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The Confidence Project

References

The following references up to March 31, 2023 were used to inform the content for the relevant sections of the Confidence Project infographics for all languages – a pdf of references is also available here. 

Risks Associated With COVID-19 in Pregnancy:  

  1. McClymont E, Albert AY, Alton GD, et al. Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes.?JAMA. 2022;327(20):1983-1991. doi:10.1001/jama.2022.5906 
  2. Smith ER, Oakley E, Grandner GW, et al. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis.?BMJ Glob Health. 2023;8(1):e009495. doi:10.1136/bmjgh-2022-009495 
  3. Villar J, Ariff S, Gunier RB, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study [published correction appears in JAMA Pediatr. 2022 Jan 1;176(1):104].?JAMA Pediatr. 2021;175(8):817-826. doi:10.1001/jamapediatrics.2021.1050 
  4. Ackerman CM, Nguyen JL, Ambati S, et al. Clinical and Pregnancy Outcomes of Coronavirus Disease 2019 Among Hospitalized Pregnant Women in the United States.?Open Forum Infect Dis. 2021;9(2):ofab429. Published 2021 Sep 3. doi:10.1093/ofid/ofab429 
  5. Kasehagen L, Byers P, Taylor K, et al. COVID-19–Associated Deaths After SARS-CoV-2 Infection During Pregnancy — Mississippi, March 1, 2020–October 6, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1646–1648. doi:?http://dx.doi.org/10.15585/mmwr.mm7047e2external icon 
  6. Metz TD, Clifton RG, Hughes BL, et al. Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications.?JAMA. 2022;327(8):748-759. doi:10.1001/jama.2022.1190
  7. Mullins E, Hudak ML, Banerjee J, et al. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and?AAP-SONPM registries.?Ultrasound Obstet Gynecol. 2021;57(4):573-581. doi:10.1002/uog.23619 
  8. Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis.?BMJ. 2020;370:m3320. Published 2020 Sep 1. doi:10.1136/bmj.m3320 
  9. Zambrano LD, Ellington S, Strid P, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641–1647. DOI:?http://dx.doi.org/10.15585/mmwr.mm6944e3 
  10. Ko JY, DeSisto CL, Simeone RM, et al. Adverse Pregnancy Outcomes, Maternal Complications, and Severe Illness Among US Delivery Hospitalizations With and Without a Coronavirus Disease 2019 (COVID-19) Diagnosis.?Clin Infect Dis. 2021;73(Suppl 1):S24-S31. doi:10.1093/cid/ciab344
  11. Galang RR, Newton SM, Woodworth KR, et al. Risk Factors for Illness Severity Among Pregnant Women With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 Infection-Surveillance for Emerging Threats to Mothers and Babies Network, 22 State, Local, and Territorial Health Departments, 29 March 2020-5 March 2021.?Clin Infect Dis. 2021;73(Suppl 1):S17-S23. doi:10.1093/cid/ciab432 
  12. Money D. Canadian surveillance of COVID-19 in pregnancy: Epidemiology, maternal and infant outcomes. Report #4: Released June 3rd, 2021. Maternal and infant outcomes (March 1, 2020 to March 31, 2021) from five Canadian provinces. https://med-fom-ridprogram.sites.olt.ubc.ca/files/2021/06/CANCOVID_Preg-Report-4-ON-BC-QC-MB-AB_FINAL.pdf  
  13. Ackerman CM, Nguyen JL, Ambati S, et al. Clinical and Pregnancy Outcomes of Coronavirus Disease 2019 Among Hospitalized Pregnant Women in the United States.?Open Forum Infect Dis. 2021;9(2):ofab429. Published 2021 Sep 3. doi:10.1093/ofid/ofab429 
  14. Lipkind HS, Vazquez-Benitez G, DeSilva M, et al. Receipt of COVID-19 Vaccine During Pregnancy and Preterm or Small-for-Gestational-Age at Birth – Eight Integrated Health Care Organizations, United States, December 15, 2020-July 22, 2021.?MMWR Morb Mortal Wkly Rep. 2022;71(1):26-30. Published 2022 Jan 7. doi:10.15585/mmwr.mm7101e1 
  15. Stock SJ, Carruthers J, Calvert C, et al. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland [published correction appears in Nat Med. 2022 Feb 4;:].?Nat Med. 2022;28(3):504-512. doi:10.1038/s41591-021-01666-2 
  16. Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status – United States, January 22-June 7, 2020.?MMWR Morb Mortal Wkly Rep. 2020;69(25):769-775. Published 2020 Jun 26. doi:10.15585/mmwr.mm6925a1

