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Research Article
ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2025.60.009460
COVID-19 Vaccination and Preterm Birth: Current
Evidence and Gaps
Copyright@ : Irami Araújo-Filho | Biomed J Sci & Tech Res | BJSTR.MS.ID.009460. 52662
Amália Cinthia Meneses do Rêgo1 and Irami Araújo-Filho1,2*
1Institute of Teaching, Research, and Innovation, Liga Contra o Câncer, Full Professor of the Postgraduate Program in Biotechnology at Potiguar
University, Potiguar University (UnP), Brazil
2Full Professor, Department of Surgery, Potiguar University. Ph.D. in Health Science, Brazil
*Corresponding author: Irami Araújo-Filho, Postgraduate Program in Biotechnology at Potiguar University/ UnP, Full Professor Department
of Surgery, Federal University of Rio Grande do Norte. Full Professor, Department of Surgery, Potiguar University. Ph.D. in Health Science/
Natal-RN, Brazil
ABSTRACT
This review article examines current evidence on COVID-19 vaccination in pregnant women, focusing on its
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ies indicate that maternal vaccination is safe and effective in mitigating the risk of severe SARS-CoV-2-related
infections, including a reduced incidence of premature deliveries. The vaccine’s immune response supports in-
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of vaccination recommendations. This review supports the continued promotion of COVID-19 vaccination for
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nant individuals.
Keywords: COVID-19; Vaccines; Pregnancy; Immunization; Sars-Cov-2; Pregnancy Complications; Premature
Birth
ARTICLE INFO
Received: January 27, 2025
Published:
Citation: Amália Cinthia Meneses do
Rêgo and Irami Araújo-Filho. COV-
ID-19 Vaccination and Preterm Birth:
J Sci & Tech Res 60(3)-2025. BJSTR.
MS.ID.009460.
Introduction
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-
-
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cal impairments, and weakened immune responses, often necessitat-
further intensify during pregnancy. The immune system of preg-
with immunological changes intrinsic to pregnancy, may heighten
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tive measures to reduce the risks and complications associated with
COVID-19 among pregnant populations.
Copyright@ : Irami Araújo-Filho | Biomed J Sci & Tech Res | BJSTR.MS.ID.009460.
Volume 60- Issue 3 DOI: 10.26717/BJSTR.2025.60.009460
52663
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tial in mitigating the adverse effects of the pandemic on maternal and
However, pregnant women were frequently excluded from early clini-
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dicate that COVID-19 vaccination is generally safe for pregnant women
the incidence of adverse pregnancy outcomes, including preterm
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nation in preventing prematurity, particularly in different gestational
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explored aspect in the literature is the effect of maternal vaccination
distinct clinical characteristics and corresponding risks of neonatal
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tion, supporting the development of more precise and individualized
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ly mRNA and inactivated vaccines, and the different dosing sched-
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vated vaccines remain an essential option, especially in developing
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especially in regions where logistical and economic factors limit vac-
on preterm infants exposed in utero represents an emerging area of
interest. Initial studies primarily examine immediate neonatal out-
However, limited information regarding these children’s neurocogni-
tive and immunological development over their early years is avail-
-
ment of preterm neonates exposed to maternal vaccination highlights
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Therefore, research focusing on these long-term outcomes is es-
sential to provide a more comprehensive view of the implications of
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cy of COVID-19 vaccination in pregnant women who have conditions
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ture provides limited insights into COVID-19 vaccination in pregnant
women with such conditions, hindering the development of tailored
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-
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uterine environment, helping protect the fetus and reduce the likeli-
through which maternal immunization confers this protection remain
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cal for understanding how vaccination prevents pregnancy complica-
The emergence of new SARS-CoV-2 variants, such as Delta and
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mission and virulence characteristics, which may alter the immune
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cine effectiveness against these variants is essential to ensure con-
tinued protection for pregnant women and their infants as the virus
is fundamental to sustained maternal and neonatal health protection
developing countries where socioeconomic constraints and health-
