The COVID-19 Pandemic Period, SARS-CoV-2 Infection, and Perinatal Health (2024)
We examined the following outcomes: preterm birth (PTB), hypertensive disorders of pregnancy (HDP), gestational diabetes (GD), and severe maternal morbidity (SMM).
Our findings suggest that SARS-CoV-2 infection was associated with increased PTB, HDP, and SMM, consistent with other studies.2,4 Interestingly, the pandemic period was associated with decreased risk of PTB, but increased risk of HDP and GD; this has been reported elsewhere, but not using designs that could disentangle infection from the pandemic period.5,6 The pandemic period association with decreased risk of PTB was largest for spontaneous PTB, suggesting that it may be explained by socioenvironmental and behavioral modifications, such as commute changes and reduced non-SARS-CoV-2 infections. Increased risk of HDP and GD may be due to stress and reduced and/or remote prenatal care due to the pandemic.
The result that COVID-19 vaccination is associated with decreased infection rates is comparable to results previously reported in non-pregnant adults.31
We report better birth outcomes in people who were vaccinated before delivery compared with unvaccinated people…even after controlling for multiple demographic, lifestyle, clinical, geographical, and chronological characteristics.
Unlike previous studies, we observed a significantly lower rate of preterm birth and stillbirth in vaccinated individuals.7, 24 Previous studies provided descriptive statistics (prevalence or odds ratio with 95% CI), whereas we conducted additional quantitative analyses to evaluate these outcomes. Our study also had a larger sample size and a longer observation period, which included patients delivering during and after the omicron BA.1, BA.2, BA.2.12.1, and BA.5 waves. Maternal SARS-CoV-2 infection is known to increase the risk for preterm birth, stillbirth, small-for-gestational-age, and decreased birthweight.1, 2, 3, 4, 5, 6, 7 COVID-19 vaccination reduces the risk of maternal SARS-CoV-2 infection, and this decreased infection rate in vaccinated individuals could explain the decreased rates in these negative birth outcomes.13, 14, 15
Neonatal Outcomes After COVID-19 Vaccination in Pregnancy (2024)
Of 196,470 newborn infants included (51.3% male, 93.8% born at term, 62.5% born in Sweden), 94,303 (48.0%) were exposed to COVID-19 vaccination during pregnancy. Exposed infants exhibited no increased odds of adverse neonatal outcomes, and they exhibited lower odds for neonatal nontraumatic intracranial hemorrhage (event rate, 1.7 vs 3.2/1000; adjusted odds ratio [aOR], 0.78 [95% CI, 0.61-0.99]), hypoxic-ischemic encephalopathy (1.8 vs 2.7/1000; aOR, 0.73 [95% CI, 0.55-0.96]), and neonatal mortality (0.9 vs 1.8/1000; aOR, 0.68 [95% CI, 0.50-0.91]). Subgroup analyses found a similar association between vaccination during pregnancy and lower neonatal mortality.
This large population-based safety study found no evidence of increases in adverse neonatal events in infants born to individuals vaccinated against COVID-19 during pregnancy. In contrast, exposure to COVID-19 vaccination during pregnancy was associated with reduced rates of nontraumatic intracranial hemorrhage, hypoxic-ischemic encephalopathy, and neonatal mortality. The observed reduction in risk may reflect residual confounding rather than an actual protective effect of vaccination. However, these findings may provide reassurance to public health authorities, clinicians, pregnant individuals, and their families that infants are not at higher risk of adverse events due to COVID-19 vaccination during pregnancy.
We followed 127 children for one year, 69 in the COVID-19-exposed Group (EG), and 68 in the control group (CG). All mothers were unvaccinated at the time of cohort inclusion and maternal demographics were similar in the two groups. 20.3% of EG children and 5.9% of the CG received a diagnosis of neurodevelopmental delay within 12 months of life (p=0.013, RR= 3.44; 95% CI, 1.19- 9.95). For the exposed group, the prevalence of neurodevelopment impairment using ASQ-3 was 35.7% at 4 months, 7% at 6 months, and 32.1% at 12 months.
ur findings indicated that intrauterine exposure to SARS-CoV-2 infection can have consequences for offspring in the first year of life, including developmental delay. Given the importance of appropriate early child development for improved future health and educational outcomes, it is extremely important to understand the maternal infection impact on infant exposed developmental trajectories to identify the need to recommend appropriate early interventions.
Fetal brain vulnerability to SARS-CoV-2 infection (2023)
In the current study, our results demonstrate that a COVID-19 infection during pregnancy causes more severe disease in the mother, with increased viral dissemination compared to a non-pregnant state. Furthermore, SARS-CoV-2 transmission from mother to fetus does occur during later stages of gestation, possibly through the circulatory system. In the fetal brain, we found that SARS-CoV-2 infects blood vessels, neurons, glial cells, and cells of the choroid plexus, and leads to an increase in gliosis even after viral clearance. Early developmental differences were also observed between groups.
