COVID-19 vaccination during pregnancy: coverage and safety.
COVID-19 vaccination during pregnancy: coverage and safety.
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怀孕期间接种 COVID-19 疫苗：覆盖范围和安全性。
DOI：
10.1016/j.ajog.2021.08.007
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发表时间：
2022-03
影响因子：
9.8
通讯作者：
Khalil A
中科院分区：
文献类型：
--
作者：
Blakeway H;Prasad S;Kalafat E;Heath PT;Ladhani SN;Le Doare K;Magee LA;O'Brien P;Rezvani A;von Dadelszen P;Khalil A
人们对COVID-19在怀孕期间可能激增表示担忧，这是由于社区COVID-19人数增加、社会限制放宽以及疫苗犹豫所致。尽管英国现已向所有孕妇提供COVID-19疫苗接种；关于其摄取和安全性的数据有限。本研究旨在调查孕妇COVID-19疫苗接种的接受情况和安全性。这是一项对2020年3月1日至2021年7月4日期间在英国伦敦圣乔治大学医院国家卫生服务基金会信托基金分娩的孕妇进行的队列研究。主要结局指标为COVID-19疫苗接种情况及其决定因素。次要结局为围产期安全结局。收集了有关COVID-19疫苗接种率、疫苗接种类型、疫苗接种时的胎龄和孕产妇特征（包括年龄、胎次、种族、多重剥夺指数评分和合并症）的数据。进一步收集围产期结局的数据，包括死产（妊娠≥24周胎儿死亡）、早产、胎儿和先天性异常以及产时并发症。将接种疫苗的妇女的妊娠和新生儿结局与具有平衡倾向评分的匹配队列妇女的妊娠和新生儿结局进行比较。接种疫苗对围产期结局的影响程度以95%置信区间的平均差异或优势比报告。采用logistic回归分析评估产前疫苗接种相关因素。获得了1328名孕妇的数据，其中140名孕妇在分娩前至少接种了一剂COVID-19疫苗，1188名孕妇没有接种疫苗；85.7%的接种者在妊娠晚期接种疫苗，14.3%在妊娠中期接种疫苗。在接种疫苗的人中，127人（90.7%）接种了信使RNA疫苗，13人（9.3%）接种了病毒载体疫苗。有证据表明，与白人妇女相比，较年轻妇女（P= 0.001）、免疫剥夺程度较高的妇女（即，多重免疫剥夺指数的五分之一；P= 0.008）以及非洲-加勒比或亚洲妇女的疫苗接种率降低（P< 0.001）。妊娠前糖尿病妇女的疫苗接种率增加（P= 0.008）。在多变量模型中，第五剥夺五分位数（最剥夺五分位数）（校正优势比0.10,95%可信区间0.02-0.10，P= 0.003）和非洲-加勒比族裔（校正优势比0.27,95%可信区间0.06-0.85，P= 0.044）与产前疫苗吸收率较低显著相关，而孕前糖尿病与产前疫苗吸收率较高显著相关（校正优势比10.5,95%可信区间1.74-83.2，P= 0.014）。在倾向评分匹配的队列中，133名在怀孕期间接种至少1剂COVID-19疫苗的妇女的不良妊娠结局率与未接种疫苗的孕妇相似（所有人的P < 0.05）：死产（0.0% vs 0.2%）、胎儿异常（2.2% vs 2.5%）、产后出血（9.8% vs 9.0%）、剖宫产（30.8% vs 34.1%）、胎龄小（12.0% vs 12.8%）、产妇入住高依赖病房或重症监护病房（6.0% vs 4.0%）或新生儿入住重症监护病房（5.3% vs 5.0%）。产时发热（3.7% vs 1.0%， P= 0.046）显著升高，但排除产前感染COVID-19的妇女后，无临界统计学意义（P= 0.079）。混合效应Cox回归显示，接种疫苗与妊娠<40周的出生无显著相关（风险比为0.93；95%可信区间为0.71-1.23；P= 0.624）。在符合COVID-19疫苗接种条件的孕妇中，不到三分之一的人在怀孕期间接受了COVID-19疫苗接种，她们的妊娠结局与未接种疫苗的孕妇相似。在年轻女性、非白种人和社会经济背景较低的人群中，吸收率较低。这项研究提供了大量证据，证明怀孕期间接种COVID-19疫苗不会改变围产期结局。需要进行明确的沟通，以提高孕妇和卫生保健专业人员对疫苗安全的认识，同时还需要制定解决疫苗犹豫问题的战略。这些战略包括疫苗接种后监测，以收集有关妊娠结局的进一步数据，特别是在妊娠早期接种疫苗后，以及婴儿长期随访。
Concerns have been raised regarding a potential surge of COVID-19 in pregnancy, secondary to the rising numbers of COVID-19 in the community, easing of societal restrictions, and vaccine hesitancy. Although COVID-19 vaccination is now offered to all pregnant women in the United Kingdom; limited data exist on its uptake and safety. This study aimed to investigate the uptake and safety of COVID-19 vaccination among pregnant women. This was a cohort study of pregnant women who gave birth at St George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom, between March 1, 2020, and July 4, 2021. The primary outcome was uptake of COVID-19 vaccination and its determinants. The secondary outcomes were perinatal safety outcomes. Data were collected on COVID-19 vaccination uptake, vaccination type, gestational age at vaccination, and maternal characteristics, including age, parity, ethnicity, index of multiple deprivation score, and comorbidities. Further data were collected on perinatal outcomes, including stillbirth (fetal death at ≥24 weeks’ gestation), preterm birth, fetal and congenital abnormalities, and intrapartum complications. Pregnancy and neonatal outcomes of women who received the vaccine were compared with that of a matched cohort of women with balanced propensity scores. Effect magnitudes of vaccination on perinatal outcomes were reported as mean differences or odds ratios with 95% confidence intervals. Factors associated with antenatal vaccination were assessed with logistic regression analysis. Data were available for 1328 pregnant women of whom 140 received at least 1 dose of the COVID-19 vaccine before giving