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Reductions in stillbirths and preterm birth in COVID-19 vaccinated women: a multi-center cohort study of vaccination uptake and perinatal outcomes

  • Lisa Hui
    Correspondence
    CORRESPONDING AUTHOR: A/Prof Lisa Hui, Dept of Perinatal Medicine, Level 3, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, VIC 3084 Australia, fx. 61 3 8458 4504. Ph. 61 3 8458 4248
    Affiliations
    Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia

    Reproductive Epidemiology Group, Murdoch Children’s Research Institute, Parkville VIC 3052 Australia

    Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg VIC 3084 Australia

    Department of Obstetrics and Gynaecology, The Northern Hospital, Northern Health, Epping VIC 3076 Australia
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  • Melvin Barrientos Marzan
    Affiliations
    Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia

    Reproductive Epidemiology Group, Murdoch Children’s Research Institute, Parkville VIC 3052 Australia

    Center for Alcohol Policy Research (CAPR), La Trobe University, Bundoora VIC 3086 Australia
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  • Daniel L. Rolnik
    Affiliations
    Department of Obstetrics and Gynaecology, Monash Health, Clayton VIC 3168

    Department of Obstetrics and Gynaecology, Monash University, Clayton VIC 3168

    Harvard School of Public Health, Harvard University, Cambridge MA, 02115 USA
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  • Stephanie Potenza
    Affiliations
    Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg VIC 3084 Australia
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  • Natasha Pritchard
    Affiliations
    Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia

    Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg VIC 3084 Australia
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  • Joanne M. Said
    Affiliations
    Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia

    Maternal-Fetal Medicine Department, Joan Kirner Women’s and Children’s Hospital, Western Health, St Albans VIC 3021 Australia
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  • Kirsten R. Palmer
    Affiliations
    Department of Obstetrics and Gynaecology, Monash Health, Clayton VIC 3168

    Department of Obstetrics and Gynaecology, Monash University, Clayton VIC 3168
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  • Clare L. Whitehead
    Affiliations
    Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia

    Department of Obstetrics and Gynaecology, the Royal Women’s Hospital, Parkville VIC 3052 Australia
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  • Penelope M. Sheehan
    Affiliations
    Department of Obstetrics and Gynaecology, Monash University, Clayton VIC 3168

    Department of Obstetrics and Gynaecology, Box Hill Hospital, Eastern Health, Box Hill VIC 3128 Australia
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  • Jolyon Ford
    Affiliations
    Department of Obstetrics and Gynaecology, Frankston Hospital, Peninsula Health VIC 3199, Australia
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  • Ben W. Mol
    Affiliations
    Department of Obstetrics and Gynaecology, Monash Health, Clayton VIC 3168

    Department of Obstetrics and Gynaecology, Monash University, Clayton VIC 3168
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  • Susan P. Walker
    Affiliations
    Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3052, Australia

    Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg VIC 3084 Australia
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Published:November 03, 2022DOI:https://doi.org/10.1016/j.ajog.2022.10.040
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      ABSTRACT

      Background

      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.

      Objective

      The aim of this study was to measure the rate of COVID-19 vaccine uptake among women giving birth in Melbourne, Australia, and to compare perinatal outcomes by vaccination status.

      Study design

      Retrospective multicenter cohort study occurring after the June 2021 government recommendations for mRNA COVID-19 vaccination during pregnancy. Routinely collected data from all 12 public maternity hospitals in Melbourne were extracted on births > 20 weeks’ gestation from 1st July 2021 to 31 March 2022. Maternal sociodemographic characteristics were analyzed from the total birth cohort. Perinatal outcomes were compared between vaccinated and unvaccinated women for whom weeks 20-43 of gestation fell entirely within the 9-month data collection period. The primary outcomes were the rates of stillbirth and preterm birth (spontaneous and iatrogenic) in singleton pregnancies of at least 24 weeks gestation, after exclusion of congenital anomalies. Secondary perinatal outcomes included the rate of congenital anomalies among infants born > 20 weeks gestation; and birthweight < 3rd centile and newborn intensive care unit (NICU) admissions among infants born without congenital anomalies at > 24 weeks gestation. We calculated the adjusted odds ratio of perinatal outcomes among vaccinated versus unvaccinated women using inverse propensity score weighting regression adjustment with multiple covariates; p< 0.05 was considered statistically significant.

      Results

      Births from 32,536 women were analyzed: 17,365 (53.4%) were vaccinated and 15,171 (47.6%) were unvaccinated. Vaccinated women were significantly more likely to be older, nulliparous, non-smoking, not requiring an interpreter, of higher socioeconomic status, and vaccinated against pertussis and influenza. Vaccination status also varied by region of birth.Vaccinated women had a significantly lower rate of stillbirth compared with unvaccinated women (0.2% vs 0.8%, aOR 0.18, 95%CI 0.09-0.37, P < 0.001. Vaccination was associated with a significant reduction in total preterm births < 37 weeks (5.1% vs 9.2%, aOR 0.60, 95% CI 0.51-0.71, p< 0.001), spontaneous preterm birth (2.4% vs 4.0%, aOR 0.73 95% CI 0.56-0.96, p=0.02) and iatrogenic preterm birth (2.7% vs 5.2%, aOR 0.52, 95%CI 0.41-0.65, p< 0.001). Babies born to vaccinated mothers also had lower NICU admission rates.There was no significant increase in the rate of congenital anomalies or birth weight < 3rd centile in vaccinated women. Vaccinated women were significantly less like to have an infant with a major congenital anomaly compared with the unvaccinated group (2.4% vs 3.0%, aOR 0.72, 95%CI 0.56-0.94, p=0.02). This finding remained significant even when the analysis was restricted to women vaccinated before 20 weeks’ gestation.

      Conclusions

      COVID-19 vaccination during pregnancy was associated with a reduction in stillbirth and preterm birth, and not associated with any adverse impacts on fetal growth or development. Vaccine coverage was significantly influenced by known social determinants of health.

      Keywords