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Review
. 2023 Jul 15;8(1):103.
doi: 10.1038/s41541-023-00698-8.

Maternal and neonatal outcomes of COVID-19 vaccination during pregnancy, a systematic review and meta-analysis

Greg Marchand  1 , Ahmed Taher Masoud  2   3 , Sandeep Grover  4 , Alexa King  2 , Giovanna Brazil  2 , Hollie Ulibarri  2 , Julia Parise  2 , Amanda Arroyo  2 , Catherine Coriell  2 , Sydnee Goetz  2 , Carmen Moir  2 , Malini Govindan  2 , Atley Moberly  2 , Anna Proctor  5 , Katelyn Sainz  6 , Richard Blumrick  7
Affiliations
Review

Maternal and neonatal outcomes of COVID-19 vaccination during pregnancy, a systematic review and meta-analysis

Greg Marchand et al. NPJ Vaccines. .

Abstract

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is associated with increased pregnancy complications. Despite effective vaccination strategies for the general population, the evidence on the safety and efficacy of Coronavirus disease 2019 (COVID-19) vaccinations in pregnancy is limited due to a lack of well-powered studies. The present study compares the maternal, neonatal, and immunological outcomes between vaccinated pregnant and unvaccinated pregnant women using a systematic review and meta-analysis approach. We included 37 studies with a total of 141,107 pregnant women (36.8% vaccinated) spread across all outcomes. Our evidence indicates a higher rate of cesarean section in the 1898 vaccinated pregnant women compared to the 6180 women who did not receive vaccination (OR = 1.20, CI = (1.05, 1.38), P = 0.007, I2 = 45%). Regarding immunological outcomes, the risk of SARS-CoV-2 infection during pregnancy or postpartum was significantly reduced in 6820 vaccinated pregnant women compared to 17,010 unvaccinated pregnant women (OR = 0.25, CI = 0.13-0.48, P < 0.0001, I2 = 61%), as evident from qualitative assessment indicating significantly higher postpartum antibody titers compared to that observed in both unvaccinated mothers and mothers who have recently recovered from a SARS-CoV-2 infection. Our analysis represents high quality evidence showing that COVID-19 vaccination effectively raises antibody titers against SARS-CoV-2. This may confer protection against infection during pregnancy and the postpartum period. In addition to being protective against SARS-CoV-2, the vaccine was associated with decreased odds of preterm delivery. Furthermore, COVID-19 vaccination may also be associated with higher odds of cesarean section.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA workflow diagram.
Fig. 2
Fig. 2
Forest Plot of the odds ratio of cesarean section in vaccinated pregnant women vs. unvaccinated pregnant women using Mantel-Haenszel.
Fig. 3
Fig. 3
Forest Plot of the odds ratio of preterm birth in vaccinated pregnant women vs. unvaccinated pregnant women using Mantel-Haenszel.
Fig. 4
Fig. 4. Forest plots are shown of the odds ratio of COVID-19 infection in vaccinated pregnant women vs. non-vaccinated pregnant women.
Using Mantel-Haenszel, both before (A) and after (B) removing Dagan et al. to solve heterogeneity.
See this image and copyright information in PMC

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