birth and 1188 women who did not; 85.7% of those vaccinated received their vaccine in the third trimester of pregnancy and 14.3% in the second trimester of pregnancy. Of those vaccinated, 127 (90.7%) received a messenger RNA vaccine and 13 (9.3%) a viral vector vaccine. There was evidence of reduced vaccine uptake in younger women (P=.001), women with high levels of deprivation (ie, fifth quintile of the index of multiple deprivation; P=.008), and women of Afro-Caribbean or Asian ethnicity compared with women of White ethnicity (P<.001). Women with prepregnancy diabetes mellitus had increased vaccine uptake (P=.008). In the multivariable model the fifth deprivation quintile (most deprived) (adjusted odds ratio, 0.10; 95% confidence interval, 0.02–0.10; P=.003) and Afro-Caribbean ethnicity (adjusted odds ratio, 0.27; 95% confidence interval, 0.06–0.85; P=.044) were significantly associated with lower antenatal vaccine uptake, whereas prepregnancy diabetes mellitus was significantly associated with higher antenatal vaccine uptake (adjusted odds ratio, 10.5; 95% confidence interval, 1.74–83.2; P=.014). In a propensity score–matched cohort, the rates of adverse pregnancy outcomes of 133 women who received at least 1 dose of the COVID-19 vaccine in pregnancy were similar to that of unvaccinated pregnant women (P>.05 for all): stillbirth (0.0% vs 0.2%), fetal abnormalities (2.2% vs 2.5%), postpartum hemorrhage (9.8% vs 9.0%), cesarean delivery (30.8% vs 34.1%), small for gestational age (12.0% vs 12.8%), maternal high-dependency unit or intensive care admission (6.0% vs 4.0%), or neonatal intensive care unit admission (5.3% vs 5.0%). Intrapartum pyrexia (3.7% vs 1.0%; P=.046) was significantly increased but the borderline statistical significance was lost after excluding women with antenatal COVID-19 infection (P=.079). Mixed-effects Cox regression showed that vaccination was not significantly associated with birth at <40 weeks’ gestation (hazard ratio, 0.93; 95% confidence interval, 0.71–1.23; P=.624). Of pregnant women eligible for COVID-19 vaccination, less than one-third accepted COVID-19 vaccination during pregnancy, and they experienced similar pregnancy outcomes with unvaccinated pregnant women. There was lower uptake among younger women, non-White ethnicity, and lower socioeconomic background. This study has contributed to the body of evidence that having COVID-19 vaccination in pregnancy does not alter perinatal outcomes. Clear communication to improve awareness among pregnant women and healthcare professionals on vaccine safety is needed, alongside strategies to address vaccine hesitancy. These strategies include postvaccination surveillance to gather further data on pregnancy outcomes, particularly after first-trimester vaccination, and long-term infant follow-up.
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影响因子：
13.6
作者：
Skjefte M;Ngirbabul M;Akeju O;Escudero D;Hernandez-Diaz S;Wyszynski DF;Wu JW
通讯作者：
Wu JW
影响因子：
15.1
作者：
Townsend R;Chmielewska B;Barratt I;Kalafat E;van der Meulen J;Gurol-Urganci I;O'Brien P;Morris E;Draycott T;Thangaratinam S;Doare KL;Ladhani S;Dadelszen PV;Magee LA;Khalil A
通讯作者：
Khalil A
影响因子：
6.1
作者：
Freiesleben, N. la Cour;Egerup, P.;Nielsen, H. S.
通讯作者：
Nielsen, H. S.
DOI：
10.1016/s2214-109x(21)00079-6
发表时间：
2021-06
期刊：
The Lancet. Global health
影响因子：
--
作者：
Chmielewska B;Barratt I;Townsend R;Kalafat E;van der Meulen J;Gurol-Urganci I;O'Brien P;Morris E;Draycott T;Thangaratinam S;Le Doare K;Ladhani S;von Dadelszen P;Magee L;Khalil A
通讯作者：
Khalil A
影响因子：
7.1
作者：
Poon, L. C. Y.;Tan, M. Y.;Nicolaides, K. H.
通讯作者：
Nicolaides, K. H.