#VisualAbstract: COVID-19 vaccination is safe during pregnancy and has benefits for neonatal outcomes

1. In a systematic review with meta-analysis, COVID-19 vaccination during pregnancy was associated with lower risk of neonatal intensive care unit (NICU) admission and intrauterine fetal death.

2. COVID-19 vaccination during pregnancy was associated with a lower risk of infection with no increased risks of maternal complications such as cesarean delivery, postpartum hemorrhage, and chorioamnionitis.

Evidence Rating Level: 2 (Good)

Study Rundown: COVID-19 during pregnancy has been linked to an increased risk of maternal and neonatal morbidity. As a result, COVID-19 vaccination has been recommended in pregnancy by major medical organizations. However, vaccine hesitancy has been prominent in this population. This systematic review and meta-analysis attempts to address potential safety concerns of COVID-19 vaccines during pregnancy by investigating associated neonatal and maternal outcomes. 9 studies were included in the analysis. When assessing maternal outcomes, vaccination was associated with lower risk of COVID-19 during follow-up but not with adverse maternal events such as risk of cesarean section, postpartum hemorrhage, or chorioamnionitis. Similarly, for neonatal outcomes, COVID vaccination in pregnancy was associated with a  lower risk of NICU admission and intrauterine fetal death (IFD). Some major limitations of this study include the lack of randomized control studies included in the meta-analysis and absence of long-term follow up data. However, overall, this study suggests that COVID-19 vaccination during pregnancy is beneficial for maternal and neonatal outcomes with minimal safety concerns, although future studies are required to study long-term outcomes.

Click here to read the article in the JAMA Pediatrics

Relevant Reading: Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection

In Depth [Systematic Review]: This systematic review included pregnant individuals with at least one dose of a COVID-19 vaccine during pregnancy compared to individuals who did not. Neonatal outcomes included preterm birth (<37 weeks of gestational age), small for gestational age (SGA; birth weight below 10th percentile), low APGAR score (AGPAR < 7 at 5 mins), NICU admission, and IFD. Following the search strategy, 263 articles were identified, and 9 articles were included in qualitative and quantitative meta-analysis. COVID-19 vaccinations during pregnancy were associated with a lower risk of maternal COVID-19 (OR, 0.46; 95% CI, 0.22-0.93), but not with higher risks of cesarean delivery (OR, 1.05; 95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95; 95% CI, 0.83-1.07), or chorioamnionitis (OR, 1.06; 95% CI, 0.86-1.31). COVID-19 vaccination was associated with lower risk of neonatal adverse outcomes, including NICU admission (OR, 0.88; 95% CI, 0.80-0.97) and IFD (OR, 0.73; 95% CI, 0.57-0.94). Other primary outcomes such as preterm birth (OR, 0.89; 95% CI 0.76-1.04), SGA (OR, 0.99; 95% CI, 0.94-1.04), and low APGAR score (OR, 0.94; 95%CI, 0.87-1.02) was not different between women who received COVID-19 vaccination in pregnancy and those who did not.

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