妊娠期间接种百日咳疫苗对加拿大安大略省产科和围产期健康结局的影响：一项回顾性队列研究。
Obstetric and perinatal health outcomes after pertussis vaccination during pregnancy in Ontario, Canada: a retrospective cohort study.
机构信息
Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC.
Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
出版信息
CMAJ Open. 2021 Apr 13;9(2):E349. doi: 10.9778/cmajo.20200239. Print 2021 Apr-Jun.
BACKGROUND
In February 2018, Canada's National Advisory Committee on Immunization recommended maternal vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy to prevent severe pertussis infection in young infants. This study assessed the relation between maternal Tdap vaccination and obstetric and perinatal outcomes in Ontario.
METHODS
We performed a population-based cohort study of all births from April 2012 to March 2017 using multiple linked health administrative databases. We used Cox regression with a time-dependent exposure variable to estimate adjusted hazard ratios (HRs) for preterm birth (< 37 wk), very preterm birth (< 32 wk) and stillbirth. We assessed remaining outcomes (gestational hypertension, chorioamnionitis, postpartum hemorrhage, severe postpartum hemorrhage, being small for gestational age, neonatal intensive care unit stay > 24 h, composite neonatal morbidity) using log-binomial regression to generate adjusted risk ratios (RRs). We adjusted estimates for potential confounding using propensity score weighting.
RESULTS
Of 615 213 infants (live births and stillbirths), 11 519 were exposed to Tdap vaccination in utero. There was no increased risk for preterm birth (adjusted HR 0.98, 95% confidence interval [CI] 0.91-1.06), very preterm birth (adjusted HR 1.10, 95% CI 0.86-1.41), stillbirth (adjusted HR 1.15, 95% CI 0.82-1.60) or being small for gestational age (adjusted RR 0.96, 95% CI 0.90-1.02). The risks of a neonatal intensive care unit stay exceeding 24 hours (adjusted RR 0.82, 95% CI 0.76-0.88) and neonatal morbidity (adjusted RR 0.81, 95% CI 0.75-0.87) were decreased. There was no association with chorioamnionitis (adjusted RR 1.17, 95% CI 0.99-1.39), postpartum hemorrhage (adjusted RR 1.01, 95% CI 0.91-1.13) or severe postpartum hemorrhage (adjusted RR 0.79, 95% CI 0.55-1.13), but we observed a reduced risk of gestational hypertension (adjusted RR 0.87, 95% CI 0.78-0.96).
INTERPRETATION
Our results complement evidence that maternal Tdap vaccination is not associated with adverse outcomes in mothers or infants. Ongoing evaluation in Canada is needed as maternal Tdap vaccination coverage increases in coming years.
背景
2018 年 2 月，加拿大国家免疫咨询委员会建议孕妇接种破伤风、白喉和无细胞百日咳（Tdap）疫苗，以预防婴幼儿严重百日咳感染。本研究评估了安大略省孕妇 Tdap 疫苗接种与产科和围产期结局之间的关系。
方法
我们使用多个链接的健康管理数据库，对 2012 年 4 月至 2017 年 3 月期间的所有分娩进行了基于人群的队列研究。我们使用具有时间依赖性暴露变量的 Cox 回归来估计早产（<37 周）、极早产（<32 周）和死产的调整危险比（HR）。我们使用对数二项式回归评估其余结局（妊娠期高血压、绒毛膜羊膜炎、产后出血、严重产后出血、胎儿生长受限、新生儿重症监护病房住院时间>24 小时、新生儿复合发病率），以生成调整后的风险比（RR）。我们使用倾向评分加权来调整估计值，以控制潜在的混杂因素。
结果
在 615213 名婴儿（活产儿和死产儿）中，有 11519 名婴儿在子宫内接触 Tdap 疫苗。早产（调整 HR 0.98，95%置信区间 [CI] 0.91-1.06）、极早产（调整 HR 1.10，95%CI 0.86-1.41）、死产（调整 HR 1.15，95%CI 0.82-1.60）或胎儿生长受限（调整 RR 0.96，95%CI 0.90-1.02）的风险均无增加。新生儿重症监护病房住院时间超过 24 小时（调整 RR 0.82，95%CI 0.76-0.88）和新生儿发病率（调整 RR 0.81，95%CI 0.75-0.87）的风险降低。与绒毛膜羊膜炎（调整 RR 1.17，95%CI 0.99-1.39）、产后出血（调整 RR 1.01，95%CI 0.91-1.13）或严重产后出血（调整 RR 0.79，95%CI 0.55-1.13）无关，但我们观察到妊娠期高血压（调整 RR 0.87，95%CI 0.78-0.96）的风险降低。
解释
我们的研究结果补充了证据，即母亲 Tdap 疫苗接种与母亲或婴儿的不良结局无关。随着未来几年母亲 Tdap 疫苗接种覆盖率的提高，加拿大需要进行持续评估。
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