School of Medicine, University of Notre Dame, Fremantle, WA, Australia.
School of Public Health, Curtin University, Perth, WA, Australia.
Paediatr Perinat Epidemiol. 2021 Mar;35(2):196-205. doi: 10.1111/ppe.12715. Epub 2020 Nov 5.
In many countries, influenza vaccination is routinely recommended during any stage of pregnancy, yet uptake remains low, particularly in the first trimester. This is thought to be due to maternal concerns regarding vaccine safety.
To evaluate the safety of influenza vaccination in the first trimester of pregnancy.
In a 4-year retrospective cohort study using probabilistic record linkage of administrative health data, we established a population-based cohort of 2391 women vaccinated in first trimester and 68 447 never vaccinated women with a date of conception between 2012 and 2015 in Western Australia. We estimated the relative risk (RR) of perinatal health outcomes among first trimester vaccinated women as compared to never vaccinated women using log-binomial logistic regression following a propensity score matched (PSM) analyses (2391 vaccinated women matched with 9564 never vaccinated women).
First trimester vaccination was not associated with increased risk of stillbirth (RR 1.18, 95% confidence interval [CI] 0.64, 2.19), small for gestational age (RR 0.96, 95% CI 0.83, 1.11) or preeclampsia (RR 0.97, 95% CI 0.74, 1.28). The risk of spontaneous birth at 32-36 weeks was higher in first trimester vaccinated women compared with never vaccinated women (RR 1.40, 95% CI 1.11, 1.77). Vaccination was associated with a 10-19% increase in the risk of gestational diabetes (RR 1.18, 95% CI 0.94, 1.49), premature rupture of membranes (RR 1.10, 95% CI 0.82, 1.48), and threatened preterm labour (RR 1.19, 95% CI 0.90, 1.59).
With exception to spontaneous preterm birth, findings suggest that first trimester vaccination is not associated with adverse maternal and foetal outcomes. Results can be used to support patient and provider-level vaccine decision making during first trimester.
在许多国家，流感疫苗接种在妊娠的任何阶段都被常规推荐，但接种率仍然很低，尤其是在妊娠早期。这被认为是由于产妇对疫苗安全性的担忧。
评估流感疫苗在妊娠早期接种的安全性。
在一项为期 4 年的使用基于概率的记录链接行政健康数据的回顾性队列研究中，我们在西澳大利亚州建立了一个基于人群的队列，其中 2391 名在妊娠早期接种疫苗的妇女和 68447 名从未接种疫苗的妇女在 2012 年至 2015 年期间有受孕日期。我们使用倾向评分匹配（PSM）分析（2391 名接种疫苗的妇女与 9564 名从未接种疫苗的妇女匹配）后，使用对数二项逻辑回归估计妊娠早期接种疫苗的妇女与从未接种疫苗的妇女相比，围产期健康结局的相对风险（RR）。
妊娠早期接种疫苗与死产风险增加无关（RR 1.18，95%置信区间 [CI] 0.64，2.19）、小于胎龄儿（RR 0.96，95% CI 0.83，1.11）或子痫前期（RR 0.97，95% CI 0.74，1.28）。与从未接种疫苗的妇女相比，妊娠早期接种疫苗的妇女在 32-36 周自然分娩的风险更高（RR 1.40，95% CI 1.11，1.77）。接种疫苗与妊娠期糖尿病风险增加 10-19%相关（RR 1.18，95% CI 0.94，1.49）、胎膜早破（RR 1.10，95% CI 0.82，1.48）和早产威胁（RR 1.19，95% CI 0.90，1.59）。
除自发性早产外，研究结果表明妊娠早期接种疫苗与不良母婴结局无关。研究结果可用于支持妊娠早期的患者和提供者层面的疫苗决策。
