ArticleVaccine2026
COVID-19 vaccination during or just prior to pregnancy and hypertensive disorders of pregnancy.
Article in Vaccine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
Hypertensive disorders of pregnancy (HDP) are leading causes of maternal and fetal morbidity/mortality. To identify potential safety concerns, we evaluated whether COVID-19 vaccination during pregnancy or within 30 days of last menstrual period was associated with self-reported HDP. We also evaluated HDP risk associated with COVID-19 illness during pregnancy. We conducted a matched cohort study using data from the Centers for Disease Control and Prevention's COVID-19 Vaccine Pregnancy Registry (C19VPR; vaccinated) and Pregnancy Risk Assessment Monitoring System (PRAMS; unvaccinated). Participants included nulliparous women with singleton pregnancies ending in livebirth (C19VPR, December 2020-March 2022; PRAMS, 2019-2021). Participants were matched by age group, race/ethnicity, and gestational age at delivery. We estimated relative risk (RR) for self-reported HDP by vaccination status using Poisson regression, adjusting for confounders. We tested for effect modification by vaccine manufacturer and vaccination timing (<20 or ≥ 20 weeks' gestation). Among matched pairs with data on self-reported COVID-19 illness in pregnancy, we estimated risk of HDP by illness status. Of 8030 eligible C19VPR participants, 8024 (99.9%) were matched to a PRAMS participant. Most C19VPR participants delivered in 2021 (98.9%); PRAMS participants delivered predominantly in 2020 (54.5%) and 2019 (17.4%). Adjusted RR for HDP was 1.24 (95% confidence interval [CI]: 1.08, 1.43) among C19VPR versus PRAMS participants. We observed no effect modification. Results of an analysis restricted to matched pairs who delivered in 2021 (n = 2231) were similar. Among matched pairs (n = 4039) with data on COVID-19 illness in pregnancy, adjusted RR for HDP was 1.28 (95%CI: 1.02, 1.60) for those reporting illness compared with no illness. Risk of HDP was higher among COVID-19 vaccinated compared to unvaccinated women; however, the two groups were sampled from different cohorts. Risk was similar to those who reported COVID-19 illness. Given cohort differences, the associations observed cannot be considered causal; updated assessments of HDP risks after illness and vaccination would be useful.
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