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on COVID-19 vaccination and prematurity is relevant for various de-
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-
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cation strategies that promote adherence. Informed approaches that
Copyright@ : Irami Araújo-Filho | Biomed J Sci & Tech Res | BJSTR.MS.ID.009460. 52664
Volume 60- Issue 3 DOI: 10.26717/BJSTR.2025.60.009460
Vaccination during pregnancy is a relatively new preventive strategy,
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neonatal outcomes associated with maternal vaccination is critical, as
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-
-
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tion in pregnancy, numerous questions remain unanswered. Contin-
type, maternal health conditions, and viral variants, is essential for a
more comprehensive understanding of COVID-19 vaccination effects
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ments and remaining data gaps. By synthesizing existing knowledge
and identifying critical areas for future research, this review aims to
guide ongoing investigations on maternal vaccination, ultimately en-
hancing understanding of how COVID-19 immunization during preg-
Methods
This review study was designed to assess the effectiveness of
COVID-19 vaccination among pregnant women and its role in miti-
gating infectious complications during pregnancy, with a particular
emphasis on prematurity-related outcomes. A systematic literature
-
“COVID-19,” “Vaccines,” “Pregnancy,” “Immunization,” “SARS-CoV-2,”
“Pregnancy Complications, Infectious,” and “Premature Birth.” Bool-
ensure the comprehensive retrieval of studies relevant to this topic.
Inclusion criteria for this review span a range of study designs, in-
cluding randomized clinical trials, cohort studies, case-control stud-
ies, cross-sectional studies, case series, systematic reviews, and
analysis of vaccinated versus unvaccinated pregnant women, focus-
-
potential long-term health implications for neonates. Two reviewers
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olution was sought through discussion; if necessary, a third reviewer
-
-
iations during the selection process. Data extraction was conducted
following a standardized protocol, with key data points collected on
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comes related to COVID-19 vaccination during pregnancy. Thematic
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as the implications for neonatal health in the long term. Additionally,
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vides a comprehensive synthesis of current literature, offering in-
sights into the strengths and limitations of COVID-19 vaccination for
pregnant women. By identifying existing knowledge gaps and propos-
and child across diverse healthcare environments.
Results and Discussion
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-
gests that SARS-CoV-2 infection during pregnancy heightens the risk
the intrauterine environment, increasing the chances of premature
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and fetus from adverse outcomes. Thus, understanding the complex
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-
Copyright@ : Irami Araújo-Filho | Biomed J Sci & Tech Res | BJSTR.MS.ID.009460.
Volume 60- Issue 3 DOI: 10.26717/BJSTR.2025.60.009460
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ness in reducing the severity of COVID-19. However, few studies have
directly compared mRNA vaccines with inactivated vaccines, such as
This lack of comparative data limits our understanding of whether
prematurity.
Table 1: COVID-19 Vaccination - Pregnancy and Prematurity.
Author Study Results
Blakeway, et al. [1] Retrospective Cohort
This study found that COVID-19 vaccination during pregnancy posed no signicant safety risks.
Vaccinated pregnant women showed a reduced incidence of severe COVID-19 complications, in-
cluding a lower rate of preterm births. These results support vaccination as a preventive measure to
reduce adverse pregnancy outcomes associated with COVID-19 infection.
Carbone, et al. [2] Systematic Review &
Meta-analysis
This meta-analysis across multiple studies revealed that maternal COVID-19 vaccination is linked
to a reduced risk of adverse neonatal outcomes, including prematurity and low birth weight. The
ndings underscore the value of maternal immunization to improve neonatal health outcomes by
mitigating the risks associated with maternal SARS-CoV-2 infection.
Jamieson, et al. [3] Review
This review highlighted the protective effects of COVID-19 vaccination in pregnant women, empha-
sizing reduced risks of maternal and neonatal complications due to COVID-19. It strongly supports
vaccination as part of routine prenatal care to safeguard maternal and newborn health by prevent-
ing severe infection-related outcomes.
Male [4] Narrative Review
This study explored the immunological benets of maternal COVID-19 vaccination, particularly
the potential for antibody transfer from mother to fetus, which could offer early-life protection for
newborns. The review suggests that maternal vaccination provides passive immunity to the fetus,
shielding infants from SARS-CoV-2 in early infancy.
