美国 COVID-19 疫苗接种孕妇中早产人数减少。
Reduction in preterm birth among COVID-19-vaccinated pregnant individuals in the United States.
机构信息
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Darwin, Uribe, and Eke).
Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Kohn and Gaur).
出版信息
Am J Obstet Gynecol MFM. 2023 Oct;5(10):101114. doi: 10.1016/j.ajogmf.2023.101114. Epub 2023 Aug 3.
BACKGROUND
Most studies investigating preterm birth and COVID-19 vaccination have suggested no difference in preterm birth rates between vaccinated and unvaccinated pregnant individuals; however, 1 recent study suggested a protective effect of COVID-19 vaccination on preterm birth rates in Australia.
OBJECTIVE
This study aimed to determine whether a similar association and protective effect of COVID-19 vaccination on preterm birth would be found in our multistate, US cohort.
STUDY DESIGN
A cohort study was conducted using the Vizient Clinical Database, which included data from 192 hospitals in 38 states. Pregnant individuals who delivered between January 2021 and April 2022 were included. Propensity score matching was used to match a "treated" group of pregnant individuals with any COVID-19 vaccination (incomplete or complete vaccination) to a group that had not received any COVID-19 vaccination (the "untreated" group). A complete vaccination series of ≥2 doses of the Moderna or Pfizer vaccines or at least 1 dose of the Johnson & Johnson vaccine was considered. An incomplete series was receipt of 1 dose of the Pfizer or Moderna vaccine. We examined the association between COVID-19 vaccination status and preterm birth at <28, <34, and <37 weeks of gestation. Multivariable logistic regression models were used to adjust for potential confounders, with adjusted odds ratios as the measure of treatment effect.
RESULTS
Matching with replacement was performed for 5749 treated participants. After propensity score matching, there was no difference in maternal demographics of age, race, insurance status, parity, or comorbid conditions. Vaccinated individuals were 26% less likely to deliver at <37 weeks of gestation (adjusted odds ratio, 0.74; 95% confidence interval, 0.73-0.75; P<.001), 37% less likely to deliver at <34 weeks of gestation (adjusted odds ratio, 0.63; 95% confidence interval, 0.61-0.64; P<.001), and 43% less likely to deliver at <28 weeks of gestation (adjusted odds ratio, 0.57; 95% confidence interval, 0.55-0.60; P<0.001) than unvaccinated individuals.
CONCLUSION
Vaccination against COVID-19 may be protective against preterm birth.
背景
大多数研究表明，接种 COVID-19 疫苗与未接种疫苗的孕妇相比，早产率没有差异；然而，最近一项研究表明，COVID-19 疫苗对澳大利亚的早产率有保护作用。
目的
本研究旨在确定在我们的多州、美国队列中是否会发现 COVID-19 疫苗接种与早产之间存在类似的关联和保护作用。
研究设计
使用 Vizient 临床数据库进行了一项队列研究，该数据库包含来自 38 个州的 192 家医院的数据。纳入 2021 年 1 月至 2022 年 4 月分娩的孕妇。使用倾向评分匹配将任何 COVID-19 疫苗（不完全或完全接种疫苗）接种的“治疗”组孕妇与未接种任何 COVID-19 疫苗的组（“未治疗”组）相匹配。完整的疫苗系列是指接受至少 2 剂 Moderna 或辉瑞疫苗或至少 1 剂强生疫苗。不完全系列是指接受了 1 剂辉瑞或 Moderna 疫苗。我们检查了 COVID-19 疫苗接种状况与 <28 周、<34 周和<37 周早产之间的关系。使用多变量逻辑回归模型调整潜在混杂因素，以调整后的优势比作为治疗效果的衡量标准。
结果
对 5749 名治疗参与者进行了有放回的匹配。进行倾向评分匹配后，产妇年龄、种族、保险状况、产次或合并症等人口统计学特征无差异。接种疫苗的个体在<37 周时分娩的可能性降低 26%（调整后的优势比，0.74；95%置信区间，0.73-0.75；P<.001），在<34 周时分娩的可能性降低 37%（调整后的优势比，0.63；95%置信区间，0.61-0.64；P<.001），在<28 周时分娩的可能性降低 43%（调整后的优势比，0.57；95%置信区间，0.55-0.60；P<0.001）。
结论
接种 COVID-19 疫苗可能对预防早产有保护作用。
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