The relationship between COVID-19 vaccination status in pregnancy and birthweight.
The relationship between COVID-19 vaccination status in pregnancy and birthweight.
复制标题
DOI：
10.1016/j.ajogmf.2023.101057
复制
发表时间：
2023-09
影响因子：
6.3
通讯作者：
中科院分区：
文献类型：
--
作者：
尽管研究发现孕妇在孕期感染新冠肺炎与低出生体重(体重2500克)有关，但先前的研究表明，接种新冠肺炎疫苗的孕妇和未接种新冠肺炎的孕妇在低出生体重风险方面没有差异。然而，很少有研究研究LBW上未接种、不完全和完全接种疫苗的相关性，而且它们受到样本量小和缺乏对协变量调整的限制。我们试图解决先前工作的主要局限性，并评估怀孕期间未接种、不完全和完全接种新冠肺炎疫苗状态与低体重之间的这种关联。我们预测了LBW疫苗接种的保护性关联，这种关联因接种剂量的不同而不同。我们使用Vizient®临床数据库进行了一项基于人群的回溯性研究，其中包括美国192家医院的数据。我们的样本包括在2021年1月至2022年4月期间在医院分娩的孕妇，这些医院报告了母亲接种疫苗的数据和分娩时的出生体重。孕妇被分为三组：未接种疫苗；不完全接种疫苗(一剂辉瑞或莫迪纳)；或完全接种(一剂强生或≥，两剂莫德纳或辉瑞)。使用标准的统计检验来分析人口统计学和结果。我们进行了多变量Logistic回归，以说明初始队列中疫苗接种状况和LBW之间的潜在混杂因素。使用倾向得分匹配来减少与接种可能性相关的偏差，然后将多变量Logistic回归模型应用于倾向得分匹配的队列。对胎龄和人种/民族进行分层分析。在377,995名参与者中，31,155人(8.2%)患有低出生体重，这些参与者比没有低出生体重的人更有可能没有接种疫苗(98.8%比98.5%，p<；0.001)。未完全接种疫苗的孕妇与未接种疫苗的人相比，出生低出生体重的可能性低13%(优势比0.87，95%可信区间0.73-1.04)，完全接种的孕妇出生低出生体重的可能性低21%(优势比0.79，95%可信区间0.79-0.89)。在原始队列中控制了母亲年龄、种族/民族、高血压、糖尿病、狼疮、烟草使用、多胎妊娠、肥胖、辅助生殖技术的使用以及母亲/新生儿新冠肺炎感染后，只有完全接种(调整后的优势比0.80，95%可信区间0.70-0.91)和不完全接种(调整后的优势比0.87，95%可信区间0.71-1.04)仍然显著。在倾向得分匹配的队列中，完全接种新冠肺炎疫苗的孕妇与未接种疫苗和未完全接种疫苗的孕妇相比，低出生体重的可能性降低22%(AOR 0.78，95%CI 0.76~0.79)。完全接种新冠肺炎疫苗的孕妇与未接种疫苗和未完全接种疫苗的人相比，生下低出生体重的可能性较小。在调整了低体重和影响接种新冠肺炎疫苗可能性的因素的混杂因素后，在大量人群中观察到了这种新的关联。
Despite findings that maternal COVID-19 infection in pregnancy is associated with low birth weight (LBW; weight < 2,500 grams), previous studies demonstrate no difference in LBW risk between COVID-19 vaccinated and unvaccinated pregnant persons. Few studies, however, have examined the association of unvaccinated, incomplete, and complete vaccination on LBW, and they have been limited by small sample sizes and lack of adjustment for covariates. We sought to address key limitations of prior work and evaluate this association between unvaccinated, incomplete, and complete COVID-19 vaccination status in pregnancy and LBW. We predicted a protective association of vaccination on LBW that varies by number of doses received. We performed a population-based retrospective study using the Vizient® clinical database, which included data from 192 hospitals in the United States. Our sample included pregnant persons who delivered between January 2021 and April 2022 at hospitals that reported maternal vaccination data and birth weight at delivery. Pregnant persons were categorized into three groups: unvaccinated; incompletely vaccinated (one dose of Pfizer or Moderna); or completely vaccinated (one dose of Johnson & Johnson or ≥ two doses of Moderna or Pfizer). Demographics and outcomes were analyzed using standard statistical tests. We performed multivariable logistic regression to account for potential confounders between vaccination status and LBW in the original cohort. Propensity score matching was used to reduce bias related to likelihood of vaccination, and the multivariable logistic regression model was then applied to the propensity score matched cohort. Stratification analysis was performed for gestational age and race/ethnicity. Of the 377,995 participants, 31,155 (8.2%) had LBW, and these participants were more likely to be unvaccinated than those without LBW (98.8% versus 98.5%, p < 0.001). Incompletely vaccinated pregnant persons were 13% less likely to have LBW neonates compared to unvaccinated persons (odds ratio 0.87, 95% confidence interval 0.73-1.04), and completely vaccinated persons were 21% less likely to have LBW neonates (odds ratio 0.79, 95% confidence interval 0.79-0.89). After controlling for maternal age, race/ethnicity, hypertension, diabetes, lupus, tobacco use, multifetal gestation, obesity, use of assisted reproductive technology, and maternal/neonatal COVID-19 infections in the original cohort, these associations remained significant for only complete vaccination (adjusted odds ratio 0.80, 95% confidence interval 0.70-0.91) and not incomplete vaccination (adjusted odds ratio 0.87, 95% confidence interval 0.71-1.04). In the propensity score matched cohort, pregnant persons who were completely vaccinated against COVID-19 were 22% less likely to have LBW neonates compared to unvaccinated and incompletely vaccinated individuals (aOR 0.78, 95% CI 0.76-0.79). Pregnant persons who were completely vaccinated against COVID-19 were less likely to have LBW neonates compared to unvaccinated and incompletely vaccinated individuals. This novel association was observed among a large population after adjusting for confounders of LBW and factors influencing the likelihood of receiving the COVID-19 vaccine.
登录
查看更多内容
影响因子：
3.7
作者：
Nguyen NT;Chinn J;De Ferrante M;Kirby KA;Hohmann SF;Amin A
通讯作者：
Amin A
影响因子：
3.9
作者：
Bianchi ME;Restrepo JM
通讯作者：
Restrepo JM
影响因子：
4.9
作者：
Hameed, Ishaque;Khan, Mohammad Omer;Nusrat, Khushboo;Mahmood, Samar;Nashit, Muhammad;Malik, Shanza;Siddiqui, Omer Mustafa;Samad, Syed Abdus;Marsia, Shayan;Shariq, Muhammad;Siddiqi, Tariq Jamal
通讯作者：
Siddiqi, Tariq Jamal
DOI：
10.1016/j.jstrokecerebrovasdis.2020.105535
发表时间：
2021-03
期刊：
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
影响因子：
--
作者：
de Havenon A;Ney JP;Callaghan B;Delic A;Hohmann S;Shippey E;Esper GJ;Stulberg E;Tirschwell D;Frontera J;Yaghi S;Anadani M;Majersik JJ
通讯作者：
Majersik JJ
影响因子：
7.2
作者：
Rasmussen, Sonja A.;Kelley, Colleen F.;Jamieson, Denise J.
通讯作者：
Jamieson, Denise J.