Adverse events associated with the use of recommended vaccines during pregnancy: An overview of systematic reviews
Por:
Saint-Gerons, DM, Arnau, IS, De Mucio, B, Arevalo-Rodriguez, I, Aleman, A, Castro, JL, Alvarez, AMR
Publicada:
30 jul 2021
Ahead of Print:
1 jul 2021
Resumen:
Introduction: Maternal immunization is aimed at reducing morbidity and mortality in pregnant women and their newborns. Updated evidence synthesis of maternal-fetal outcomes is constantly needed to ensure that the risk-benefit of vaccination during pregnancy remains positive.
Methods: An overview of systematic reviews (OoSRs) was performed. We searched The Cochrane Library, MEDLINE and EMBASE for SRs including recommended vaccines for maternal immunization reporting the following: abortion, stillbirth, chorioamnionitis, congenital anomalies, microcephaly, neonatal death, neonatal infection, preterm birth (PTB), low birth weight (LBW), maternal death and small for gestational age (SGA) from 2010 to April 2019. Quality and overlap of SRs was assessed.
Results: Seventeen SRs were identified, eight of them included meta-analysis; quality was high in three SRs, moderate in six SRs, low in two SRs, and critically low in six SRs. Stillbirth and PTB were the most frequently reported outcomes by 15 and 13 SRs, respectively, followed by abortion (9 SRs), congenital anomalies (9 SRs), SGA (8 SRs), neonatal death (8 SRs), LBW (4 SRs), chorioamnionitis (3 SRs), maternal death (1 SR). SRs included mainly observational evidence for influenza and Tdap vaccines (11 SRs and 4 SRs, respectively); limited evidence was found for hepatitis (1 SR), yellow fever (1 SR), and meningococcal (1 SR) vaccines. Most of the SRs found no effect. Eight SRs found benefit/protection of influenza vaccine (for stillbirth, neonatal death, preterm birth, LBW), or Tdap vaccine (for preterm birth and SGA); one found a probable risk (chorioamnionitis/Tdap). The SRs for Hepatitis B, meningococcal and yellow fever vaccines were inconclusive.
Conclusions: Definite risks were not identified for any vaccine and outcome; however better evidence is needed for all outcomes and vaccines. The available evidence in the SRs to support vaccine safety was based mainly on observational data. More RCTs with adequate reporting of maternal-fetal outcomes and larger high-quality observational studies are needed. (C) 2020 The Authors. Published by Elsevier Ltd.
Filiaciones:
Saint-Gerons, DM:
Univ Valencia, Dept Med, INCLIVA Hlth Res Inst, Valencia, Spain
CIBERSAM, Valencia, Spain
WHO, Dept Hlth Syst & Serv HSS, Unit Med & Hlth Technol MT, Pan Amer Hlth Org PAHO, Washington, DC USA
Arnau, IS:
CIBER Epidemiol & Publ Hlth, Iberoamer Cochrane Ctr, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
De Mucio, B:
Univ Republica, Sch Med, Dept Prevent Med, Montevideo, Uruguay
Arevalo-Rodriguez, I:
Hosp Univ Ramon y Cajal, Clin Biostat Unit, IRYCIS, CIBER Epidemiol & Publ Hlth, Madrid, Spain
Aleman, A:
Univ Republica, Sch Med, Dept Prevent Med, Montevideo, Uruguay
Castro, JL:
WHO, Dept Hlth Syst & Serv HSS, Unit Med & Hlth Technol MT, Pan Amer Hlth Org PAHO, Washington, DC USA
Alvarez, AMR:
WHO, Dept Family Gender & Life Course, Immunizat Unit, Pan Amer Hlth Org PAHO, Washington, DC 20037 USA
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