Obstetric Outcomes during COVID-19 Pandemic: Vaccination and Infection in Pregnancy

Abstract

Background: Coronavirus disease 2019 (COVID-19) infection is associated with increased perinatal morbidity and mortality. Despite this, vaccination hesitancy among pregnant women remains to be a huge problem. In this study we aimed to evaluate COVID-19 vaccination safety and uptake in pregnancy, and to evaluate adverse perinatal outcomes associated with COVID-19 in pregnancy, compared with non-infected pregnant women. Methods: This is a retrospective single-institution cohort study of women who gave birth in 2021. The primary outcomes of the study were the safety of COVID-19 vaccination during pregnancy, and the comparison of perinatal outcomes in COVID-19 infected women during pregnancy group vs non-infected. The secondary outcomes included vaccine uptake rate, trimester evaluation of vaccination safety, and side effects. Results: Among 3620 deliveries, 1943 individuals who were vaccine eligible before delivery were included in the vaccine safety and uptake analysis. Out of 1943 pregnant women, 212 (10.9%) women received at least one dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine during pregnancy. 189 (89.2%) of them received BNT162b2 (Pfizer/BioNTech) and 23 (10.8%) CoronaVac (Sinovac). Following propensity score matching, no significant increase in emergency cesarean section (C-section) rates, intrapartum complications, stillbirth, congenital anomalies, maternal or neonatal intensive care unit (NICU) admissions were found in COVID-19 vaccinated group compared to the non-vaccinated (p > 0.05, for all). 436 women with a history of COVID-19 polymerase chain reaction (PCR) positivity during pregnancy were compared with 2972 women who tested negative. No overall significant adverse effects were identified due to COVID-19 infection during pregnancy. Perinatal outcomes were similar in both groups (p > 0.05, for all). In the subgroup analysis of 212 pregnant women vaccinated during pregnancy, NICU admission was lowest in the third trimester group (p < 0.001). Antenatal vaccine uptake was higher among women with pregestational diabetes, hypothyroidism and autoimmune diseases compared to the overall vaccination rate (23%, 14%, 20.8% and 10.9% respectively). Conclusions: In this study, COVID-19 vaccination in pregnancy was not associated with significant adverse perinatal outcomes. Overall, COVID-19 infection was not associated with increased adverse perinatal outcomes. Our results should be confirmed in a bigger cohort in order to draw more definite conclusions.

Keywords

• covid-19
• inactivated vaccine
• mrna vaccines
• pregnancy outcome
• safety
• sars-cov-2