COVID-19 INFECTION AND VACCINATION IN PREGNANCY: A REVIEW
DOI:
https://doi.org/10.22159/ijcpr.2023v15i5.3065Keywords:
Pregnancy, Vaccination, COVID-19Abstract
A higher frequency of severe COVID-19 has been associated to pregnancy. Pregnant women are now regarded potentially sensitive to severe SARS-CoV-2 infection based on clinical experience with pregnancies complicated by infection by other coronaviruses, such as severe acute respiratory syndrome (SARS) and Middle Eastern Respiratory Syndrome. The immune system, respiratory system, cardiovascular function, and coagulation are all affected by physiological changes during pregnancy. The consequences of SARS-CoV-2 on implantation, foetal growth and development, labour, and new-born health have yet to be fully determined, and a focussed, global effort is needed to find out. Asymptomatic infection adds to the difficulty of providing services, preventing infection, and managing it. Finding safe immunizations that induce protective immune responses in pregnant and developing foetus is crucial. Although pregnancy safety data is rapidly increasing and no warning signals have been identified, further information about birth outcomes, particularly among those who were vaccinated earlier in pregnancy, is required. The rate of COVID-19 infection, maternal antibody response, placenta antibody transmission, and adverse effects after COVID-19 vaccination in pregnancy are all summarised in this review.
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References
Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection, pregnancy and women health. Available from: https://www.rcog.org.uk/coronavirus-pregnancy. [Last accessed on 24 Mar 2022]
WHO. Coronavirus (COVID-19) dashboard. WHO. Available from: https://covid19.who.int. [Last accessed on 25 Mar 2022]
MoHFW. In: India COVID-19. Available from: https://www.mohfw.gov.in/index.html. [Last accessed on 25 Mar 2022]
Male V. SARS-CoV-2 infection and COVID-19 vaccination in pregnancy. Nat Rev Immunol. 2022 Mar 18;22(5):277-82. doi: 10.1038/s41577-022-00703-6, PMID 35304596.
Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L. Coronavirus disease 2019 in pregnancy. Int J Infect Dis. 2020 Jun;95:376-83. doi: 10.1016/j.ijid.2020.04.065, PMID 32353549.
Sunder A, Varghese B, Darwish B, Shaikho N, Rashid M. Impacts and effects of COVID-19 infection in pregnancy. Saudi Med J. 2022;43(1):67-74. doi: 10.15537/smj.2022.43.1.20210694, PMID 35022286.
Fell DB, Dhinsa T, Alton GD, Torok E, Dimanlig Cruz S, Regan AK. Association of COVID-19 vaccination in pregnancy with adverse peripartum outcomes. JAMA. 2022 Apr 19;327(15):1478-87. doi: 10.1001/jama.2022.4255, PMID 35323842.
COVID-19 vaccines and pregnancy: conversation guide. The American College of Obstetricians and Gynecologists (ACOG). Available from: https://www.acog.org/covid-19/covid-19-vaccines-and-pregnancy-conversation-guide-for-clinicians. [Last accessed on 25 Mar 2022]
Omer SB. Maternal immunization. N Engl J Med. 2017;376(25):2497. doi: 10.1056/NEJMc1705482, PMID 28636853.
John Hopkins Berman Institute of Bioethics. Coronavirus ethics and policy insights and resources. COVID-19 maternal immunization tracker. Available from: https://bioethics.jhu.edu/research-and-outreach/covid-19-bioethics-expert-insights. [Last accessed on 24 Mar 2022]
Magnus MC, Gjessing HK, Eide HN, Wilcox AJ, Fell DB, Haberg SE. Covid-19 vaccination during pregnancy and first-trimester miscarriage. N Engl J Med. 2021;385(21):2008-10. doi: 10.1056/NEJMc2114466, PMID 34670062.
Kharbanda EO, Haapala J, DeSilva M, Vazquez Benitez G, Vesco KK, Naleway AL. Spontaneous abortion following COVID-19 vaccination during pregnancy. JAMA. 2021 Oct 26;326(16):1629-31. doi: 10.1001/jama.2021.15494, PMID 34495304.
Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020 Sep 1;370:m3320. doi: 10.1136/bmj.m3320, PMID 32873575.
Marchand G, Patil AS, Masoud AT, Ware K, King A, Ruther S. Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021. AJOG Glob Rep. 2022 Feb;2(1):100049. doi: 10.1016/j.xagr.2021.100049, PMID 35005663.
Galang RR, Chang K, Strid P, Snead MC, Woodworth KR, House LD. Severe coronavirus infections in pregnancy: a systematic review. Obstet Gynecol. 2020 Aug;136(2):262-72. doi: 10.1097/AOG.0000000000004011, PMID 32544146.
