Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study.

Autor:	Fell DB; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada dfell@cheo.on.ca.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Dimanlig-Cruz S; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada., Regan AK; School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA.; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA., Håberg SE; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway., Gravel CA; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada., Oakley L; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK., Alton GD; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada., Török E; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada., Dhinsa T; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada., Shah PS; Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.; Department of Paediatrics, University of Toronto, Toronto, ON, Canada.; Maternal-infant Care Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada., Wilson K; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.; Bruyère Research Institute, Ottawa, ON, Canada., Sprague AE; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada., El-Chaâr D; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada., Walker MC; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada., Barrett J; Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada., Okun N; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada., Buchan SA; Public Health Ontario, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Kwong JC; Public Health Ontario, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada., Wilson SE; Public Health Ontario, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Dunn SI; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.; School of Nursing, University of Ottawa, Ottawa, ON, Canada., MacDonald SE; Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.; School of Public Health, University of Alberta, Edmonton, AB, Canada.; Department of Paediatrics, University of Calgary, Calgary, AB, Canada., Dougan SD; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.; Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON, Canada.
Jazyk:	angličtina
Zdroj:	BMJ (Clinical research ed.) [BMJ] 2022 Aug 17; Vol. 378, pp. e071416. Date of Electronic Publication: 2022 Aug 17.
DOI:	10.1136/bmj-2022-071416
Abstrakt:	Objective: To assess the risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy. Design: Population based retrospective cohort study. Setting: Ontario, Canada, 1 May to 31 December 2021. Participants: All liveborn and stillborn infants from pregnancies conceived at least 42 weeks before the end of the study period and with gestational age ≥20 weeks or birth weight ≥500 g. Main Outcome Measures: Using Cox regression, hazard ratios and 95% confidence intervals were estimated for preterm birth before 37 weeks (overall and spontaneous preterm birth), very preterm birth (<32 weeks), small for gestational age at birth (<10th centile), and stillbirth. Vaccination against covid-19 was treated as a time varying exposure in the outcome specific risk window, and propensity score weighting was used to adjust hazard ratios for potential confounding. Results: Among 85 162 births, 43 099 (50.6%) occurred in individuals who received one dose or more of a covid-19 vaccine during pregnancy-42 979 (99.7%) received an mRNA vaccine. Vaccination during pregnancy was not associated with any increased risk of overall preterm birth (6.5% among vaccinated v 6.9% among unvaccinated; adjusted hazard ratio 1.02, 95% confidence interval 0.96 to 1.08), spontaneous preterm birth (3.7% v 4.4%; 0.96, 0.90 to 1.03), or very preterm birth (0.59% v 0.89%; 0.80, 0.67 to 0.95). No increase was found in risk of small for gestational age at birth (9.1% v 9.2%; 0.98, 0.93 to 1.03) or stillbirth (0.25% v 0.44%; 0.65, 0.51 to 0.84). Findings were similar by trimester of vaccination, mRNA vaccine product, and number of doses received during pregnancy. Conclusion: The findings suggest that vaccination against covid-19 during pregnancy is not associated with a higher risk of preterm birth, small for gestational age at birth, or stillbirth. Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the Public Health Agency of Canada through the Vaccine Surveillance Reference Group and the COVID-19 Immunity Task Force; SEH and LO were partly funded by the Norwegian Research Council. KW is chief executive officer of CANImmunize, which hosts a national digital immunisation record, and is a member of the independent data safety board for the Medicago covid-19 vaccine trial. There are no other relationships or activities that could appear to have influenced the submitted work. (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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