The association between maternal influenza vaccination during pregnancy and adverse birth outcomes in the United States: Pregnancy risk Assessment Monitoring System (PRAMS)

Objective: Influenza vaccination during pregnancy is highly recommended. We examined the association between maternal influenza vaccination and adverse birth outcomes.Methods: This cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) during 2012-2017. The primary exposure was the receipt of influenza vaccination during preg-nancy. Low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) were the primary outcomes. We conducted multivariable logistic regression models to estimate the adjusted odds ratios (AOR) and 95% confidence intervals (CI). Covariates used to adjust confounding included maternal age, marital status, education, race and ethnicity, insurance status before pregnancy, and smoking status. For a subgroup in 2012-2015, we analyzed the association between influenza vaccination in each trime-ster and adverse birth outcomes.Results: During 2012-2017, compared with unvaccinated women, women vaccinated during pregnancy had a lower risk of LBW and PTB. During 2012-2015, maternal influenza vaccination in the 1st and 3rd trimesters was associated with a reduced risk of LBW and PTB, and vaccination in the 3rd trimester had a greater protective effect than in the 1st trimester. Influenza vaccination was not associated with SGA regardless of trimester. Conclusions: Our findings suggest that influenza vaccination during pregnancy is a safe and effective way to protect newborns.(c) 2023 Elsevier Ltd. All rights reserved.