COVID-19 vaccination during pregnancy: coverage and safety

Abstract

Background Concerns have been raised regarding a potential surge of COVID-19 in pregnancy, secondary to rising numbers of COVID-19 in the community, easing of societal restrictions, and vaccine hesitancy. Even though COVID-19 vaccination is now offered to all pregnant women in the UK, there are limited data on its uptake and safety. Objectives and study design : This was a cohort study of pregnant women who gave birth at St George’s University Hospitals NHS Foundation Trust, London, UK, between March 1 st and July 4 th 2021. The primary outcome was uptake of COVID-19 vaccination and its determinants. The secondary outcomes were perinatal safety outcomes. Data were collected on COVID-19 vaccination uptake, vaccination type, gestational age at vaccination, as well as maternal characteristics including age, parity, ethnicity, index of multiple deprivation score and co-morbidities. Further data were collected on perinatal outcomes including stillbirth (fetal death ≥24 weeks’ gestation), preterm birth, fetal/congenital abnormalities and intrapartum complications. Pregnant women who received the vaccine were compared with a matched cohort of propensity balanced pregnant women to compare outcomes. Effect magnitudes of vaccination on perinatal outcomes were reported as mean differences or odds ratios with 95% confidence intervals. Factors associated with antenatal vaccination were assessed with logistic regression analysis. Results Data were available for 1328 pregnant women of whom 141 received at least one dose of vaccine before giving birth and 1187 women who did not; 85.8% of those vaccinated received their vaccine in the third trimester and 14.2% in the second trimester. Of those vaccinated, 128 (90.8%) received an mRNA vaccine and 13 (9.2%) a viral vector vaccine. There was evidence of reduced vaccine uptake in younger women (P=0.002), those with high levels of deprivation (i.e., fifth quintile of Index of Multiple Deprivation, P=0.008) and women of Afro-Caribbean or Asian ethnicity, compared to Caucasian ethnicity (P<0.001). Women with pre-pregnancy diabetes had increased vaccine uptake (P=0.008). In the multivariable model adjusting for variables that had a significant effect according to the univariable analysis, fifth deprivation quintile (most deprived) was significantly associated with lower antenatal vaccine uptake (adjusted OR 0.09, 95% CI 0.02–0.39, P=0.002), while pre-pregnancy diabetes was significantly associated with higher antenatal vaccine uptake (adjusted OR 11.1, 95% CI 2.01–81.6, P=0.008). In a propensity score matched cohort, compared with non-vaccinated pregnant women, 133 women who received at least one dose of the COVID-19 vaccine in pregnancy (vs. those unvaccinated) had similar rates of adverse pregnancy outcomes (P>0.05 for all): stillbirth (0.0% vs 0.3%), fetal abnormalities (2.2% vs 2.7%), intrapartum pyrexia (3.7% vs 1.5%), postpartum hemorrhage ...

Receipt of COVID-19 Vaccine During Pregnancy and Preterm or Small-for-Gestational-Age at Birth — Eight Integrated Health Care Organizations, United States, December 15, 2020–July 22, 2021

“…An observational study from Israel also reported no association between COVID-19 vaccination in pregnancy and adverse maternal or birth outcomes (2). In addition, in a cohort study from the United Kingdom, among 1,328 pregnant women, 140 (10.5%) received a COVID-19 vaccine during pregnancy, and birth outcomes did not differ between vaccinated and unvaccinated women (10). The current study further demonstrates the safety of COVID-19 vaccination among pregnant women related to preterm birth and SGA at birth outcomes.…”

COVID-19 Vaccine Acceptance of Pregnant and Lactating Women (PLW) in Czechia: An Analytical Cross-Sectional Study

“…One can also put forward the risk perception of medications, which makes PW avoid medicines during the first trimester, as it is depicted as a critical period for organogenesis [42,43]. As a confirmation, Blakeway et al, 2021 found within a sample of vaccinated PW in the UK that 85.7% of the vaccinees were in the third trimester versus 14.3% who were in the second trimester [44]. On the contrary, the first-trimester PW in Turkey had higher levels of COVID-19 vaccine acceptance compared to second-and third-trimester PW [30].…”

COVID-19 vaccination perceptions and intentions of maternity care consumers and providers in Australia

“…Global regions that have experienced higher prevalence of COVID-19, such as the United Kingdom (UK) [ 3 ] and the United States (US) [ 4 ], adopted recommendations encouraging women to consider vaccination in pregnancy owing to the risk for severe illness. In Australia, recent updates to guidelines (v5) have also recommended routine COVID-19 vaccination for pregnant women [ 5 ] following evidence that the vaccination in pregnancy is safe for pregnant and breastfeeding women [ 6 – 8 ].…”