendance, particularly among women with increased risk, than a less personal health authority call system.

Cellular composition of cervical smears taken by general practitioners

The quality of the cervical smears taken by general practitioners, and also by some practice assistants, of the Dutch Screening Programme in the region of Nijmegen was evaluated. Of 18,398 preventive cervical smears taken by GPs in this region, 437 (2%) were diagnosed as "class" 0 and 2907 (16%) smears did not contain endocervical cells (EC-). The quality of the smears per general practitioner varied enormously. The percentage of smears without endocervical cells taken by six practice assistants was 18. During the screening period the percentage of smears without endocervical cells taken by GPs decreased from 19 (1989) to 14 (1992). In February 1990 the six practice assistants followed a theoretical and practical course on cervical smear-taking. Remarkable was the decrease in the percentage of smears without an endocervical component from 25% in 1990 to 13% in 1991. The quality of smears taken by GPs would improve if the general practitioner had more experience in smear-taking. We recommend to offer GPs the opportunity to take practical training courses in smear-taking, just as the practice assistants in this project.

Preliminary results of a general practice based call system for cervical cancer screening in The Netherlands

A study was undertaken in Nijmegen, in the Netherlands, to compare the attendance rate following a call system for cervical cancer screening organized by general practitioners, with the attendance rate resulting from the Dutch national call system. Women are invited for screening on a three yearly basis and in 1990 1616 women were identified by nine practices as being in the appropriate age group (35 to 54 years) to attend for cervical cancer screening while 10,387 women were identified by the national call system. The attendance rate among the 1101 women in the rural general practices was 58%, compared with 49% of 4154 women in the matched group receiving an invitation from the national call system. The attendance rate among the 515 women in the urban general practices was 55%, compared with 41% of 6233 women in the matched group receiving an invitation from the national call system. Invitations from general practitioners resulted in similar percentages of women in all age groups attending for screening. Four general practices sent a reminder letter or made a telephone call to non-attenders. A reminder increased the attendance rate from 58% to 70%. It is concluded that a general practice based call system for cervical screening produces a higher attendance rate than the national call system.

Implementation of the national cervical cancer screening in general practice and feasibility of a general practice-based call system: the GP's opinion

Thus far, the response to the nationwide screening programme for cervical cancer in The Netherlands, which was started in 1989, has been disappointing. One way to improve response is to involve general practitioners in the call system. A postal survey was conducted to review the implementation of the current screening programme in general practice and to examine the willingness of general practitioners to participate in a general practice-based call system. The response rate to the survey was 90%. The general practitioners were dissatisfied with follow-up, cost and time spent and compliance of women. Of all respondents 60% had already set up a call system within the practice or were willing to do so; another 31% were willing to participate in a regionally organized practice-based call system. On the basis of the results of this study a centralized general practice-based call system is recommended. The next step is to study the applicability of this system in a pilot programme.

[14 years of screening for cervix carcinoma in a family practice]

Since 1975 the general practitioners of 'Ons Medies Centrum' in Oss have been inviting women systematically for cervical screening and cervical smears. The attendance and protection rate were evaluated for the period 1975-1989. 85% of the women 35-54 years of age had had a cervical smear within 5 years after they entered the general practice or had not been invited because of a total hysterectomy. After a starting period of a few years the protection rate stabilised at 75%. There was no relation between residential quarter, health insurance, ethnic origin and attendance for the screening. Age was the only factor related to attendance: the attendance rate among older women was lower.