Baby and Maternal Outcomes Following SARS-CoV-2 Infection and COVID-19 Vaccination During Pregnancy: A National Population-Based Matched Cohort Study by Laura Lindsay, Clara Calvert, Ting Shi, Jade Carruthers, Cheryl Denny, Jack Donaghy, Lisa EM Hopcroft, Leanne Hopkins, Anna Goulding, Terry McLaughlin, Emily Moore, Bob Taylor, Krishnan Bhaskaran, Srinivasa Vittal Katikireddi, Ronan McCabe, Colin McCowan, Colin Simpson, Chris Robertson, Aziz Sheikh, Rachael Wood, Sarah J. Stock :: SSRN



Background: Understanding the impact of SARS-CoV-2 infection and COVID-19 vaccination in pregnancy on maternal and perinatal outcomes informs clinical decision-making.

Methods: We undertook a national, population-based, matched cohort study to investigate associations between SARS-CoV-2 infection and, separately, COVID-19 vaccination just before or during pregnancy and the risk of adverse baby and maternal outcomes among women in Scotland with a singleton pregnancy ending at ≥20 weeks gestation. Baby outcomes examined were stillbirth, neonatal death, extended perinatal mortality, preterm birth (overall, spontaneous, and provider-initiated), small-for-gestational age, and low Apgar score. Maternal outcomes were admission to critical care or death, venous thromboembolism, hypertensive disorders of pregnancy, and pregnancy-related bleeding. Conditional logistic regression models were used to derive odds ratios adjusted for socio-demographic and clinical characteristics (aORs) and 95% confidence intervals (CIs).

Findings: Our infection analyses of 4,074 women with confirmed SARS-CoV-2 infection matched on maternal age, season of conception, and gestational age at infection/matching to 12,222 uninfected controls, found that infection was associated with an increased risk of preterm (aOR=1·36, 95% CI 1·16-1·59) and very preterm birth (aOR=1·90, 95% CI 1·20-3·02), maternal admission to critical care or death (aOR=1·72, 95% CI 1·39-2·12), and venous thromboembolism (aOR=2·53, 95% CI 1·47-4·35).  Our vaccination analyses found no evidence of increased risk for any baby or maternal outcomes following vaccination.InterpretationSARS-CoV-2 infection during pregnancy is associated with adverse baby and maternal outcomes, but COVID-19 vaccination is not. COVID-19 vaccination remains the safest way for pregnant women to protect themselves and their babies against SARS-CoV-2 infection.



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