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Since the start of the COVID-19 pandemic, pregnant women and their infants have been at increased risk for adverse outcomes (NEJM JW Gen Med May 15 2021 and Obstet Gynecol 2021; 137:571). Vaccination of pregnant women benefits both mother and baby (NEJM JW Infect Dis Aug 2022 and N Engl J Med 2022 Jul 14; 387:109); however, despite reassuring clinical data (NEJM JW Gen Med May 1 2022 and JAMA 2022 Apr 19; 327:1469; multiple citations), COVID-19 vaccination rates in pregnant women remain low, in part due to misinformation about infection risk and vaccine safety.
In the INTERCOVID-2022 prospective cohort study, investigators examined the outcomes of SARS-CoV-2 infection during pregnancy in 18 countries during the first 6 months of Omicron circulation. Infected women with COVID-19 were matched with uninfected women to compare maternal, perinatal, and neonatal outcomes. Findings include:
36% of the 4618 enrolled women were completely vaccinated or boosted.
Overall likelihood of adverse outcomes was lower with Omicron than past variants but still included excess risk for maternal morbidity and mortality (adjusted relative risk, 1.16) and perinatal morbidity and mortality (adjusted RR, 1.21).
Although vaccination did not prevent Omicron infection, vaccine effectiveness (VE) against severe outcomes including death was seen in those who received complete vaccination (VE, 74%) and those who were also boosted (91%).
Villar J et al. Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: A multinational, observational study. Lancet 2023 Jan 17; [e-pub]. (https://doi.org/10.1016/S0140-6736(22)02467-9)
Comment
As we begin another year of the COVID-19 pandemic, the truths observed before vaccine availability have persisted during Omicron circulation. Pregnancy remains a significant risk factor for severe outcomes from COVID-19. This study is a reminder that pregnant women are at increased risk for complications from COVID-19 and that the vaccines are highly effective at preventing dire outcomes. We should continue to strongly recommend vaccination for all eligible individuals, with messaging that focuses on preventing severe COVID-19 outcomes in pregnancy rather than merely preventing infection.