Adenovirus-Based Vaccines and Thrombosis in Pregnancy: A Systematic Review and Meta-analysis

Clin Infect Dis. 2022 Sep 30;75(7):1179-1186. doi: 10.1093/cid/ciac080.


Background: Rare cases of thrombosis and thrombocytopenia (thrombosis with thrombocytopenia syndrome [TTS]) have been associated with 2 coronavirus disease 2019 adenovirus vector vaccines: the ChAdOx1 nCoV-19 Vaxzevria vaccine (Oxford/AstraZeneca) and the JNJ-7836735 Johnson & Johnson vaccine (Janssen). It is unknown if TTS is a class-mediated effect of adenovirus-based vaccines or if it could worsen known hypercoagulable states. Since most cases of TTS happen in women of childbearing age, pregnancy is a crucial risk factor to assess. Understanding these risks is important for advising vaccine recipients and future adenovirus vector vaccine development.

Methods: To explore the potential associations of adenovirus-based vaccine components with symptoms of TTS in the general clinical trial population and in pregnant women in clinical trials, we conducted a systematic review and meta-analysis of adenovirus-based vector vaccines to document cases of thrombocytopenia, coagulopathy, and or pregnancy from 1 January 1966 to 9 August 2021.

Results: We found 167 articles from 159 studies of adenovirus vector-based vaccines, 123 of which targeted infectious diseases. In the general population, 20 studies reported an event of thrombocytopenia and 20 studies indicated some coagulopathy. Among pregnant women, of the 28 studies that reported a total of 1731 pregnant women, thrombocytopenia or coagulopathy were not reported.

Conclusions: In this systematic review and meta-analysis, there was no class-wide effect of adenovirus vector vaccines toward thrombocytopenia or coagulopathy events in the general population or in pregnant women.

Keywords: COVID-19; adenovirus; platform-based vaccines; pregnancy; thrombosis.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenoviridae / genetics
  • Adenovirus Vaccines*
  • COVID-19*
  • ChAdOx1 nCoV-19
  • Female
  • Humans
  • Pregnancy
  • Thrombocytopenia*
  • Thrombosis* / etiology
  • Vaccines*


  • Adenovirus Vaccines
  • Vaccines
  • ChAdOx1 nCoV-19