评估美国孕妇在德尔塔变异株出现之前、德尔塔变异株流行期和奥密克戎变异株流行期的新冠疫苗有效性：来自国家新冠协作队列（N3C）全国抽样队列的回顾性队列分析。
Evaluating COVID-19 vaccine effectiveness during pre-Delta, Delta and Omicron dominant periods among pregnant people in the U.S.: Retrospective cohort analysis from a nationally sampled cohort in National COVID Collaborative Cohort (N3C).
作者信息
Qin Qiuyuan Crystal, Wilkins Kenneth J, Jones Sara E, Bradwell Katie R, Chan Lauren E, Sun Jing, Anzalone Jerrod, Zheng Qulu, Liebman Michael, Mariona Federico, Faherty Emily A Groene, Challa Anup P, Hill Elaine, Patel Rena C
机构信息
Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
Biostatistics Program / Office of Clinical Research Support, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
出版信息
BMJ Public Health. 2024 Jul;2(1). doi: 10.1136/bmjph-2023-000770. Epub 2024 Jun 3.
OBJECTIVES
To evaluate the effectiveness of COVID-19 vaccinations (initial and booster) during pre-Delta, Delta, and Omicron dominant periods among pregnant people via (1) COVID-19 incident and severe infections among pregnant people who were vaccinated vs. unvaccinated and (2) post-COVID-19 vaccination breakthrough infections and severe infections among vaccinated females who were pregnant vs. non-pregnant.
DESIGN
Retrospective cohort study using nationally sampled electronic health records data from the National COVID Cohort Collaborative (N3C), December 10, 2020, to June 07, 2022.
PARTICIPANTS
Cohort 1 included pregnant people (15-55 years), and Cohort 2 included vaccinated females of reproductive age (15-55 years).
EXPOSURES
(1) COVID-19 vaccination and (2) pregnancy.
MAIN OUTCOME MEASURES
Adjusted hazard ratios (aHRs) for COVID-19 incident or breakthrough infections and severe infections (i.e., COVID-19 infections with related hospitalizations).
RESULTS
In Cohort 1, 301,107 pregnant people were included. Compared to unvaccinated pregnant people, the aHRs for pregnant people with initial vaccinations pregnancy of incident COVID-19 were 0.77 (95% CI: 0.62, 0.96) and 0.88 (95%CI: 0.73, 1.07) and aHRs of severe COVID-19 infections were 0.65 (95% CI: 0.47, 0.90) and 0.79 (95% CI: 0.51, 1.21) during the Delta and Omicron periods, respectively. Compared to pregnant people with full initial vaccinations, the aHR of incident COVID-19 for pregnant people with booster vaccinations was 0.64 (95% CI: 0.58, 0.71) during the Omicron period. In Cohort 2, 934,337 vaccinated people were included. Compared to vaccinated non-pregnant females, the aHRs of severe COVID-19 infections for people with initial vaccinations pregnancy was 2.71 (95% CI: 1.31, 5.60) during the Omicron periods.
CONCLUSIONS
Pregnant people with initial and booster vaccinations during pregnancy had a lower risk of incident and severe COVID-19 infections compared to unvaccinated pregnant people across the pandemic stages. However, vaccinated pregnant people still had a higher risk of severe infections compared to non-pregnant females.
目的
通过（1）接种疫苗与未接种疫苗的孕妇中新冠病毒感染及重症感染情况，以及（2）接种新冠疫苗的孕妇与非孕妇中疫苗突破性感染及重症感染情况，评估在德尔塔毒株出现前、德尔塔毒株流行期和奥密克戎毒株流行期孕妇接种新冠疫苗（初始接种和加强接种）的效果。
设计
回顾性队列研究，使用来自国家新冠队列协作组（N3C）的全国抽样电子健康记录数据，时间范围为2020年12月10日至2022年6月7日。
参与者
队列1包括15至55岁的孕妇，队列2包括15至55岁的育龄接种疫苗女性。
暴露因素
（1）新冠疫苗接种；（2）怀孕。
主要观察指标
新冠病毒感染或突破性感染及重症感染（即因新冠病毒感染而住院）的调整风险比（aHRs）。
结果
在队列1中，纳入了301,107名孕妇。与未接种疫苗的孕妇相比，在德尔塔毒株流行期和奥密克戎毒株流行期，初始接种疫苗的孕妇发生新冠病毒感染的aHR分别为0.77（95%置信区间：0.62, 0.96）和0.88（95%置信区间：0.73, 1.07），发生新冠重症感染的aHR分别为0.65（95%置信区间：0.47,）和0.79（95%置信区间：0.51, 1.21）。与初始全程接种疫苗的孕妇相比，在奥密克戎毒株流行期，接种加强针的孕妇发生新冠病毒感染的aHR为0.64（95%置信区间：0.58, 0.71）。在队列2中，纳入了934,337名接种疫苗者。与接种疫苗的非孕妇相比，在奥密克戎毒株流行期，初始接种疫苗且怀孕的人群发生新冠重症感染的aHR为2.71（95%置信区间：1.31, 5.60）。
结论
在整个疫情阶段，孕期接种初始疫苗和加强针的孕妇与未接种疫苗的孕妇相比，发生新冠病毒感染及重症感染的风险更低。然而，与未怀孕的女性相比，接种疫苗的孕妇发生重症感染的风险仍然更高。
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