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Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes.
Fell, Deshayne B; Dhinsa, Tavleen; Alton, Gillian D; Török, Eszter; Dimanlig-Cruz, Sheryll; Regan, Annette K; Sprague, Ann E; Buchan, Sarah A; Kwong, Jeffrey C; Wilson, Sarah E; Håberg, Siri E; Gravel, Christopher A; Wilson, Kumanan; El-Chaâr, Darine; Walker, Mark C; Barrett, Jon; MacDonald, Shannon E; Okun, Nannette; Shah, Prakesh S; Dougan, Shelley D; Dunn, Sandra; Bisnaire, Lise.
  • Fell DB; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
  • Dhinsa T; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.
  • Alton GD; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.
  • Török E; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.
  • Dimanlig-Cruz S; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.
  • Regan AK; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.
  • Sprague AE; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.
  • Buchan SA; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.
  • Kwong JC; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
  • Wilson SE; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.
  • Håberg SE; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.
  • Gravel CA; School of Nursing and Health Professions, University of San Francisco, San Francisco, California.
  • Wilson K; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California.
  • El-Chaâr D; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.
  • Walker MC; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.
  • Barrett J; Public Health Ontario, Toronto, Ontario, Canada.
  • MacDonald SE; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Okun N; Public Health Ontario, Toronto, Ontario, Canada.
  • Shah PS; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Dougan SD; ICES, Toronto, Ontario, Canada.
  • Dunn S; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Bisnaire L; Public Health Ontario, Toronto, Ontario, Canada.
JAMA ; 327(15): 1478-1487, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1756509
ABSTRACT
Importance There is limited comparative epidemiological evidence on outcomes associated with COVID-19 vaccination during pregnancy; monitoring pregnancy outcomes in large populations is required.

Objective:

To evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Design, Setting, and

Participants:

Population-based retrospective cohort study in Ontario, Canada, using a birth registry linked with the provincial COVID-19 immunization database. All births between December 14, 2020, and September 30, 2021, were included. Exposures COVID-19 vaccination during pregnancy, COVID-19 vaccination after pregnancy, and no vaccination. Main Outcomes and

Measures:

Postpartum hemorrhage, chorioamnionitis, cesarean delivery (overall and emergency cesarean delivery), admission to neonatal intensive care unit (NICU), and low newborn 5-minute Apgar score (<7). Linear and robust Poisson regression was used to generate adjusted risk differences (aRDs) and risk ratios (aRRs), respectively, comparing cumulative incidence of outcomes in those who received COVID-19 vaccination during pregnancy with those vaccinated after pregnancy and those with no record of COVID-19 vaccination at any point. Inverse probability of treatment weights were used to adjust for confounding.

Results:

Among 97 590 individuals (mean [SD] age, 31.9 [4.9] years), 22 660 (23%) received at least 1 dose of COVID-19 vaccine during pregnancy (63.6% received dose 1 in the third trimester; 99.8% received an mRNA vaccine). Comparing those vaccinated during vs after pregnancy (n = 44 815), there were no significantly increased risks of postpartum hemorrhage (incidence 3.0% vs 3.0%; aRD, -0.28 per 100 individuals [95% CI, -0.59 to 0.03]; aRR, 0.91 [95% CI, 0.82-1.02]), chorioamnionitis (0.5% vs 0.5%; aRD, -0.04 per 100 individuals [95% CI, -0.17 to 0.09]; aRR, 0.92 [95% CI, 0.70-1.21]), cesarean delivery (30.8% vs 32.2%; aRD, -2.73 per 100 individuals [95% CI, -3.59 to -1.88]; aRR, 0.92 [95% CI, 0.89-0.95]), NICU admission (11.0% vs 13.3%; aRD, -1.89 per 100 newborns [95% CI, -2.49 to -1.30]; aRR, 0.85 [95% CI, 0.80-0.90]), or low Apgar score (1.8% vs 2.0%; aRD, -0.31 per 100 newborns [95% CI, -0.56 to -0.06]; aRR, 0.84 [95% CI, 0.73-0.97]). Findings were qualitatively similar when compared with individuals who did not receive COVID-19 vaccination at any point (n = 30 115). Conclusions and Relevance In this population-based cohort study in Ontario, Canada, COVID-19 vaccination during pregnancy, compared with vaccination after pregnancy and with no vaccination, was not significantly associated with increased risk of adverse peripartum outcomes. Study interpretation should consider that the vaccinations received during pregnancy were primarily mRNA vaccines administered in the second and third trimester.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Chorioamnionitis / COVID-19 Vaccines / COVID-19 / Postpartum Hemorrhage / Infant, Newborn, Diseases Type of study: Etiology study / Incidence study / Observational study / Qualitative research / Risk factors Topics: Vaccines Limits: Adult / Female / Humans / Infant, Newborn / Pregnancy Country/Region as subject: North America Language: English Journal: JAMA Year: 2022 Document Type: Article Affiliation country: Jama.2022.4255

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Chorioamnionitis / COVID-19 Vaccines / COVID-19 / Postpartum Hemorrhage / Infant, Newborn, Diseases Type of study: Etiology study / Incidence study / Observational study / Qualitative research / Risk factors Topics: Vaccines Limits: Adult / Female / Humans / Infant, Newborn / Pregnancy Country/Region as subject: North America Language: English Journal: JAMA Year: 2022 Document Type: Article Affiliation country: Jama.2022.4255