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A peer-reviewed study has found that women who took a COVID shot during pregnancy reported significantly higher rates of life-threatening hypertensive disorders linked to pregnancy than those who did not take the shot.
The study, published earlier this month in the journal Vaccine, and included at the Centers for Disease Control and Prevention (CDC) registry, analyzed data from more than 16,000 (approximately 8,000 vaccinated and 8,000 unvaccinated) first-time pregnancies.
Outcomes associated with pregnancy-related hypertensive disorders (HDP) include “perinatal death, fetal death, stillbirth, neonatal death, congenital malformation, intrauterine growth retardation (IUGR), small for gestational age (SGA), preterm birth (PTB), very preterm birth (VPTB), low birth weight (LBW), and very low birth weight (VLBW).”
Researchers Andrea J. Sharma, et al conducted the matched cohort study, finding that risk of HDP was found to be 24% higher – 15% vs. 12% – among the pregnant women who received the COVID vaccine, compared to those who did not take the shot.
Since the two groups were sampled from different cohorts, however, results cannot be considered causal.
“Risk did not differ by vaccine manufacturer or gestational age at time of vaccination,” the researchers also noted. “Among the matched pairs with COVID-19 illness during pregnancy data available, we also observed a 28% increase in the risk of HDP among participants reporting COVID-19 illness in pregnancy compared with those reporting no COVID-19 illness in pregnancy.”
McCullough Foundation epidemiologist Nicolas Hulscher, MPH emphasized last week at Focal Points that, despite non-causal results, the association found in the study “was statistically significant, persisted in sensitivity analyses, and remained after adjustment for multiple confounders.”
“The absolute difference observed was 3 percentage points,” Hulscher explained. “That means roughly 1 additional case of hypertensive pregnancy complications for every 33 vaccinated pregnancies. If even 40–60 million pregnant women worldwide received COVID-19 vaccination during the global rollout period, a 3% absolute increase would translate into an estimated 1.2 to 1.8 million additional cases of hypertensive pregnancy complications globally.”
“Hypertensive disorders are not benign,” he stressed. “They increase the risk of preterm birth, NICU admission, emergency induction, C-section, long-term maternal cardiovascular disease, and in severe cases, maternal and fetal death. Even in well-resourced settings, these conditions significantly alter pregnancy outcomes.”
The American College of Obstetricians and Gynecologists (ACOG) continues to recommend that “patients receive an updated COVID-19 vaccine or ‘booster’ at any point during pregnancy, when planning to become pregnant, in the postpartum period, or when lactating.”
“Side effects of the COVID-19 vaccine are generally localized and minor, and the rates of side effects are not higher in pregnant individuals,” ACOG claims. “Data strongly show that COVID-19 vaccination is not associated with a negative effect on pregnancy outcomes.”
Mark Turrentine, M.D., who co-authored ACOG’s practice advisory update on COVID vaccination during pregnancy, said in the organization’s statement that a look “closely at the full body of data clearly shows that the COVID-19 vaccines are not only completely safe for use during pregnancy but also protective both during pregnancy and after the infant is born.”
“I know that my patients do all that they can to make decisions that will help them have a healthy baby, and choosing to get vaccinated against COVID-19 is one decision that I encourage them all to make,” he added.
The study follows one published January 30 at medRxiv that found only 40% of those American adults participating in a national cohort study launched during the COVID pandemic saw the COVID-19 shots as safe during pregnancy, while just over half of respondents perceived the shots as effective.
The preprint study – research that has not yet been peer-reviewed – used data from the Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort to examine views on pregnant women taking the COVID shots.
Researchers analyzed responses collected across 16 surveys between March 2020 and December 2023 (N=4488).
“Pregnant women are at higher risk of severe COVID-19, and vaccination significantly reduces the risk of severe infection,” wrote researchers Rachael Piltch-Loeb, et al, of City University of New York (CUNY).
Nevertheless, they observed that “only 13% of pregnant women in the U.S. had received the updated 2024–25 vaccine by December 2024,” and set out to understand the variables that led to low COVID shot intake.
Variables included “sociodemographic characteristics, susceptibility to severe COVID-19 disease, perceived worry about COVID-19, individual and household vaccination status, symptoms of anxiety and depression, trusted information sources, and having a regular healthcare provider.”
“[L]ess than half (40%) perceived the COVID-19 vaccine as safe during pregnancy, and just over half recognized its efficacy,” the investigators reported. “Individuals with a personal physician and those who trusted public health institutions or healthcare providers were more inclined to agree with the vaccine’s safety and efficacy.”
“These findings highlight the influence of demographic factors on vaccine perceptions, the potential impact of social networks during pregnancy, and the critical role of trust in public health institutions in promoting vaccine uptake,” the researchers concluded.
While this research needs to be further reviewed, its finding that trust in public health institutions is a key determinant of confidence in vaccine communications during pregnancy appears to carry weight.
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