Benefits and Effectiveness of mRNA Vaccines in Pregnancy: 

  1. Carlsen EØ, Magnus MC, Oakley L, et al. Association of COVID-19 Vaccination During Pregnancy With Incidence of SARS-CoV-2 Infection in Infants.?JAMA Intern Med. 2022;182(8):825-831. doi:10.1001/jamainternmed.2022.2442
  2. Dagan N, Barda N, Biron-Shental T, et al. Effectiveness of the BNT162b2 mRNA COVID-19 vaccine in pregnancy.?Nat Med. 2021;27(10):1693-1695. doi:10.1038/s41591-021-01490-8 
  3. Nevo L, Cahen-Peretz A, Vorontsov O, et al. Boosting maternal and neonatal humoral immunity following SARS-CoV-2 infection using a single messenger RNA vaccine dose.?Am J Obstet Gynecol. 2022;227(3):486.e1-486.e10. doi:10.1016/j.ajog.2022.04.010 
  4. Goldshtein I, Nevo D, Steinberg DM, et al. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women.?JAMA. 2021;326(8):728-735. doi:10.1001/jama.2021.11035 
  5. Watanabe A, Yasuhara J, Iwagami M, et al. Peripartum Outcomes Associated With COVID-19 Vaccination During Pregnancy: A Systematic Review and Meta-analysis. JAMA Pediatr. 2022;176(11):1098-1106. doi: 10.1001/jamapediatrics.2022.3456. 
  6. Mithal LB, Otero S, Shanes ED, Goldstein JA, Miller ES. Cord blood antibodies following maternal coronavirus disease 2019 vaccination during pregnancy.?Am J Obstet Gynecol. 2021;225(2):192-194. doi:10.1016/j.ajog.2021.03.035 
  7. Kelly JC, Carter EB, Raghuraman N, et al. Anti-severe acute respiratory syndrome coronavirus 2 antibodies induced in breast milk after Pfizer-BioNTech/BNT162b2 vaccination.?Am J Obstet Gynecol. 2021;225(1):101-103. doi:10.1016/j.ajog.2021.03.031 
  8. Nir O, Schwartz A, Toussia-Cohen S, et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy.?Am J Obstet Gynecol MFM. 2022;4(1):100492. doi:10.1016/j.ajogmf.2021.100492 
  9. Prabhu M, Murphy EA, Sukhu AC, et al. Antibody Response to Coronavirus Disease 2019 (COVID-19) Messenger RNA Vaccination in Pregnant Women and Transplacental Passage Into Cord Blood.?Obstet Gynecol. 2021;138(2):278-280. doi:10.1097/AOG.0000000000004438 
  10. Gray KJ, Bordt EA, Atyeo C, et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study.?Am J Obstet Gynecol. 2021;225(3):303.e1-303.e17. doi:10.1016/j.ajog.2021.03.023 
  11. Magnus MC, Örtqvist AK, Dahlqwist E, et al. Association of SARS-CoV-2 Vaccination During Pregnancy With Pregnancy Outcomes.?JAMA. 2022;327(15):1469-1477. doi:10.1001/jama.2022.3271 
  12. Ibroci E, Liu X, Lieb W, et al. Impact of prenatal COVID-19 vaccination on delivery and neonatal outcomes: Results from a New York City cohort.?Vaccine. 2023;41(3):649-656.  
  13. Morgan JA, Biggio JR Jr, Martin JK, et al. Maternal Outcomes After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Vaccinated Compared With Unvaccinated Pregnant Patients.?Obstet Gynecol. 2022;139(1):107-109. doi:10.1097/AOG.0000000000004621 
  14. Rottenstreich M, Sela HY, Rotem R, Kadish E, Wiener-Well Y, Grisaru-Granovsky S. Covid-19 vaccination during the third trimester of pregnancy: rate of vaccination and maternal and neonatal outcomes, a multicentre retrospective cohort study.?BJOG. 2022;129(2):248-255. doi:10.1111/1471-0528.16941 
  15. Blakeway H, Prasad S, Kalafat E, et al. COVID-19 vaccination during pregnancy: coverage and safety.?Am J Obstet Gynecol. 2022;226(2):236.e1-236.e14. doi:10.1016/j.ajog.2021.08.007 
  16. Jorgensen SCJ, Hernandez A, Fell DB, et al. Maternal mRNA covid-19 vaccination during pregnancy and delta or omicron infection or hospital admission in infants: test negative design study. BMJ. 2023;380:e074035. doi:https://doi.org/10.1136/bmj-2022-074035\ 
  17. Jorgensen SCJ, Hernandez A, Fell DB, et al. Estimated Effectiveness of Postpartum Maternal Messenger RNA COVID-19 Vaccination Against Delta and Omicron SARS-CoV-2 Infection and Hospitalization in Infants Younger Than 6 Months. JAMA Pediatrics. 2023. https://doi.org/10.1001/jamapediatrics.2022.6134 
  18. Prasad S, Kalafat E, Blakeway H, et al. Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy.?Nat Commun. 2022;13(1):2414. Published 2022 May 10. doi:10.1038/s41467-022-30052-w 
  19. Theiler RN, Wick M, Mehta R, Weaver AL, Virk A, Swift M. Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy.?Am J Obstet Gynecol MFM. 2021;3(6):100467. doi:10.1016/j.ajogmf.2021.100467 
  20. Fell DB, Dhinsa T, Alton GD, et al. Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes.?JAMA. 2022;327(15):1478-1487. doi:10.1001/jama.2022.4255 
  21. Morgan JA, Biggio JR, Jr., Martin JK, et al. Pregnancy Outcomes in Patients After Completion of the mRNA Coronavirus Disease 2019 (COVID-19) Vaccination Series Compared With Unvaccinated Patients. Obstet Gynecol. 2023;141(3):555-562. doi: 10.1097/AOG.0000000000005072. 

