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Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Among pregnant women, what is the association between receipt of BNT162b2 messenger RNA vaccine and risk of SARS-CoV-2 infection?

Findings  In a retrospective cohort study that included 15 060 pregnant women in Israel, vaccination with BNT162b2 vs nonvaccination was associated with an adjusted hazard ratio for incident SARS-CoV-2 infection of 0.22; this was statistically significant.

Meaning  Among pregnant women, receipt of the BNT162b2 vaccine was associated with a lower risk of incident SARS-CoV-2 infection.

Abstract

Importance  Data on BNT162b2 messenger RNA (mRNA) vaccine (Pfizer-BioNTech) effectiveness and safety in pregnancy are currently lacking because pregnant women were excluded from the phase 3 trial.

Objective  To assess the association between receipt of BNT162b2 mRNA vaccine and risk of SARS-CoV-2 infection among pregnant women.

Design, Setting, and Participants  This was a retrospective cohort study within the pregnancy registry of a large state-mandated health care organization in Israel. Pregnant women vaccinated with a first dose from December 19, 2020, through February 28, 2021, were 1:1 matched to unvaccinated women by age, gestational age, residential area, population subgroup, parity, and influenza immunization status. Follow-up ended on April 11, 2021.

Exposures  Exposure was defined by receipt of the BNT162b2 mRNA vaccine. To maintain comparability, nonexposed women who were subsequently vaccinated were censored 10 days after their exposure, along with their matched pair.

Main Outcomes and Measures  The primary outcome was polymerase chain reaction–validated SARS-CoV-2 infection at 28 days or more after the first vaccine dose.

Results  The cohort included 7530 vaccinated and 7530 matched unvaccinated women, 46% and 33% in the second and third trimester, respectively, with a mean age of 31.1 years (SD, 4.9 years). The median follow-up for the primary outcome was 37 days (interquartile range, 21-54 days; range, 0-70). There were 118 SARS-CoV-2 infections in the vaccinated group and 202 in the unvaccinated group. Among infected women, 88 of 105 (83.8%) were symptomatic in the vaccinated group vs 149 of 179 (83.2%) in the unvaccinated group (P ≥ .99). During 28 to 70 days of follow-up, there were 10 infections in the vaccinated group and 46 in the unvaccinated group. The hazards of infection were 0.33% vs 1.64% in the vaccinated and unvaccinated groups, respectively, representing an absolute difference of 1.31% (95% CI, 0.89%-1.74%), with an adjusted hazard ratio of 0.22 (95% CI, 0.11-0.43). Vaccine-related adverse events were reported by 68 patients; none was severe. The most commonly reported symptoms were headache (n = 10, 0.1%), general weakness (n = 8, 0.1%), nonspecified pain (n = 6, <0.1%), and stomachache (n = 5, <0.1%).

Conclusions and Relevance  In this retrospective cohort study of pregnant women, BNT162b2 mRNA vaccination compared with no vaccination was associated with a significantly lower risk of SARS-CoV-2 infection. Interpretation of study findings is limited by the observational design.

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Article Information

Corresponding Author: Inbal Goldshtein, PhD, Maccabi Healthcare Services, 4 Yehezkel Kaufmann St, Tel Aviv, Israel 68125 (goldst_in@mac.org.il).

Accepted for Publication: June 21, 2021.

Published Online: July 12, 2021. doi:10.1001/jama.2021.11035

Author Contributions: Dr Goldshtein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Goldshtein, Rotem, Gorfine, Chodick, Segal.

Acquisition, analysis, or interpretation of data: Goldshtein, Nevo, Steinberg, Gorfine, Segal.

Drafting of the manuscript: Goldshtein, Steinberg, Segal.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Goldshtein, Nevo, Steinberg, Gorfine.

Administrative, technical, or material support: Goldshtein.

Supervision: Goldshtein, Gorfine, Segal.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Iris Goren, MD, Vered Mourad, DVM, Rivka Maroko, BSC, and Hillel Alapi, BA, from Maccabi Healthcare Services for their contribution to the establishment and maintenance of computerized pregnancy and COVID-19 registries. Their assistance was provided as part of their work in the health fund. No one received any additional compensation beyond usual salary for his or her contributions.

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