Rahmati, et al. [5] Systematic Review &
Meta-analysis
This systematic review conrmed that COVID-19 vaccination in pregnant women lowers both infec-
tion rates and the severity of outcomes, indirectly decreasing the risk of prematurity. The ndings
advocate for incorporating COVID-19 vaccination into prenatal care as it reduces risks associated
with maternal infection and improves neonatal health outcomes.
Kalafat, et al. [7] Cohort Study
Findings showed that vaccinated pregnant women had signicantly lower rates of stillbirth
and preterm birth compared to their unvaccinated counterparts. This study supports the role of
COVID-19 vaccination in reducing pregnancy complications and highlights the need for public
health policies that encourage maternal vaccination.
Du, et al. [10] Cohort Study
This study examined the safety of inactivated COVID-19 vaccines administered in the rst trimester,
concluding there were no adverse effects on pregnancy outcomes. It reinforces the safety of early
vaccination with inactivated vaccines, supporting its use even at early gestational stages without
increased risk of complications.
Lipkind, et al. [11] Population-based
Study
In this large-scale study, no increased risk for preterm or small-for-gestational-age births was found
in vaccinated women, providing robust evidence for the safety of COVID-19 vaccination in preg-
nancy across diverse populations. The study highlights that vaccination does not increase the risk of
adverse pregnancy outcomes.
Shaee, et al. [12] Meta-analysis
A meta-analysis conrming that COVID-19 vaccination during pregnancy does not negatively
affect neonatal outcomes, such as birth weight or gestational age. It supports the safety of vaccina-
tion across all pregnancy trimesters and advocates for maternal immunization as part of standard
prenatal care.
Jaswa, et al. [13] Longitudinal Cohort
This cohort study investigated early neurodevelopmental outcomes in infants exposed to COVID-19
vaccination in utero, nding no adverse effects on cognitive or motor development at 12-18 months.
The study supports the safety of maternal vaccination, showing no negative impact on early child-
hood developmental milestones.
Zhao, et al. [14] Cohort Study
Examined outcomes in pregnancies where inactivated COVID-19 vaccines were administered before
conception, reporting no association with adverse outcomes. These results conrm the safety of
preconception vaccination, indicating no increased risk for complications later in pregnancy.
Fell, et al. [17] Retrospective Cohort
Analysis from a large retrospective cohort study showed a marked reduction in preterm birth
and stillbirth rates among vaccinated mothers, especially among high-risk pregnancies. The study
supports COVID-19 vaccination as a means to improve neonatal survival by preventing SARS-CoV-
2-related adverse outcomes in pregnant women.
Goldshtein, et al. [18] Cohort Study
Results from this cohort study found that maternal vaccination with the BNT162b2 mRNA vaccine
was associated with favorable neonatal outcomes, including the potential enhancement of early-life
immunity through antibody transfer. Findings suggest that vaccination may provide neonates with
some protection against SARS-CoV-2 infection after birth.
Copyright@ : Irami Araújo-Filho | Biomed J Sci & Tech Res | BJSTR.MS.ID.009460. 52666
Volume 60- Issue 3 DOI: 10.26717/BJSTR.2025.60.009460
Hui, et al. [20] Cohort Study
The study found that vaccinated pregnant women had signicantly lower rates of stillbirth and
preterm birth than those unvaccinated, underscoring the importance of maternal vaccination pro-
grams as a strategy to reduce adverse pregnancy outcomes during the pandemic.
Zhang, et al. [25] Meta-analysis
This meta-analysis focused on neonatal outcomes, reporting reduced respiratory complications,
including lower rates of respiratory distress in infants born to vaccinated mothers. Findings support
maternal vaccination for its potential positive impact on neonatal respiratory health, contributing to
healthier neonatal outcomes.
Darwin, et al. [26] Retrospective Cohort
This U.S.-based cohort study found signicant reductions in preterm births among vaccinated
pregnant women. Results underscore the protective effect of COVID-19 vaccination in preventing
preterm births and related neonatal complications, positioning vaccination as a crucial preventive
intervention for maternal and child health.
