Accepted for Publication: August 8, 2022.
Published: September 26, 2022. doi:10.1001/jamanetworkopen.2022.33273
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Schrag SJ et al. JAMA Network Open.
Corresponding Author: Ruth Link-Gelles, PhD, CDC COVID-19 Emergency Response Team, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30029 (hzt7@cdc.gov).
Author Contributions: Mx Butterfield and Dr Lazariu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Schrag and Verani contributed equally.
Concept and design: Schrag, Verani, Dixon, Butterfield, Vazquez-Benitez, Zerbo, Beaver, Ellington, Irving, Grannis, Midturi, Fadel, Link-Gelles, Valvi, Ball, Thompson, Naleway.
Acquisition, analysis, or interpretation of data: Schrag, Verani, Dixon, Page, Butterfield, Gaglani, Vazquez-Benitez, Zerbo, Natarajan, Ong, Lazariu, Rao, Ellington, Klein, Irving, Grannis, Kiduko, Barron, Dickerson, Lewis, Stockwell, Stenehjem, Link-Gelles, Murthy, Goddard, Grisel, Fireman, Arndorfer, Konatham, Thompson, Naleway.
Drafting of the manuscript: Schrag, Verani, Natarajan, Lazariu, Beaver, Grisel, Arndorfer.
Critical revision of the manuscript for important intellectual content: Schrag, Dixon, Page, Butterfield, Gaglani, Vazquez-Benitez, Zerbo, Ong, Lazariu, Rao, Beaver, Ellington, Klein, Irving, Grannis, Kiduko, Barron, Midturi, Dickerson, Lewis, Stockwell, Stenehjem, Fadel, Link-Gelles, Murthy, Goddard, Valvi, Fireman, Konatham, Ball, Thompson, Naleway.
Statistical analysis: Butterfield, Vazquez-Benitez, Zerbo, Lazariu, Fadel, Fireman.
Obtained funding: Klein, Irving, Goddard, Ball, Thompson.
Administrative, technical, or material support: Schrag, Verani, Dixon, Page, Butterfield, Gaglani, Natarajan, Ong, Lazariu, Ellington, Irving, Grannis, Kiduko, Dickerson, Lewis, Stenehjem, Goddard, Valvi, Arndorfer, Ball, Thompson.
Supervision: Schrag, Dixon, Ong, Klein, Grannis, Midturi, Thompson.
Conflict of Interest Disclosures: Dr Dixon reported receiving personal fees from Elsevier and Springer Nature and grants from the US Centers for Disease Control and Prevention (CDC) outside the submitted work. Dr Gaglani reported receiving grants from CDC–Abt Associates Baylor Scott & White Health during the conduct of the study and grants from CDC Baylor Scott & White Health, CDC–Abt Associates Baylor Scott & White Health, CDC–Vanderbilt University Medical Center, CDC–Westat Baylor Scott & White Health, and Janssen Baylor Scott & White Health outside the submitted work. Dr Vazquez-Benitez reported having a contract with the CDC during the conduct of the study and receiving grants from Sanofi outside the submitted work. Dr Natarajan reported receiving grants from the CDC during the conduct of the study. Dr Rao reported receiving grants from the CDC during the conduct of the study and grants from Biofire outside the submitted work. Dr Klein reported receiving grants from the CDC during the conduct of the study and grants from Pfizer, Merck, GlaxoSmithKline, Sanofi Pasteur, and Protein Science (now Sanofi Pasteur) outside the submitted work. Dr Irving reported receiving grants from the CDC to her institution, through a contract mechanism with Westat, during the conduct of the study and outside the submitted work. Dr Stockwell reported receiving grants from the CDC to Trustees of Columbia during the conduct of the study. Dr Stenehjem reported receiving grants from the CDC during the conduct of the study and outside the submitted work. Dr Fadel reported receiving grants from the CDC during the conduct of the study and outside the submitted work. Dr Goddard reported receiving grants from the CDC during the conduct of the study. Dr Grisel reported receiving grants from Intermountain Healthcare during the conduct of the study. Dr Arndorfer reported receiving grants from the CDC during the conduct of the study. Dr Ball reported receiving contractual support from the CDC during the conduct of the study. Dr Naleway reported receiving grants from the CDC during the conduct of the study and grants from Pfizer and Vir Biotechnology outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by the CDC through contract 75D30120C07986 to Westat and contract 75D30120C07765 to Kaiser Foundation Hospitals.
