Neonatal and maternal outcomes following SARS-CoV-2 infection and COVID-19 vaccination : a population-based matched cohort study

Lindsay, Laura and Calvert, Clara and Shi, Ting and Carruthers, Jade and Denny, Cheryl and Donaghy, Jack and Hopcroft, Lisa E. M. and Hopkins, Leanne and Goulding, Anna and McLaughlin, Terry and Moore, Emily and Taylor, Bob and Bhaskaran, Krishnan and Katikireddi, Srinivasa Vittal and McCabe, Ronan and McCowan, Colin and Simpson, Colin R. and Robertson, Chris and Sheikh, Aziz and Wood, Rachael and Stock, Sarah J. (2023) Neonatal and maternal outcomes following SARS-CoV-2 infection and COVID-19 vaccination : a population-based matched cohort study. Nature Communications, 14 (1). 5275. ISSN 2041-1723 (

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Understanding the impact of SARS-CoV-2 infection and COVID-19 vaccination in pregnancy on neonatal and maternal outcomes informs clinical decision-making. Here we report a national, population-based, matched cohort study to investigate associations between SARS-CoV-2 infection and, separately, COVID-19 vaccination just before or during pregnancy and the risk of adverse neonatal and maternal outcomes among women in Scotland with a singleton pregnancy ending at ≥20 weeks gestation. Neonatal outcomes are stillbirth, neonatal death, extended perinatal mortality, preterm birth (overall, spontaneous, and provider-initiated), small-for-gestational age, and low Apgar score. Maternal outcomes are admission to critical care or death, venous thromboembolism, hypertensive disorders of pregnancy, and pregnancy-related bleeding. We use conditional logistic regression to derive odds ratios adjusted for socio-demographic and clinical characteristics (aORs). We find that infection is associated with an increased risk of preterm (aOR=1.36, 95% Confidence Interval [CI] = 1.16–1.59) and very preterm birth (aOR = 1.90, 95% CI 1.20–3.02), maternal admission to critical care or death (aOR=1.72, 95% CI = 1.39–2.12), and venous thromboembolism (aOR = 2.53, 95% CI = 1.47–4.35). We find no evidence of increased risk for any of our outcomes following vaccination. These data suggest SARS-CoV-2 infection during pregnancy is associated with adverse neonatal and maternal outcomes, and COVID-19 vaccination remains a safe way for pregnant women to protect themselves and their babies against infection.