Note: Source: Authors.
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to guide recommendations in settings where vaccine choice is con-
regimen is also critically important in developing effective maternal
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-
-
-
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are commonly studied, the long-term effects of maternal vaccination
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derstanding the implications of maternal immunization on neurocog-
This research is critical, as it may reveal whether vaccination
during pregnancy supports neonatal immune resilience over time or
-
cinated neonates could also elucidate whether maternal vaccination
confers indirect protection against infections in early infancy-a peri-
-
-
effect would reinforce the value of maternal immunization. Addition-
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mune-related metrics, would provide a comprehensive view of ma-
women with high-risk conditions, such as gestational hypertension
prematurity risk, and vaccination could provide an additional safe-
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groups remains limited, complicating the creation of targeted guide-
lines. Future studies should prioritize including high-risk pregnant
populations to determine whether immunization strategies should
pregnancy. Research into immune response variations across tri-
-
derstanding how timing affects fetal immunity is especially relevant
for optimizing vaccination protocols and could yield insights that re-
impact on placental function and development is a vital yet underex-
plored area. The placenta is essential for nutrient transfer and fetal
health, including vascular function and immune interactions, could
-
-
-
ing respiratory diseases and neonatal infections during pregnancy,
highlighting the importance of maternal immunization against infec-
if COVID-19 vaccines similarly offer protective effects, especially in
Copyright@ : Irami Araújo-Filho | Biomed J Sci & Tech Res | BJSTR.MS.ID.009460.
Volume 60- Issue 3 DOI: 10.26717/BJSTR.2025.60.009460
52667
of SARS-CoV-2 variants, such as Delta and Omicron, poses additional
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indicates that the immune response in vaccinated pregnant women
might vary depending on the circulating variant, emphasizing the
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ies on the effectiveness of different vaccine formulations and dosing
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tion protocols to ensure consistent protection for pregnant women
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-
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among pregnant women, ultimately increasing vaccination rates and
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ally. Many studies on vaccination and prematurity are conducted in
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must include diverse populations from the underrepresented areas
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-
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nicities.
Research in underserved regions and among varied demograph-
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-
-
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data on COVID-19 vaccination in pregnancy are promising, many
questions remain. Research addressing critical gaps—such as optimal
vaccine types, ideal dose schedules, interactions with maternal health
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-
For instance, studies exploring rates of congenital infections, re-
spiratory distress, and NICU admissions among vaccinated mothers’
infants could add depth to our understanding of maternal vaccina-
-
posed to COVID-19 vaccination in utero, particularly regarding neu-
rocognitive and immune development, are critical for assessing the
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-
in pregnant women represents a vital intervention to mitigate risks
timing, maternal immune responses across viral variants, and specif-
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tational age are essential to ensure maternal vaccination guidelines
Conclusion
This review underscores the critical role of COVID-19 vaccina-
tion in pregnancy as a protective measure for maternal and neonatal
safe and effective in mitigating severe infectious complications during
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with SARS-CoV-2 infection. Furthermore, vaccination facilitates ma-
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nant women, further research is needed to address the remaining
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ferent vaccine types, outcomes in high-risk pregnancies, and the im-
-
tion. Additionally, further investigation into varied and underserved
-
Copyright@ : Irami Araújo-Filho | Biomed J Sci & Tech Res | BJSTR.MS.ID.009460. 52668
Volume 60- Issue 3 DOI: 10.26717/BJSTR.2025.60.009460
lines. Current evidence supports continuing COVID-19 vaccination
trust and reduce vaccine hesitancy to maximize coverage.
-
-
care providers and pregnant individuals to make well-informed, safe
decisions.
Acknowledgments
The authors thank the Federal University of Rio Grande do Norte,
study.
Conict of Interest
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Volume 60- Issue 3 DOI: 10.26717/BJSTR.2025.60.009460
52671
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ISSN: 2574-1241
DOI: 10.26717/BJSTR.2025.60.009460
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