ABSTRACT
Objectives: Evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Methods: Ontario population-based retrospective cohort between December 14, 2020 and September 30, 2021 using linkage of provincial birth registry and COVID-19 immunization databases. Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI), adjusted for temporal, socio-demographic, and clinical factors using propensity scores. Obstetric (postpartum hemorrhage, chorioamnionitis, cesarean birth) and newborn (NICU admission and 5-minute Apgar<7) outcomes were compared for those who received ≥1 dose of COVID-19 vaccine during pregnancy with 2 unexposed groups—Group 1: individuals vaccinated postpartum, Group 2: never vaccinated. Results: Among 97 590 individuals, 22 660 (23%) received ≥1 dose of vaccine during pregnancy (64% received dose 1 in 3rd trimester). Compared with those vaccinated postpartum, we found no increased risks of postpartum hemorrhage (aRR 0.91, 95% CI 0.82–1.02);chorioamnionitis (aRR 0.92, 95% CI 0.70–1.21);or cesarean (aRR 0.92, 95% CI 0.89–0.95) following COVID-19 vaccination, nor any increased risk of NICU admission or 5-minute Apgar <7. All findings were similar when compared with individuals who did not receive COVID-19 vaccination at any point. We did not observe any difference according to vaccine product, number of doses received during pregnancy, or trimester of dose 1. Conclusions: As of late 2021, there is limited evidence from comparative studies in large populations on outcomes following COVID-19 vaccination during pregnancy. Our study of births up to September 30, 2021 did not identify any increased adverse peripartum outcomes associated with later pregnancy COVID-19 vaccination. Once more individuals vaccinated earlier in pregnancy deliver, we will report on other important obstetric and perinatal outcomes. Keywords: COVID-19 vaccine;pregnancy;epidemiology
ABSTRACT
In response to the COVID-19 pandemic, governments around the world imposed confinement and physical distancing directives for all citizens. Although essential to reduce the spread of the SARS-CoV-2 virus, these measures may have collateral consequences for older adults, such as increased psychological distress. Research suggests, as a population, older adults have been experiencing less psychological distress than younger adults during COVID-19. However, most of these studies examine mean levels of psychological distress and do not capture the heterogeneity of outcomes, like subgroups who may experience increased psychological distress. The goal of this longitudinal study was to use group-based trajectory modelling (GBTM) to identify meaningful subgroups that follow different trajectories of psychological distress among 645 older adults with a mean age of 78.69 (SD = 5.67). Participants were recruited from two research cohorts and newspaper ads. Telephone-based assessments were conducted across four time periods: T1-Spring 2020-first confinement, T2-Summer 2020-first deconfinement, T3-Fall 2020-second confinement, and T4-Winter/Spring 2021-continued confinement. Participants completed the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point and provided information on socioeconomic, medical, and psychosocial factors. Results indicated that the average psychological distress level was stable across the first three time points but slightly increased at the fourth assessment (Fig. 1). Using GBTM, three groups emerged to best characterize the different trajectories of psychological distress: resilient (50.5%), fluctuating (34.9%), and elevated (14.6%) distress groups (Fig. 1). Those in the fluctuating and elevated groups were more likely to have chronic mental health problems, mobility issues, insomnia symptoms, loneliness, COVID-19 related acute stress and general health anxiety than those in the resilient group. Those who lived in poverty, who could not use technology, and who took psychotropic medication had uniquely increased odds of being in the elevated group. These findings identify subgroups of older adults at greater risk of psychological distress with potential intervention targets to alleviate distress during and after the pandemic.
ABSTRACT
Background: The value of rapid reviews in informing health care decisions is more evident since the onset of the coronavirus disease 2019 (COVID-19) pandemic. While systematic reviews can be completed rapidly, rapid reviews are usually a type of evidence synthesis in which components of the systematic review process may be simplified or omitted to produce information more efficiently within constraints of time, expertise, funding or any combination thereof. There is an absence of high-quality evidence underpinning some decisions about how we plan, do and share rapid reviews. We will conduct a modified James Lind Alliance Priority Setting Partnership to determine the top 10 unanswered research questions about how we plan, do and share rapid reviews in collaboration with patients, public, reviewers, researchers, clinicians, policymakers and funders.