Role of the Funder/Sponsor: The CDC was involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication. The CDC controlled publication decisions.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Additional Contributions: We would like to acknowledge the contributions of the VISION Network CDC: Catherine H. Bozio, PhD, Sue Reynolds, PhD, Lenee Blanton, MPH, Jill Ferdinands, PhD, Palak Patel, MBBS, Eric P. Griggs, MPH, Alexandra Dalton, PhD, Mehiret Wondimu, MPH, Alicia M. Fry, MD, PhD, and Eduardo Azziz-Baumgartner, MD; Westat: Patrick Mitchell, ScD, Duck-Hye Yang, PhD, and Margaret Dunne, MSc; Baylor Scott & White Health: I-Chia Liao, MPH, Deborah Hendricks, BS, Jason Ettlinger, MA, Joel Blais, BTh, Elisa Priest, DrPH, Michael Smith, BS, Spencer Rose, BS, Natalie Settele, MBA, Jennifer Thomas, MS, Muralidhar Jatla, MD, Madhava Beeram, MD, and Alejandro Arroliga, MD; School of Medicine, University of Colorado Anschutz Medical Campus, Health Data Compass: David Mayer, BS, Bryant Doyle, Briana Kille, PhD, and Catia Chavez, MPH; Regenstrief Institute: Ashley Wiensch, MPH and Amy Hancock, MPA, MSES; Center for Health Research, Kaiser Permanente Northwest: Bradley Crane, MS and Padma Dandamudi, MPH; Columbia: Jungmi Han, BS; Health Partners: Malini B. DeSilva, MD, Charlene McEvoy, MD, and Anupam B. Kharbanda, MD; InterMountain: Kristen Dascomb, MD, PhD.
1.Allotey
J , Stallings
E , Bonet
M ,
et al; for PregCOV-19 Living Systematic Review Consortium. 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. doi:
10.1136/bmj.m3320PubMedGoogle ScholarCrossref 3.Marchand
G , Patil
AS , Masoud
AT ,
et al. Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021. AJOG Glob Rep 2022;2(1):100049-100049. doi:
10.1016/j.xagr.2021.100049 10.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.0000000000004621PubMedGoogle ScholarCrossref 15.Austin
PC , Stuart
EA . Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.
Stat Med. 2015;34(28):3661-3679. doi:
10.1002/sim.6607PubMedGoogle ScholarCrossref 16.Ferdinands
JM , Rao
S , Dixon
BE ,
et al. Waning 2-dose and 3-dose effectiveness of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of Delta and Omicron variant predominance—VISION Network, 10 states, August 2021-January 2022.
MMWR Morb Mortal Wkly Rep. 2022;71(7):255-263. doi:
10.15585/mmwr.mm7107e2PubMedGoogle ScholarCrossref 19.Lauring
AS , Tenforde
MW , Chappell
JD ,
et al; Influenza and Other Viruses in the Acutely Ill (IVY) Network. Clinical severity of, and effectiveness of mRNA vaccines against, COVID-19 from Omicron, Delta, and Alpha SARS-CoV-2 variants in the United States: prospective observational study.
BMJ. 2022;376:e069761. doi:
10.1136/bmj-2021-069761PubMedGoogle ScholarCrossref 20.Metz
TD , Clifton
RG , Hughes
BL ,
et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. 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.2022.1190PubMedGoogle ScholarCrossref 21.Tenforde
MW , Self
WH , Adams
K ,
et al; Influenza and Other Viruses in the Acutely Ill (IVY) Network. Association between mRNA vaccination and COVID-19 hospitalization and disease severity.
JAMA. 2021;326(20):2043-2054. doi:
10.1001/jama.2021.19499PubMedGoogle ScholarCrossref 22.Halasa
NB , Olson
SM , Staat
MA ,
et al; Overcoming COVID-19 Investigators; Overcoming COVID-19 Network. Effectiveness of maternal vaccination with mRNA COVID-19 vaccine during pregnancy against COVID-19-associated hospitalization in infants aged <6 months—17 states, July 2021-January 2022.
MMWR Morb Mortal Wkly Rep. 2022;71(7):264-270. doi:
10.15585/mmwr.mm7107e3PubMedGoogle ScholarCrossref 23.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. doi:
10.15585/mmwr.mm7101e1PubMedGoogle ScholarCrossref