Systematic reviews: vaccination during pregnancy
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Systematic reviews: vaccination during pregnancy According to the results of an overview of systematic reviews reported in Vaccine, definitely increased risks of any evaluated adverse events were not identified for any vaccine recommended during pregnancy, although "better evidence is needed for all outcomes and vaccines". The overview included 17 published systematic reviews which stated pre-defined eligibility criteria and included controlled studies; 8 reviews included meta-analysis. Of the evaluated outcomes, the most frequently reported was stillbirth (n=15), followed by preterm birth (PTB; n=13), abortion (n=9), congenital abnormalities (n=9), small for gestational age (SGA; n=8), neonatal death (n=8), low birth weight (LBW; n=4), chorioamnionitis (n=3) and maternal death (n=1). In 6 reviews, influenza vaccination did not appear to increase the risk of abortion or stillbirth, and may have a moderate protective effect for stillbirth. In 2 reviews, no increased risk of neonatal or maternal death was found. In 2 reviews, no increased risk of stillbirth was found for Tdap vaccination, and another 2 reviews did not find an increased risk of neonatal or maternal death. "More studies investigating women vaccinated during their first trimester, rather than combining all trimesters, are needed to obtain more precise estimates on the risk of spontaneous abortion", note the authors. Three reviews did not find an increased risk of congenital defects following influenza vaccination, while 2 reviews found an inconclusive impact. For Tdap vaccination, 1 review found that the risk was not likely to be increased, while another found a very uncertain risk due to scarce data. For PTB, most of the 5 reviews involving influenza vaccination and both reviews involving Tdap vaccination were inconclusive. For chorioamnionitis, only assessed with Tdap vaccination, the 3 reviews found an increased risk, no effect, or were inconclusive, respectively. "Nevertheless", note the authors, "the excess of chorioamnionitis was not accompanied by an increase of adverse infant clinical outcomes such as preterm birth, a major sequela". The 2 reviews involving yellow fever, hepatitis B or meningococcal vaccination "had major methodological limitations", note the authors. They concluded that there was an inconclusive effect for abortion and stillbirth, PTB, and neonatal death. "No major safety concerns with regard to maternal immunization have been identified", note the authors, although "differences in the available evidence and its quality have been found". Macias Saint-Gerons D, et al. Adverse events associated with the use of recommended vaccines during pregnancy: An overview of systematic reviews. Vaccine : 12 Sep 2020. 803505818 Available from: URL: http://doi.org/10.1016/j.vaccine.2020.07.048
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Reactions 10 Oct 2020 No. 1825
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