Safety of COVID-19 Vaccines During Pregnancy: 

  1. Magnus MC, Örtqvist AK, Dahlqwist E, et al. Association of SARS-CoV-2 Vaccination During Pregnancy With Pregnancy Outcomes.?JAMA. 2022;327(15):1469-1477. doi:10.1001/jama.2022.3271 
  2. Goldshtein I, Steinberg DM, Kuint J, et al. Association of BNT162b2 COVID-19 Vaccination During Pregnancy With Neonatal and Early Infant Outcomes.?JAMA Pediatr. 2022;176(5):470-477. doi:10.1001/jamapediatrics.2022.0001 
  3. Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons [published correction appears in N Engl J Med. 2021 Oct 14;385(16):1536].?N Engl J Med. 2021;384(24):2273-2282. doi:10.1056/NEJMoa2104983 
  4. Zauche LH, Wallace B, Smoots AN, et al. Receipt of mRNA Covid-19 Vaccines and Risk of Spontaneous Abortion.?N Engl J Med. 2021;385(16):1533-1535. doi:10.1056/NEJMc2113891 
  5. Calvert C, Carruthers J, Denny C, et al. A population-based matched cohort study of major congenital anomalies following COVID-19 vaccination and SARS-CoV-2 infection.?Nat Commun. 2023;14(1):107. Published 2023 Jan 6. doi:10.1038/s41467-022-35771-8 

Safety of COVID-19 Vaccines During Breastfeeding: 

