妊娠期或妊娠前接种季节性流感疫苗与流产风险的关系。
Risk of Miscarriage in Relation to Seasonal Influenza Vaccination Before or During Pregnancy.
机构信息
School of Nursing and Health Professions, University of San Francisco, Orange, and Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Boston University School of Public Health, Boston, Massachusetts; and Brown University School of Public Health, Providence, Rhode Island.
出版信息
Obstet Gynecol. 2023 Sep 1;142(3):625-635. doi: 10.1097/AOG.0000000000005279.
OBJECTIVE
To evaluate the association between seasonal influenza vaccination and miscarriage using data from an ongoing, prospective cohort study.
METHODS
We analyzed 2013-2022 data from PRESTO (Pregnancy Study Online), a prospective prepregnancy cohort study of female pregnancy planners and their male partners in the United States and Canada. Female participants completed a baseline questionnaire and then follow-up questionnaires every 8 weeks until pregnancy, during early and late pregnancy, and during the postpartum period. Vaccine information was self-reported on all questionnaires. Miscarriage was identified from self-reported information during follow-up. Male partners were invited to complete a baseline questionnaire only. We used Cox proportional hazard models to estimate the hazard ratio (HR) and 95% CI for the association between vaccination less than 3 months before pregnancy detection through the 19th week of pregnancy and miscarriage, with gestational weeks as the time scale. We modeled vaccination as a time-varying exposure and used propensity-score fine stratification to control for confounding from seasonal and female partner factors.
RESULTS
Of 6,946 pregnancies, 23.3% of female partners reported exposure to influenza vaccine before or during pregnancy: 3.2% during pregnancy (gestational age 4-19 weeks) and 20.1% during the 3 months before pregnancy detection. The miscarriage rate was 16.2% in unvaccinated and 17.0% among vaccinated participants. Compared with no vaccine exposure, influenza vaccination was not associated with increased rate of miscarriage when administered before (HR 0.99, 95% CI 0.81-1.20) or during (HR 0.83, 95% CI 0.47-1.47) pregnancy. Of the 1,135 couples with male partner vaccination data available, 10.8% reported vaccination less than 3 months before pregnancy. The HR for the association between male partner vaccination and miscarriage was 1.17 (95% CI 0.73-1.90).
CONCLUSION
Influenza vaccination before or during pregnancy was not associated with miscarriage.
目的
利用正在进行的前瞻性队列研究的数据评估季节性流感疫苗接种与流产之间的关联。
方法
我们分析了 2013 年至 2022 年来自 PRESTO（妊娠在线研究）的数据，这是一项针对美国和加拿大女性妊娠计划者及其男性伴侣的前瞻性孕前队列研究。女性参与者完成基线问卷，然后在怀孕、孕早期和孕晚期以及产后期间每 8 周进行一次随访问卷。所有问卷上都报告了疫苗信息。在随访期间，通过自我报告来确定流产。仅邀请男性伴侣完成基线问卷。我们使用 Cox 比例风险模型来估计从怀孕检测前不到 3 个月到怀孕第 19 周期间以及在整个怀孕期间接种疫苗与流产之间的关联的风险比（HR）和 95%置信区间，以孕周为时间尺度。我们将疫苗建模为随时间变化的暴露，并使用倾向评分精细分层来控制季节性和女性伴侣因素引起的混杂。
结果
在 6946 例妊娠中，23.3%的女性伴侣报告在怀孕期间或之前接触过流感疫苗：3.2%在怀孕期间（妊娠年龄 4-19 周），20.1%在怀孕检测前 3 个月。未接种疫苗的流产率为 16.2%，接种疫苗的参与者为 17.0%。与未接种疫苗相比，在怀孕期间或之前接种流感疫苗与流产率增加无关（接种前 HR 0.99，95%CI 0.81-1.20；怀孕期间 HR 0.83，95%CI 0.47-1.47）。在有男性伴侣疫苗接种数据的 1135 对夫妇中，10.8%报告在怀孕前不到 3 个月接种了疫苗。男性伴侣接种疫苗与流产之间的关联的 HR 为 1.17（95%CI 0.73-1.90）。
结论
怀孕期间或之前接种流感疫苗与流产无关。
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