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. 2023 Aug 29;14(1):5275.
doi: 10.1038/s41467-023-40965-9.

Neonatal and maternal outcomes following SARS-CoV-2 infection and COVID-19 vaccination: a population-based matched cohort study

Laura Lindsay  1 , Clara Calvert  2   3 , Ting Shi  2 , Jade Carruthers  1 , Cheryl Denny  1 , Jack Donaghy  1 , Lisa E M Hopcroft  1   4 , Leanne Hopkins  1 , Anna Goulding  1   5 , Terry McLaughlin  1 , Emily Moore  1 , Bob Taylor  1 , Krishnan Bhaskaran  3 , Srinivasa Vittal Katikireddi  1   6 , Ronan McCabe  6 , Colin McCowan  7 , Colin R Simpson  2   8 , Chris Robertson  1   9 , Aziz Sheikh  2 , Rachael Wood  10   11 , Sarah J Stock  1   2
Affiliations

Neonatal and maternal outcomes following SARS-CoV-2 infection and COVID-19 vaccination: a population-based matched cohort study

Laura Lindsay et al. Nat Commun. .

Abstract

Understanding the impact of SARS-CoV-2 infection and COVID-19 vaccination in pregnancy on neonatal and maternal outcomes informs clinical decision-making. Here we report 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 neonatal and maternal outcomes among women in Scotland with a singleton pregnancy ending at ≥20 weeks gestation. Neonatal outcomes are stillbirth, neonatal death, extended perinatal mortality, preterm birth (overall, spontaneous, and provider-initiated), small-for-gestational age, and low Apgar score. Maternal outcomes are admission to critical care or death, venous thromboembolism, hypertensive disorders of pregnancy, and pregnancy-related bleeding. We use conditional logistic regression to derive odds ratios adjusted for socio-demographic and clinical characteristics (aORs). We find that infection is associated with an increased risk of preterm (aOR=1.36, 95% Confidence Interval [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). We find no evidence of increased risk for any of our outcomes following vaccination. These data suggest SARS-CoV-2 infection during pregnancy is associated with adverse neonatal and maternal outcomes, and COVID-19 vaccination remains a safe way for pregnant women to protect themselves and their babies against infection.

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Conflict of interest statement

A.S. and C.R. were members of the Scottish Government’s COVID-19 Advisory Group. A.S. is a member of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) risk stratification subgroup and the Scottish Government’s Committee on Pandemic Preparedness. C.R. is a member of the Scientific Pandemic Influenza Group on Modelling and the MHRA Covid 19 Vaccine Benefit and Risk Working Group. AS is a member of AstraZeneca’s Thrombotic Thrombocytopenic Advisory Group. All roles are unremunerated. S.V.K. was co-chair of Scottish Government’s Expert Reference Group on Ethnicity and COVID-19. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Adjusted odds ratios for the association between SARS-CoV-2 infection and neonatal and maternal outcomes, stratified by timing of first SARS-CoV-2 infection in the pregnancy exposure period.
The sample size for the analysis for each outcome is provided in Supplementary Table 5 and Supplementary Table 6. Odds ratios (represented by the points on the plot) were calculated using conditional logistic regression. The errors bars for each data point are 95% confidence intervals.
See this image and copyright information in PMC

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