The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
Front Immunol. 2021 Sep 7;12:704254. doi: 10.3389/fimmu.2021.704254. eCollection 2021.
Stillbirth and preterm birth (PTB) remain two of the most important, unresolved challenges in modern pregnancy care. Approximately 10% of all births are preterm with nearly one million children dying each year due to PTB. It remains the most common cause of death among children under five years of age. The numbers for stillbirth are no less shocking with 2.6 million babies stillborn each year. With minimal impact on the rate of these adverse birth outcomes over the past decade there is an urgent need to identify more effective interventions to tackle these problems. In this retrospective cohort study, we used whole-of-population data, to determine if maternal immunization during pregnancy against influenza and/or pertussis, is associated with a lower risk of PTB, delivering a small-for-gestational age (SGA) infant, developing preeclampsia or stillbirth. Women with a singleton pregnancy at 28 or more weeks' gestation delivering in Victoria, Australia from July 2015 to December 2018 were included in the analysis. Log-binomial regression was used to measure the relationship between vaccination during pregnancy against influenza and against pertussis, with preterm birth, SGA, preeclampsia and stillbirth. Variables included in the adjusted model were maternal age, body mass index, first or subsequent birth, maternal Indigenous status, socio-economic quintile, smoking, public or private maternity care and metropolitan or rural location of the hospital. Women who received influenza vaccine were 75% less likely to have a stillbirth (aRR 025; 95% CI 0.20, 0.31), and 31% less likely to birth <37 weeks (aRR 0.69; 95% CI 0.66, 0.72). Women who received pertussis vaccine were 77% less likely to have a stillbirth (aOR 0.23; 95% CI 0.18, 0.28) and 32% less likely to birth <37 weeks gestation (aRR 0.68; 95% CI 0.66, 0.71). Vaccination also reduced the odds of small for gestational age by 13% and reduced the odds of pre-eclampsia when restricted to primiparous women. This association was seen over four different influenza seasons and independent of the time of year suggesting that any protective effect on obstetric outcomes afforded by maternal vaccination may not be due to a pathogen-specific response but rather due to pathogen-agnostic immune-modulatory effects.
死产和早产 (PTB) 仍然是现代妊娠护理中两个最重要、尚未解决的挑战。每年约有 10%的分娩为早产，近 100 万名儿童因 PTB 而死亡。它仍然是五岁以下儿童死亡的最常见原因。死产的数字同样令人震惊，每年仍有 260 万婴儿死产。在过去十年中，这些不良分娩结局的发生率几乎没有变化，因此迫切需要确定更有效的干预措施来解决这些问题。在这项回顾性队列研究中，我们使用全人群数据来确定孕妇在怀孕期间接种流感和/或百日咳疫苗是否与较低的 PTB 风险、分娩出小于胎龄儿 (SGA) 婴儿、发生子痫前期或死产相关。纳入分析的是 2015 年 7 月至 2018 年 12 月在澳大利亚维多利亚州 28 周或以上单胎妊娠的女性。使用对数二项式回归来衡量怀孕期间接种流感疫苗和百日咳疫苗与早产、SGA、子痫前期和死产之间的关系。纳入调整模型的变量包括母亲年龄、体重指数、初产妇或经产妇、母亲土著身份、社会经济五分位数、吸烟、公共或私人产科护理以及医院所在的大都市区或农村地区。接种流感疫苗的女性死产的可能性降低了 75%（ARR 0.25；95%CI 0.20，0.31），<37 周分娩的可能性降低了 31%（ARR 0.69；95%CI 0.66，0.72）。接种百日咳疫苗的女性死产的可能性降低了 77%（aOR 0.23；95%CI 0.18，0.28），<37 周分娩的可能性降低了 32%（aRR 0.68；95%CI 0.66，0.71）。接种疫苗还将 SGA 的几率降低了 13%，并将子痫前期的几率降低了，仅限于初产妇。这种关联在四个不同的流感季节都存在，且与一年中的时间无关，这表明母体疫苗接种对产科结局的任何保护作用可能不是由于针对病原体的特异性反应，而是由于针对病原体的免疫调节作用。