Hazari KS, Abdeldayem R, Paulose L, Kurien N, Almahloul Z, Mohammad H. Covid-19 infection in pregnant women in Dubai: a case-control study. BMC Pregnancy Childbirth. 2021 Sep 28;21(1):658. doi: 10.1186/s12884-021-04130-8, PMID 34583679.
Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr. 2021 Aug 1;175(8):817-26. doi: 10.1001/jamapediatrics.2021.1050, PMID 33885740.
Akhtar H, Patel C, Abuelgasim E, Harky A. COVID-19 (SARS-CoV-2) infection in pregnancy: a systematic review. Gynecol Obstet Invest. 2020;85(4):295-306. doi: 10.1159/000509290, PMID 32728006.
Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR. Association of SARS-CoV-2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA. 2022 Feb 22;327(8):748-59. doi: 10.1001/jama.2022.1190, PMID 35129581.
Piekos SN, Roper RT, Hwang YM, Sorensen T, Price ND, Hood L. The effect of maternal SARS-CoV-2 infection timing on birth outcomes: a retrospective multicentre cohort study. Lancet Digit Health. 2022 Feb;4(2):e95-e104. doi: 10.1016/S2589-7500(21)00250-8. PMID 35034863.
Stock SJ, Carruthers J, Calvert C, Denny C, Donaghy J, Goulding A. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland. Nat Med. 2022 Mar;28(3):504-12. doi: 10.1038/s41591-021-01666-2, PMID 35027756.
Strid P, Zapata LB, Tong VT, Zambrano LD, Woodworth KR, Riser AP. Coronavirus disease 2019 (COVID-19) severity among women of reproductive age with symptomatic laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by pregnancy status-United States, 1 Jan 2020-25 Dec 2021. Clin Infect Dis. 2022 Oct 3;75Suppl 2:S317-25. doi: 10.1093/cid/ciac479, PMID 35717652.
The National Perinatal Epidemiology Unit. Key information on COVID-19 in pregnancy; 2021. Available from: www.npeu.ox.ac.uk/assets/downloads/npeu-news/MBRRACEUK_Rapid_COVID_19_DEC_2021_-__Infographic_v13.pdf. [Last accessed on 24 Mar 2022]
Edlow AG, Li JZ, Collier AY, Atyeo C, James KE, Boatin AA. Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic. JAMA Netw Open. 2020 Dec 1;3(12):e2030455. doi: 10.1001/jamanetworkopen.2020.30455, PMID 33351086.
Pique Regi R, Romero R, Tarca AL, Luca F, Xu Y, Alazizi A. Does the human placenta express the canonical cell entry mediators for SARS-CoV-2? eLife. 2020;9:e58716. doi: 10.7554/eLife.58716, PMID 32662421.
Lu Culligan A, Chavan AR, Vijayakumar P, Irshaid L, Courchaine EM, Milano KM. Maternal respiratory SARS-CoV-2 infection in pregnancy is associated with a robust inflammatory response at the maternal-fetal interface. Med. 2021 May 14;2(5):591-610.e10. doi: 10.1016/j.medj.2021.04.016, PMID 33969332.
Delorme Axford E, Sadovsky Y, Coyne CB. The placenta as a barrier to viral infections. Annu Rev Virol. 2014 Nov;1(1):133-46. doi: 10.1146/annurev-virology-031413-085524, PMID 26958718.
Watkins JC, Torous VF, Roberts DJ. Defining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) placentitis. Arch Pathol Lab Med. 2021;145(11):1341-9. doi: 10.5858/arpa.2021-0246-SA, PMID 34338723.
Linehan L, O’Donoghue K, Dineen S, White J, Higgins JR, Fitzgerald B. SARS-CoV-2 placentitis: an uncommon complication of maternal COVID-19. Placenta. 2021 Jan 15;104:261-6. doi: 10.1016/j.placenta.2021.01.012, PMID 33465727.
Resta L, Vimercati A, Cazzato G, Mazzia G, Cicinelli E, Colagrande A. SARS-CoV-2 and placenta: new insights and perspectives. Viruses. 2021 Apr 21;13(5):723. doi: 10.3390/v13050723, PMID 33919284.
Cribiu FM, Erra R, Pugni L, Rubio Perez C, Alonso L, Simonetti S. Placenta infection can impact neonatal outcome in the absence of vertical transmission. J Clin. 2021 Mar 15;131(6):e145427. doi: 10.1172/JCI145427.
Schwartz DA, Avvad-Portari E, Babal P, Baldewijns M, Blomberg M, Bouachba A. Placental tissue destruction and insufficiency from COVID-19 causes stillbirth and neonatal death from hypoxic-ischemic injury. Arch Pathol Lab Med. 2022 Jun 1;146(6):660-76. doi: 10.5858/arpa.2022-0029-SA, PMID 35142798.
