(1040) Safety and Efficacy of Maternal COVID-19 vaccination during pregnancy: Umbrella review & meta-analyses

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Giulia Bonanni, MD

Postdoctoral Research Fellow
Postdoctoral Research Fellow Fetal Care and Surgery Center Division of Fetal Medicine and Surgery Boston Children's Hospital, Harvard Medical School
Boston, MA, United States

Coauthor(s)

Nikan Zargarzadeh, MD

Research Fellow
Boston Children's Hospital, Harvard Medical School
Boston, Massachusetts, United States
MH

Mohammad Haddadi, MD

Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Tehran, Tehran, Iran
Ali Javinani, MD (he/him/his)

Postdoctoral Research Fellow
Boston Children's Hospital, Harvard Medical School
Boston, Massachusetts, United States
James Versalovic, MD, PhD

Pathology-in-Chief
Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA Department of Pathology, Texas Children’s Hospital
Houston, Texas, United States
Kjersti M. Aagaard, MD, PhD

Medical Director, HCA Healthcare and HCA Research Institute
Boston Children’s Hospital, Division of Fetal Medicine and Surgery, Boston, MA; HCA Healthcare and HCA Healthcare Research Institute, Nashville, TN; HCA Texas Maternal Fetal Medicine, Houston, TX; Baylor College of Medicine and Texas Children's Hospital, Houston, TX
Tomball, Texas, United States
SP

Stefania Papatheodorou, MD, MSc, PhD

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ, USA
New Brunswick, New Jersey, United States
Alireza A. Shamshirsaz, MD (he/him/his)

Department Director, Professor of Surgery
Fetal Surgeon Chief, Division of Fetal Medicine and Surgery Director of the Maternal Fetal Care Center Director of the Perinatal Surgery Fellowship Professor of Surgery, Boston Children’s Hospital Harvard Medical School
Boston, Massachusetts, United States

Objective: The safety & efficacy of vaccination against COVID-19 during pregnancy is crucial for not only current maternal and fetal health, but public health policy and management with future pandemics. To date, many meta-analyses on the safety and efficacy of COVID-19 vaccine were published with conflicting results; we aimed to correct this crucial knowledge gap with the current study.

Study Design:

We conducted a systematic search of PubMed, Scopus, Web of Science, and Embase from 01/01/2021 to 09/13/2023. We included 23 meta-analyses inclusive of over 200 studies and 1,300,000 gravidae with or without documented evidence of COVID-19 vaccination. Meta-analyses were performed using R to aggregate effect sizes, utilizing random-effects models. Heterogeneity was evaluated using the I² statistic, and publication bias was assessed with Egger’s test.. PROSPERO registration: CRD42024519174.

Results:

COVID vaccination during pregnancy reduced maternal COVID-19 infection rates (Risk Ratio [RR] 0.41, 95% CI 0.30-0.57), stillbirth (RR 0.75, 95% CI 0.58-0.98), PTB ≤37 wks (RR 0.92, 95% CI 0.86-0.99), congenital malformations (RR 0.83, 95% CI 0.70-0.98), SGA neonates (RR 0.94, 95% CI 0.91-0.98), and NICU admission (RR 0.91, 95% CI 0.85-0.97). No significant risk differences were observed among other outcomes, with the exception of a marginal increased risk of Cesarean delivery (RR 1.07, 95% CI 1.01-1.12; Table 1, Figure 1).

Conclusion:

With the conduct of an umbrella review of comprehensive meta-analyses and including over 1.3M patients, we demonstrate significant benefit towards vaccination at no increased risk. The quantifiable benefits may aid shared decision-making and public health communications in this and future pandemics.