COVID-19 vaccine appears safe in first-trimester pregnancy
COVID-19 vaccination does not increase the risk of miscarriage during the first trimester of pregnancy, according to a Norwegian case-control study that involved 13,956 women, 5.5% of whom were vaccinated against the virus. The results were published yesterday as a letter to the editor in the New England Journal of Medicine.
The study consisted of 13,956 pregnant women, 5.5% of whom were vaccinated. In total, 4,521 women had miscarriages, and 5.1% of those were vaccinated. A median of 19 days occurred between vaccination and either miscarriage or confirmation of ongoing pregnancy. (In Norway, pregnant women are not recommended to receive any vaccinations during their first trimester, but the researchers reason that some women may have gotten vaccinated against COVID-19 before they knew they were pregnant.)
Women vaccinated against COVID-19 did not show increased odds of miscarriage (adjusted odds ratios, 0.91 at 3 weeks and 0.81 at 5 weeks post-vaccination). Even after the researchers analyzed data via available vaccine types, number of doses, and conducted a sensitivity analysis limited to healthcare professionals or women with at least 8 weeks of follow-up after confirmed pregnancy, the results remained similar.
In a podcast involving the journal's top editors, Lindsey Baden, MD, deputy editor, says that this study, in conjunction with the other observational studies on pregnancy and vaccination, becomes "yet again" a risk-benefit analysis. "Pregnancy will require ongoing careful surveillance, but thus far, the emerging data support the use in pregnancy to prevent significant complications," he says.
Oct 20 N Engl J Med study and podcast
COVID occupational risks may be second to socioeconomic inequities
While Swedish workers' occupations were not linked to increased COVID-19 mortality risk, older people who lived with these adults had an increased risk, according to a study published yesterday in the Scandinavian Journal of Work, Environment, and Health.
The researchers looked at 4,620,395 adults 20 to 66 years old who were registered with an occupation in December 2018 and at 209,229 adults 67 years and older who lived in a household with at least one person who lived with a working-age adult. Population-wide data was collected from Mar 12, 2020, to Feb 23, 2021. While Sweden never mandated a lockdown, mobility trends for workplaces decreased 25% in March and April 2020.
At face value, frontline and essential occupations were linked to higher associated risks than other occupations—taxi and bus drivers had more than four times the COVID-19 mortality risk of skilled workers. However, after adjusting for socioeconomic status (SES), all occupation differences become nonsignificant.
Instead, data showed that older people who lived with adults of working age who could not work from home were at increased COVID mortality risk. "This relationship persisted when we adjust for the older person’s own SES (RR [relative risk] 1.005, P=0.001)," the researchers write. "This RR is for an increase in being able to work from home of only one percentage point, whereas the RR is 1.73 if we consider instead 100% versus 0% of an occupation not being able to work from home."
Post-SES adjustment, delivery and postal workers were the only occupational group that posed a higher risk for older co-residents (aRR, 2.16, P = 0.015).
"The finding that socioeconomic status better explained the risk of dying from COVID-19 than the work situation points to health inequalities playing a major role," said first author Sunnee Billingsley, PhD, MPhil, in a Stockholm University press release.
Oct 20 Scand J Work Environ Health study
Oct 20 Stockholm University press release