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

BMJ. 2022 Aug 17:378:e071416. doi: 10.1136/bmj-2022-071416.

Abstract

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.

MeSH terms

  • COVID-19 Vaccines* / adverse effects
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Cohort Studies
  • Female
  • Fetal Growth Retardation
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Ontario / epidemiology
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Premature Birth* / epidemiology
  • Premature Birth* / etiology
  • Retrospective Studies
  • Stillbirth* / epidemiology
  • Vaccination
  • Vaccines, Synthetic
  • mRNA Vaccines

Substances

  • COVID-19 Vaccines
  • Vaccines, Synthetic
  • mRNA Vaccines