Menter T, Mertz KD, Jiang S, Chen H, Monod C, Tzankov A. Placental pathology findings during and after SARS-CoV-2 infection: features of villitis and malperfusion. Pathobiology. 2021;88(1):69-77. doi: 10.1159/000511324, PMID 32950981.
Flannery DD, Gouma S, Dhudasia MB, Mukhopadhyay S, Pfeifer MR, Woodford EC. Assessment of maternal and neonatal cord blood SARS-CoV-2 antibodies and placental transfer ratios. JAMA Pediatr. 2021 Jun 1;175(6):594-600. doi: 10.1001/jamapediatrics.2021.0038, PMID 33512440.
Kotlyar AM, Grechukhina O, Chen A, Popkhadze S, Grimshaw A, Tal O. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. Am J Obstet Gynecol. 2021 Jan;224(1):35-53.e3. doi: 10.1016/j.ajog.2020.07.049, PMID 32739398.
Woodworth KR, Olsen EO, Neelam V, Lewis EL, Galang RR, Oduyebo T. Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy–SET-NET, 16 Jurisdictions, Mar 29-Oct 14, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1635-40. doi: 10.15585/mmwr.mm6944e2. PMID 33151917.
Flaherman VJ, Afshar Y, Boscardin WJ, Keller RL, Mardy H A, Prahl MK, T Phillips C, Asiodu IV, Berghella V, Chambers BD, Crear-Perry J, Jamieson DJ, Jacoby VL, Gaw SL. Infant outcomes following maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): first report from the pregnancy coronavirus outcomes registry (PRIORITY) study. Clin Infect Dis. 2021 Nov 2;73(9):e2810-e2813.
Norman M, Naver L, Soderling J, Ahlberg M, Hervius Askling H, Aronsson B. Association of maternal SARS-CoV-2 infection in pregnancy with neonatal outcomes. JAMA. 2021 May 25;325(20):2076-86. doi: 10.1001/jama.2021.5775, PMID 33914014.
Beharier O, Plitman Mayo R, Raz T, Nahum Sacks K, Schreiber L, Suissa Cohen Y. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest. 2021 Jul 1;131(13):e150319. doi: 10.1172/JCI150319, PMID 34014840.
Gee S, Chandiramani M, Seow J, Pollock E, Modestini C, Das A. The legacy of maternal SARS-CoV-2 infection on the immunology of the neonate. Nat Immunol. 2021 Dec;22(12):1490-502. doi: 10.1038/s41590-021-01049-2, PMID 34616036.
Dahlgren J, Samuelsson AM, Jansson T, Holmäng A. Interleukin-6 in the maternal circulation reaches the rat fetus in mid-gestation. Pediatr Res. 2006;60(2):147-51. doi: 10.1203/01.pdr.0000230026.74139.18, PMID 16864694.
Valdespino Vazquez MY, Helguera Repetto CA, Leon Juarez M, Villavicencio Carrisoza O, Flores Pliego A, Moreno Verduzco ER. Fetal and placental infection with SARS-CoV-2 in early pregnancy. J Med Virol. 2021 Jul;93(7):4480-7. doi: 10.1002/jmv.26965, PMID 33764543.
Carrasco I, Munoz Chapuli M, Vigil Vazquez S, Aguilera Alonso D, Hernandez C, Sanchez Sanchez C. SARS-COV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave. BMC Pregnancy Childbirth. 2021 Apr 26;21(1):326. doi: 10.1186/s12884-021-03784-8, PMID 33902483.
Stoecklein S, Koliogiannis V, Prester T, Kolben T, Jegen M, Hübener C, Hasbargen U, Flemmer A, Dietrich O, Schinner R, Dinkel J, Fink N, Muenchhoff M, Hintz S, Delius M, Mahner S, Ricke J, Hilgendorff A. Effects of SARS-CoV-2 on prenatal lung growth assessed by fetal MRI. Lancet Respir Med. 2022 Apr;10(4):e36-e37. doi: 10.1016/S2213-2600(22)00060-1, PMID 35305309.
Beharier O, Plitman Mayo R, Raz T, Nahum Sacks K, Schreiber L, Suissa Cohen Y. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest. 2021 Jul 1;131(13):e150319. doi: 10.1172/JCI150319, PMID 34014840.
Gee S, Chandiramani M, Seow J, Pollock E, Modestini C, Das A. The legacy of maternal SARS-CoV-2 infection on the immunology of the neonate. Nat Immunol. 2021 Dec;22(12):1490-502. doi: 10.1038/s41590-021-01049-2, PMID 34616036.
