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