Neonatal and maternal outcomes following SARS-CoV-2 infection and COVID-19 vaccination: a population-based matched cohort study

Laura Lindsay, Clara Calvert, Ting Shi, Jade Carruthers, Cheryl Denny, Jack Donaghy, Lisa E. M. Hopcroft, Leanne Hopkins, Anna Goulding, Terry McLaughlin, Emily Moore, Bob Taylor, Krishnan Bhaskaran, Srinivasa Vittal Katikireddi, Ronan McCabe, Colin McCowan, Colin R. Simpson, Chris Robertson, Aziz Sheikh, Rachael Wood () and Sarah J. Stock
Additional contact information
Laura Lindsay: Public Health Scotland
Clara Calvert: Usher Institute, University of Edinburgh
Ting Shi: Usher Institute, University of Edinburgh
Jade Carruthers: Public Health Scotland
Cheryl Denny: Public Health Scotland
Jack Donaghy: Public Health Scotland
Lisa E. M. Hopcroft: Public Health Scotland
Leanne Hopkins: Public Health Scotland
Anna Goulding: Public Health Scotland
Terry McLaughlin: Public Health Scotland
Emily Moore: Public Health Scotland
Bob Taylor: Public Health Scotland
Krishnan Bhaskaran: London School of Hygiene and Tropical Medicine
Srinivasa Vittal Katikireddi: Public Health Scotland
Ronan McCabe: University of Glasgow
Colin McCowan: University of St Andrews
Colin R. Simpson: Usher Institute, University of Edinburgh
Chris Robertson: Public Health Scotland
Aziz Sheikh: Usher Institute, University of Edinburgh
Rachael Wood: Public Health Scotland
Sarah J. Stock: Public Health Scotland

Nature Communications, 2023, vol. 14, issue 1, 1-13

Abstract: Abstract Understanding the impact of SARS-CoV-2 infection and COVID-19 vaccination in pregnancy on neonatal and maternal outcomes informs clinical decision-making. Here we report a national, population-based, matched cohort study to investigate associations between SARS-CoV-2 infection and, separately, COVID-19 vaccination just before or during pregnancy and the risk of adverse neonatal and maternal outcomes among women in Scotland with a singleton pregnancy ending at ≥20 weeks gestation. Neonatal outcomes are stillbirth, neonatal death, extended perinatal mortality, preterm birth (overall, spontaneous, and provider-initiated), small-for-gestational age, and low Apgar score. Maternal outcomes are admission to critical care or death, venous thromboembolism, hypertensive disorders of pregnancy, and pregnancy-related bleeding. We use conditional logistic regression to derive odds ratios adjusted for socio-demographic and clinical characteristics (aORs). We find that infection is associated with an increased risk of preterm (aOR=1.36, 95% Confidence Interval [CI] = 1.16–1.59) and very preterm birth (aOR = 1.90, 95% CI 1.20–3.02), maternal admission to critical care or death (aOR=1.72, 95% CI = 1.39–2.12), and venous thromboembolism (aOR = 2.53, 95% CI = 1.47–4.35). We find no evidence of increased risk for any of our outcomes following vaccination. These data suggest SARS-CoV-2 infection during pregnancy is associated with adverse neonatal and maternal outcomes, and COVID-19 vaccination remains a safe way for pregnant women to protect themselves and their babies against infection.

Date: 2023
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DOI: 10.1038/s41467-023-40965-9

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