Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy

Smriti Prasad; Erkan Kalafat; Helena Blakeway; Rosemary Townsend; Pat O’Brien; Edward Morris; Tim Draycott; Shakila Thangaratinam; Kirsty Le Doare; Shamez Ladhani; Peter von Dadelszen; Laura A. Magee; Paul Heath; Asma Khalil

doi:10.1038/s41467-022-30052-w

Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy

Smriti Prasad, Erkan Kalafat, Helena Blakeway, Rosemary Townsend, Pat O’Brien, Edward Morris, Tim Draycott, Shakila Thangaratinam, Kirsty Le Doare, Shamez Ladhani, Peter von Dadelszen, Laura A. Magee, Paul Heath, Asma Khalil^*

^*Corresponding author for this work

Immunisation Hepatitis and Blood Safety

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Abstract

Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 vaccinated pregnant people, I² = 73·9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0·85; 95% CI 0·73–0·99, 66,067 vaccinated vs. 424,624 unvaccinated, I² = 93·9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission (p > 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth.

Original language	English
Article number	2414
Journal	Nature Communications
Volume	13
Issue number	1
Early online date	10 May 2022
DOIs	https://doi.org/10.1038/s41467-022-30052-w
Publication status	Published - Dec 2022

Bibliographical note

Funding information: P.O.B. is co-chair of the Royal College of Obstetricians and Gynaecologists (RCOG) Vaccine Committee. P.O.B. and T.D. are RCOG Vice-Presidents. E.M. is RCOG President. P.H. is a member of the RCOG Vaccine Committee. P.H. is CI of the Preg-Cov trial (UK multicentre COVID vaccination in pregnancy). A.K. is obstetric PI of the Preg-Cov trial (UK multicentre COVID vaccination in pregnancy). A.K. is a member of the COVAX Working Group on COVID vaccination in pregnancy. A.K. is PI of the Pfizer COVID vaccination in pregnancy trial. The remaining authors declare no competing interests.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Publisher Copyright: © The Author(s) 2022

Citation: Prasad, S., Kalafat, E., Blakeway, H. et al. Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy. Nat Commun 13, 2414 (2022).

DOI: https://doi.org/10.1038/s41467-022-30052-w

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Prasad, S., Kalafat, E., Blakeway, H., Townsend, R., O’Brien, P., Morris, E., Draycott, T., Thangaratinam, S., Le Doare, K., Ladhani, S., von Dadelszen, P., Magee, L. A., Heath, P., & Khalil, A. (2022). Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy. Nature Communications, 13(1), Article 2414. https://doi.org/10.1038/s41467-022-30052-w

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abstract = "Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 vaccinated pregnant people, I2 = 73·9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0·85; 95% CI 0·73–0·99, 66,067 vaccinated vs. 424,624 unvaccinated, I2 = 93·9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission (p > 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth.",

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Prasad, S, Kalafat, E, Blakeway, H, Townsend, R, O’Brien, P, Morris, E, Draycott, T, Thangaratinam, S, Le Doare, K , Ladhani, S, von Dadelszen, P, Magee, LA, Heath, P & Khalil, A 2022, 'Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy', Nature Communications, vol. 13, no. 1, 2414. https://doi.org/10.1038/s41467-022-30052-w

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Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy

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