  1. Muyldermans J, De Weerdt L, De Brabandere L, Maertens K, Tommelein E. The Effects of COVID-19 Vaccination on Lactating Women: A Systematic Review of the Literature.?Front Immunol. 2022;13:852928. Published 2022 Apr 8. doi:10.3389/fimmu.2022.852928 

Effect COVID-19 Vaccines on Fertility:  

  1. Edelman A, Boniface ER, Benhar E, et al. Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19) Vaccination: A U.S. Cohort.?Obstet Gynecol. 2022;139(4):481-489. doi:10.1097/AOG.0000000000004695 
  2. Aharon D, Lederman M, Ghofranian A, et al. In Vitro Fertilization and Early Pregnancy Outcomes After Coronavirus Disease 2019 (COVID-19) Vaccination.?Obstet Gynecol. 2022;139(4):490-497. doi:10.1097/AOG.0000000000004713 
  3. Avraham S, Kedem A, Zur H, Youngster M, Yaakov O, Yerushalmi GM et al.?Coronavirus disease 2019 vaccination and infertility treatment outcomes.?Fertility and Sterility. 2022 Jun;117(6):1291-1299. doi: 10.1016/j.fertnstert.2022.02.025 
  4. Wesselink AK, Hatch EE, Rothman KJ, et al. A Prospective Cohort Study of COVID-19 Vaccination, SARS-CoV-2 Infection, and Fertility.?Am J Epidemiol. 2022;191(8):1383-1395. doi:10.1093/aje/kwac011 
  5. Hillson K, Clemens SC, Madhi SA, et al. Fertility rates and birth outcomes after ChAdOx1 nCoV-19 (AZD1222) vaccination.?Lancet. 2021;398(10312):1683-1684. doi:10.1016/S0140-6736(21)02282-0 

Side Effects / Adverse Outcomes of COVID-19 Vaccines: 

  1. Karlstad Ø, Hovi P, Husby A, et al. SARS-CoV-2 Vaccination and Myocarditis in a Nordic Cohort Study of 23 Million Residents.?JAMA Cardiol. 2022;7(6):600-612. doi:10.1001/jamacardio.2022.0583 
  2. Kharbanda EO, Haapala J, DeSilva M, et al. Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy [published correction appears in JAMA. 2021 Sep 10;:null].?JAMA. 2021;326(16):1629-1631. doi:10.1001/jama.2021.15494 
  3. Muir KL, Kallam A, Koepsell SA, Gundabolu K. Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination.?N Engl J Med. 2021;384(20):1964-1965. doi:10.1056/NEJMc2105869 
  4. See I, Su JR, Lale A, et al. US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021.?JAMA. 2021;325(24):2448-2456. doi:10.1001/jama.2021.7517 
  5. Pavord S, Scully M, Hunt BJ, et al. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis.?N Engl J Med. 2021;385(18):1680-1689. doi:10.1056/NEJMoa2109908 
  6. Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination.?N Engl J Med. 2021;384(22):2092-2101. doi:10.1056/NEJMoa2104840 
  7. Sangli S, Virani A, Cheronis N, et al. Thrombosis With Thrombocytopenia After the Messenger RNA-1273 Vaccine.?Ann Intern Med. 2021;174(10):1480-1482. doi:10.7326/L21-0244 
  8. Cines DB, Bussel JB. SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia [published correction appears in N Engl J Med. 2021 Jun 10;384(23):e92].?N Engl J Med. 2021;384(23):2254-2256. doi:10.1056/NEJMe2106315 
  9. Tiede A, Sachs UJ, Czwalinna A, et al. Prothrombotic immune thrombocytopenia after COVID-19 vaccination.?Blood. 2021;138(4):350-353. doi:10.1182/blood.2021011958 
  10. Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19 Vaccination in a Large Health Care Organization. New England Journal of Medicine. 2021;385(23):2132-2139. doi: 10.1056/NEJMoa2110737 
  11. Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and Pericarditis After Vaccination for COVID-19.?JAMA. 2021;326(12):1210-1212. doi:10.1001/jama.2021.13443