Protective effect of maternal immunization on birth outcomes: A data linkage study

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Objective: To explore the impact of maternal immunization on adverse pregnancy outcomes including preterm birth (PTB) and stillbirth. Methods: The authors performed a data linkage study for women who delivered a singleton baby between January 2017 and May 2021. They used Poisson models to estimate incidence rates of adverse pregnancy outcomes and Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), accounting for the time-dependent nature of the exposure and adjusting for confounders. Results: This study included 10 938 women who received at least one vaccine, and 4029 unvaccinated women. Influenza vaccine was associated with a significant reduction in stillbirth (adjusted HR [aHR], 0.55 [95% CI, 0.33–0.94]), but not in PTB (aHR, 0.92 [95% CI, 0.77–1.10]). Pertussis vaccine was associated with a significant reduction in PTB (aHR, 0.78 [95% CI, 0.64–0.94]) and a similar point estimate for reduction in stillbirth (aHR, 0.59 [95% CI, 0.31–1.10]), although not significant. Conclusion: Reductions in PTB and stillbirth associated with maternal immunization suggest possible protective effects beyond pathogen-specific protection. These findings may strengthen justification for scaling up maternal immunization in low-income settings where there remains a high burden of these adverse pregnancy outcomes.

Original languageEnglish
Pages (from-to)51-57
Number of pages7
JournalInternational Journal of Gynecology and Obstetrics
Issue number1
Publication statusPublished - Jul 2023


  • influenza
  • pertussis
  • preterm birth
  • stillbirth
  • vaccination

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