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Credit author statement
LH, SW, JS, CW, DR, BM, KP and SP conceived of the original collaboration, LH designed, coordinated, and acquired funding for the study; LH and MM drafted the data analysis plan, and all authors edited and/or approved the analysis plan; LH, SP, JS, DR, CW, PS, JF, MM collected the primary data; MM performed the data cleaning and coding; LH ,MM and DR performed the data analysis; MM and LH created the tables and figures; LH and MM wrote the primary manuscript; all authors reviewed and edited the draft manuscript for scientific content and approved the final submitted manuscript.
LH has received research funding from Ferring Pharmaceuticals outside the scope of this work. BWM is a consultant for Guerbet and has received research grants from Guerbet and Merck. KRP has received consultancy fees from Janssen. DLR has received fees from Alexion for participation in advisory boards unrelated to this work. All other authors declare no competing interests.
This study was funded by the Norman Beischer Medical Research Foundation and the University of Melbourne Department of Obstetrics and Gynaecology. LH, BWM and KRP are supported by National Health and Medical Research Council investigator grants (GNT1196010, GNT11766437 and GNT2009765). The funding bodies had no role in any aspects of the design or conduct of this study.
The findings of this study were presented as a poster communication at the Annual Scientific Meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists at the Gold Coast, QLD, Australia in October 2022.
Stillbirths, spontaneous and iatrogenic preterm births significantly lower in COVID-19 vaccinated women
AJOG AT A GLANCE
Why was this study conducted?
● COVID-19 infection in pregnancy is associated with a higher risk of progression to severe disease, but vaccine uptake by pregnant women is hindered by persistent safety concerns. COVID-19 vaccination in pregnancy has been shown to reduce stillbirth, but its relationship with preterm birth is uncertain.
● Most of the published literature on COVID-19 vaccination in pregnancy have methodological limitations including fixed cohort bias and time-varying exposure.
● We conducted this multicenter study to provide robust evidence on mRNA COVID-19 vaccination and perinatal outcomes including stillbirth, preterm birth and congenital anomalies.
What are the key findings?
● The adjusted odds of stillbirth, preterm birth, and neonatal intensive care admission were significantly reduced among infants born to COVID-19 vaccinated women compared with unvaccinated women.
● Both spontaneous and iatrogenic preterm births were significantly reduced among vaccinated women
● COVID-19 vaccination during pregnancy was not associated with an increase in congenital anomalies or fetal growth restriction.
What does this study add to what is already known?
● Our analysis confirmed a strong relationship between the COVID-19 mRNA vaccine and lower stillbirths and iatrogenic and spontaneous preterm births
● We provide further evidence to endorse the safety of the mRNA vaccine during pregnancy and to promote the benefits of reduced stillbirth and preterm birth.
● Vaccine coverage was not distributed equally in our population and was significantly influenced by known social determinants of health.
● In addition to its impact on reducing severe COVID-19 illness, vaccination may be a proxy for other biological and social determinants of health in our pregnant population.