Dahlgren J, Samuelsson AM, Jansson T, Holmang A. Interleukin-6 in the maternal circulation reaches the rat fetus in mid-gestation. Pediatr Res. 2006;60(2):147-51. doi: 10.1203/01.pdr.0000230026.74139.18, PMID 16864694.
Mackin DW, Walker SP. The historical aspects of vaccination in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2021;76:13-22. doi: 10.1016/j.bpobgyn.2020.09.005, PMID 33168428.
Mithal LB, Otero S, Shanes ED, Goldstein JA, Miller ES. Cord blood antibodies following maternal coronavirus disease 2019 vaccination during pregnancy. Am J Obstet Gynecol. 2021;225(2):192-4. doi: 10.1016/j.ajog.2021.03.035, PMID 33812808.
Prahl M, Golan Y, Cassidy AG, Matsui Y, Li L, Alvarenga B. Evaluation of transplacental transfer of mRNA vaccine products and functional antibodies during pregnancy and early infancy. medRxiv [preprint]. Nat Commun. 2021 Dec 13.12.09.21267423:2022 Jul 30;13(1):4422. doi: 10.1101/2021.12.09.21267423.
Shanes ED, Otero S, Mithal LB, Mupanomunda CA, Miller ES, Goldstein JA. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in pregnancy: measures of immunity and placental histopathology. Obstet Gynecol. 2021 Aug 1;138(2):281-3. doi: 10.1097/AOG.0000000000004457, PMID 33975329.
Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L. Preliminary findings of mRNA COVID-19 vaccine safety in pregnant persons. N Engl J Med. 2021 Jun 17;384(24):2273-82. doi: 10.1056/NEJMoa2104983, PMID 33882218.
Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol. 2021 Sep;225(3):303. e1-303. e17.
Kadali RAK, Janagama R, Peruru SR, Racherla S, Tirumala R, Madathala RR, Gajula V. Adverse effects of COVID-19 messenger RNA vaccines among pregnant women: a cross-sectional study on healthcare workers with detailed self-reported symptoms. Am J Obstet Gynecol. 2021 Oct;225(4):458-60. doi: 10.1016/j.ajog.2021.06.007, PMID 34118200.
Bookstein Peretz S, Regev N, Novick L, Nachshol M, Goffer E, Ben-David A. Short-term outcome of pregnant women vaccinated with BNT162b2 mRNA COVID-19 vaccine. Ultrasound Obstet Gynecol. 2021 Sep;58(3):450-6. doi: 10.1002/uog.23729, PMID 34198360.
Center for disease control and prevention (CDC). COVID-19 vaccines while pregnant or breastfeeding. Available from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html. [Last accessed on 24 Mar 2022]
Society for Maternal-Fetal Medicine’s (SMFM). COVID-19 information for pregnant people and families. Available from: https://www.smfm.org/covidfamily. [Last accessed on 24 Mar 2022]
World health Organization (WHO). Coronavirus disease (COVID-19): pregnancy, childbirth and the postnatal period. Available from: https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-pregnancy-and-childbirth. [Last accessed on 24 Mar 2022]
Egloff C, Couffignal C, Cordier AG, Deruelle P, Sibiude J, Anselem O, Benachi A, Luton D, Mandelbrot L, Vauloup Fellous C, Vivanti AJ, Picone O. Pregnant women'’s perceptions of the COVID-19 vaccine: a french survey. PLoS One. 2022 Feb 7;17(2):e0263512. doi: 10.1371/journal.pone.0263512, PMID 35130318.
Zauche LH, Wallace B, Smoots AN, Olson CK, Oduyebo T, Kim SY, Petersen EE. v-safe COVID-19 pregnancy registry team. Receipt of mRNA Covid-19 vaccines and risk of spontaneous abortion. N Engl J Med. 2021 Oct 14;385(16):1533-5. doi: 10.1056/NEJMc2113891, PMID 34496196.
UK Health Security Agency. COVID-19 vaccine surveillance report–week 4. Available from: https://www.gov.uk/government/publications/Covid-19-vaccine-weeklysurveillance-reports. [Last accessed on 24 Mar 2022]
Pratama NR, Wafa IA, Budi DS, Putra M, Wardhana MP, Wungu CDK. mRNA Covid-19 vaccines in pregnancy: a systematic review. PLOS ONE. 2022;17(2):e0261350. doi: 10.1371/journal.pone.0261350, PMID 35108277.
Blakeway H, Prasad S, Kalafat E, Heath PT, Ladhani SN, Le Doare K, Magee LA, O'Brien P, Rezvani A, von Dadelszen P, Khalil A. COVID-19 vaccination during pregnancy: coverage and safety. Am J Obstet Gynecol. 2022 Feb;226(2):236.e1-236.e14. e14. doi: 10.1016/j.ajog.2021.08.007, PMID 34389291.
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