The association between coronavirus disease 2019 vaccination during pregnancy and neonatal health outcomes.

Importance: Pregnant women have a higher risk of severe illness or complications due to a severe acute respiratory syndrome coronavirus 2 infection. To reduce these risks, pregnant women are advised to coronavirus disease 2019 (COVID-19) vaccination. Continued monitoring of the safety of maternal COVID-19 vaccination remains important.

Objective: To evaluate the association between maternal COVID-19 vaccination and neonatal health.

Methods: Data from the Dutch Pregnancy Drug Register were used. In this prospective cohort study, pregnant women self-reported COVID-19 vaccination and neonatal health outcomes. We included women with a due date between January 15, 2021, and May 15, 2022, and a singleton live birth after at least 24 weeks gestation. Using log-binomial regression analysis we studied the association between COVID-19 vaccination during pregnancy and the health outcomes; small for gestational age (SGA), large for gestational age (LGA), and neonatal health problems. We corrected for potential confounders using inverse probability of treatment weighting.

Results: In total, 3655 participants were included (92.1% COVID-19 vaccinated during pregnancy). Of all participants, 8.9% reported SGA, 11.1% reported LGA, and 16.4% reported neonatal health problems. Maternal COVID-19 vaccination was not statistically significantly associated with SGA (adjusted prevalence ratio [aPR]: 0.90; 95% confidence interval [CI]: 0.59-1.36), LGA (aPR: 1.07; 95% CI: 0.70-1.63), or neonatal health problems (aPR: 0.84; 95% CI: 0.63-1.11).

Interpretation: This study indicates that COVID-19 vaccination during pregnancy is not associated with self-reported adverse neonatal health outcomes. These findings contribute to the growing body of evidence on the safety of COVID-19 vaccination during pregnancy.