Discussion:
The Saudi government offered free COVID-19 vaccines to all clients,
irrespective of whether they were Saudi or nonSaudi citizens. The Saudi
minister of health approved
Pfizer-BioNTech, Moderna,
Oxford-AstraZeneca, and Johnson & Johnson COVID-19 vaccines; however,
the participants of this study received all types of vaccines except for
the Johnson & Johnson Vaccine. King Saud Medical City (KSMC) is a
tertiary center in Riyadh with approximately 6000 deliveries annually,
according to KSMC statistics. This study demonstrated that
hypertension-related diseases were more in the vaccinated group than in
the nonvaccinated group, and this result is comparable to that of a
previously published study, which showed that the COVID-19 vaccine might
play a role in acute blood pressure elevation due to an imbalance
between angiotensin II (overactivity) and
angiotensin(16). Preeclampsia was noticed more
frequently among vaccinated women than among nonvaccinated ones. It is
already known that COVID-19 causes pathophysiological changes that can
cause preeclampsia during pregnancy(17).On the other
hand, a recent study demonstrated that the COVID-19 vaccine does not
cause or lead to preeclampsia(18). It was noticed in
this study that thyroid dysfunction was more common in the vaccinated
group, irrespective of whether the diagnosis was made before pregnancy
or just discovered during pregnancy workup; however, no one of them had
a thyroid crisis or was admitted to the ICU. Some reports mentioned that
the COVID-19 vaccine could induce some autoimmune or inflammatory
adverse effects(19). Despite that, the benefits of the
COVID-19 vaccine outweigh the risk of dysfunctional thyroid
disorders(20). Our study shows that the COVID-19
vaccine does not increase the rate of gestational diabetes. This result
is similar to that of a previous report that showed the Safety of the
COVID-19 vaccine and did not link it to an increased risk of gestational
diabetes(21). A systematic review could not prove any
relationship between the COVID-19 vaccine and gestational
diabetes(22). This study showed that the COVID-19
vaccine caused neither polyhydramnios nor oligohydramnios. These
findings are comparable to the results of a previous
study(9). This study showed more NICU admissions for
newborns delivered to vaccinated women than for those born to
nonvaccinated women, and most of these admissions were due to low Apgar
scores and respiratory complications. These findings were not linked to
any type of vaccine or if the women received the vaccine before or
during pregnancy. No neonatal death was reported. A previous
observational study found that exposure to mRNA was not associated with
higher adverse pregnancy or neonatal outcomes in terms of NICU
admission(23). Another published study investigating
the relationship between COVID-19 vaccination in pregnancy and adverse
perinatal outcomes showed no increase in the rate of NICU admission or
low Apgar score(24). Another recent review did not
show any relationship between COVID-19 vaccination and adverse perinatal
outcomes(25). Regarding the gestational age and birth
weight in women who received the COVID-19 vaccine during pregnancy, our
study revealed that the average gestational age of unvaccinated women
was longer than that of vaccinated women. Evidence from prior research
also supports this finding(26). It was also noted that
the mean gestational age of vaccinated women for the second and third
doses was nearly identical to that of vaccinated women for the first
dose. In contrast to this result, one study demonstrated that the
gestational age of women who received a second dose of the COVID-19
vaccine was higher than that of women who had received only one
dose(27). Moreover, the average birth weight of newborns delivered by
unvaccinated women was similar to that of newborns delivered by
vaccinated women; however, the birth weight increased after the second
dose and even more after the third dose. As confirmed by previously
published studies, no difference in gestational age and birth weight was
observed between vaccinated and unvaccinated pregnant women(27–31).
Strength : This study examines women who received the COVID-19
vaccine before or during pregnancy with all the available types of
vaccine at the time of the study.
Limitations : It is a single-center study that lacks extended
follow-up of newborns