BMJ Global Health (Apr 2024)

Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis

  • ,
  • Mercedes Bonet,
  • Olufemi T Oladapo,
  • Madelon van Wely,
  • Shakila Thangaratinam,
  • Kate Walker,
  • Heinke Kunst,
  • Vanessa Brizuela,
  • Sami L Gottlieb,
  • Javier Zamora,
  • Asma Khalil,
  • John Allotey,
  • Magnus Yap,
  • Shaunak Chatterjee,
  • Tania Kew,
  • Luke Debenham,
  • Anna Clavé Llavall,
  • Anushka Dixit,
  • Dengyi Zhou,
  • Rishab Balaji,
  • Elizabeth van Leeuwen,
  • Elena Kostova,
  • Edna Kara,
  • Caron Rahn Kim,
  • Anna Thorson,
  • Lynne Mofenson,
  • Jameela Sheikh,
  • Heidi Lawson,
  • Kehkashan Ansari,
  • Keelin O’Donoghue,
  • Kathryn Barry,
  • Ngawai Moss,
  • Wentin Chen,
  • Halimah Khalil,
  • Silvia Fernández-García,
  • Megan Littmoden,
  • Yasmin King,
  • Adeolu Banjoko,
  • Alya Khashaba,
  • Meghnaa Hebbar,
  • Millie Manning,
  • Ankita Gupta,
  • Shruti Attarde,
  • Damilola Akande,
  • Dharshini Sambamoorthi,
  • Anoushka Ramkumar,
  • Helen Fraser,
  • Sophie Maddock,
  • Tanisha Rajah,
  • Massa Mamey,
  • Sangamithra Ravi,
  • Maurie Kumaran,
  • Laura del Campo-Albendea,
  • Karen Lau,
  • Nana Osei-Lah,
  • Harshitha Naidu,
  • Nicole Stoney,
  • Paul Sundaram,
  • Paulomi Sengupta,
  • Samay Mehta,
  • Zainita Meherally,
  • Andriya Punnoose,
  • Chloe Knight,
  • Eyna Sadeqa,
  • Jiya Cherian

DOI
https://doi.org/10.1136/bmjgh-2023-014247
Journal volume & issue
Vol. 9, no. 4

Abstract

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Objective To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes.Design Systematic review and meta-analysis.Data sources Major databases between December 2019 and January 2023.Study selection Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included.Quality assessment, data extraction and analysis Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs.Results Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women).Conclusion COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women.PROSPERO registration number CRD42020178076.