Pre-pregnancy vaccination with inactivated vaccines protects SARS-CoV-2-exposed neonates from respiratory distress.

Background: Emerging evidence from prior studies suggests that prenatal exposure to Coronavirus Disease 2019 (COVID-19) may trigger an inflammatory cascade within the neonatal airway. However, the potential impact of maternal inactivated COVID-19 vaccination prior to pregnancy on neonatal respiratory outcomes remains poorly understood.

Methods: This prospective cohort study analyzed 329 neonates exposed to maternal SARS-CoV-2 infection in utero from 322 pregnant women to evaluate neonatal outcomes based on maternal vaccination status. The primary outcome was neonatal respiratory distress (RD), with secondary outcomes including infant respiratory tract infections (RTIs) and growth parameters.

Results: The overall incidence of RD among 329 neonates was 6·1% (20/329). Neonates born to unvaccinated mothers exhibited a significantly higher risk of RD 14% compared to those born to vaccinated mothers 4% (OR = 3·48, 95% CI: 1·31-9·30). However, Longitudinal analysis revealed no statistically significant differences between groups in either SARS-CoV-2 infection rates (HR=1.89, 95%CI:0.80-4.45) or RTIs incidence (HR=1.18, 95%CI:0.72-1.93) throughout the first year of life.

Conclusions: Maternal COVID-19 vaccination prior to pregnancy provides protective benefits against neonatal RD following in utero exposure to SARS-CoV-2. Nevertheless, such vaccination does not prevent postnatal SARS-CoV-2 infection or confer cross-protection against RTIs during infancy.໿.