Maternal Tdap vaccination and risk of infant morbidity
Maternal Tdap vaccination and risk of infant morbidity
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DOI：
10.1016/j.vaccine.2017.05.041
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发表时间：
2017-06-22
期刊：
影响因子：
5.5
通讯作者：
Kharbanda, Elyse O.
中科院分区：
文献类型：
--
作者：
DeSilva, Malini;Vazquez-Benitez, Gabriela;Kharbanda, Elyse O.
简介：此前在两个疫苗安全数据链（VSD）站点检测到妊娠期间接种Tdap的妇女诊断为绒毛膜炎的风险增加。这一发现与婴儿结局相关的临床意义仍不确定。方法：回顾性队列研究，研究对象为从末次月经前6个月至产后6周连续投保，且在2010年1月1日至11月15日期间妊娠期间门诊就诊次数>1次的女性所生的单胎活产，2013年在美国七个综合医疗系统VSD的一部分。我们重新评估了母亲Tdap和绒毛膜炎之间的关联，并评估了在怀孕期间接受和未接受Tdap的母亲所生婴儿的特定婴儿发病率是否不同。我们关注2个Tdap暴露窗口：推荐的妊娠27-36周或妊娠期间的任何时间。我们确定了新生儿短暂性呼吸急促（TTN）、新生儿败血症、新生儿肺炎、呼吸窘迫综合征（RDS）和新生儿惊厥的住院诊断代码。采用Poisson分布和log-link的广义线性模型估计倾向评分调整率比（ARR）及其95%置信区间（CI）。6.4%在妊娠期间任何时间接受Tdap疫苗接种的女性和5.2%未接受Tdap疫苗接种的女性记录到绒毛膜炎（ARR [95% CI]：1.23 [1.17，1.28]）。与未接种疫苗的妇女相比，TTN的（ARR [95% CI]）（1.04 [0.98，1.111），新生儿败血症（1.06 [0.91，1.23]），新生儿肺炎（0.94 [0.72，1.22]），RDS（0.91 [0.66，1.26]），或新生儿惊厥（1.16 [0.87，1.53]）。结论和相关性：尽管观察到母亲接种Tdap疫苗和母亲绒毛膜炎之间存在相关性，但我们没有发现与母亲绒毛膜炎相关的临床显著婴儿结局风险增加。(C)2017爱思唯尔有限公司版权所有
Introduction: An increased risk of diagnosed chorioamnionitis in women vaccinated with Tdap during pregnancy was previously detected at two Vaccine Safety Datalink (VSD) sites. The clinical significance of this finding related to infant outcomes remains uncertain.Methods: Retrospective cohort study of singleton live births born to women who were continuously insured from 6 months prior to their last menstrual period through 6 weeks postpartum, with >1 outpatient visit during pregnancy from January 1, 2010 to November 15, 2013 at seven integrated United States health care systems part of the VSD. We re-evaluated the association between maternal Tdap and chorioamnionitis and evaluated whether specific infant morbidities differ among infants born to mothers who did and did not receive Tdap during pregnancy. We focused on 2 Tdap exposure windows: the recommended 27-36 weeks gestation or anytime during pregnancy. We identified inpatient diagnostic codes for transient tachypnea of the newborn (TTN), neonatal sepsis, neonatal pneumonia, respiratory distress syndrome (RDS), and newborn convulsions associated with an infant's first hospitalization. A generalized linear model with Poisson distribution and log-link was used to estimate propensity score adjusted rate ratios (ARR) with 95% confidence intervals (CI).Results: The analyses included 197,564 pregnancies. Chorioamnionitis was recorded in 6.4% of women who received Tdap vaccination any time during pregnancy and 5.2% of women who did not (ARR [95% CI]: 1.23 [1.17, 1.28]). Compared with unvaccinated women, there were no significant increased risks (ARR [95% CI]) for TTN (1.04 [0.98, 1.111), neonatal sepsis (1.06 [0.91, 1.23]), neonatal pneumonia (0.94 [0.72, 1.22]), RDS (0.91 [0.66, 1.26]), or newborn convulsions (1.16 [0.87, 1.53]) in infants born to Tdap-vaccinated women.Conclusions and Relevance: Despite an observed association between maternal Tdap vaccination and maternal chorioamnionitis, we did not find increased risk for clinically significant infant outcomes associated with maternal chorioamnionitis. (C) 2017 Elsevier Ltd. All rights reserved.