{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:46:19Z","timestamp":1790703979218,"version":"4.1.0"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec id=\"ab-poi240032-4\"><jats:title>Importance<\/jats:title><jats:p>COVID-19 vaccination is recommended throughout pregnancy to prevent pregnancy complications and adverse birth outcomes associated with COVID-19 disease. To date, data on birth defects after first-trimester vaccination are limited.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240032-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the associated risks for selected major structural birth defects among live-born infants after first-trimester receipt of a messenger RNA (mRNA) COVID-19 vaccine.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240032-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a retrospective cohort study of singleton pregnancies with estimated last menstrual period (LMP) between September 13, 2020, and April 3, 2021, and ending in live birth from March 5, 2021, to January 25, 2022. Included were data from 8 health systems in California, Oregon, Washington, Colorado, Minnesota, and Wisconsin in the Vaccine Safety Datalink.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240032-7\"><jats:title>Exposures<\/jats:title><jats:p>Receipt of 1 or 2 mRNA COVID-19 vaccine doses in the first trimester, as part of the primary series.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240032-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Selected major structural birth defects among live-born infants, identified from electronic health data using validated algorithms, with neural tube defects confirmed via medical record review.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240032-9\"><jats:title>Results<\/jats:title><jats:p>Among 42\u202f156 eligible pregnancies (mean [SD] maternal age, 30.9 [5.0] years) 7632 (18.1%) received an mRNA COVID-19 vaccine in the first trimester. Of 34\u202f524 pregnancies without a first-trimester COVID-19 vaccination, 2045 (5.9%) were vaccinated before pregnancy, 13\u202f494 (39.1%) during the second or third trimester, and 18\u202f985 (55.0%) were unvaccinated before or during pregnancy. Compared with pregnant people unvaccinated in the first trimester, those vaccinated in the first trimester were older (mean [SD] age, 32.3\u2009[4.5] years vs 30.6\u2009[5.1] years) and differed by LMP date. After applying stabilized inverse probability weighting, differences in baseline characteristics between vaccinated and unvaccinated pregnant persons in the first trimester were negligible (standardized mean difference &amp;amp;lt;0.20). Selected major structural birth defects occurred in 113 infants (1.48%) after first-trimester mRNA COVID-19 vaccination and in 488 infants (1.41%) without first-trimester vaccine exposure; the adjusted prevalence ratio was 1.02 (95% CI, 0.78-1.33). In secondary analyses, with major structural birth defect outcomes grouped by organ system, no significant differences between infants vaccinated or unvaccinated in the first trimester were identified.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240032-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this multisite cohort study, among live-born infants, first-trimester mRNA COVID-19 vaccine exposure was not associated with an increased risk for selected major structural birth defects.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.1917","type":"journal-article","created":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T15:01:48Z","timestamp":1719846108000},"page":"823","source":"Crossref","is-referenced-by-count":26,"title":["COVID-19 Vaccination in the First Trimester and Major Structural Birth Defects Among Live Births"],"prefix":"10.1001","volume":"178","author":[{"given":"Elyse O.","family":"Kharbanda","sequence":"first","affiliation":[{"name":"HealthPartners Institute, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malini B.","family":"DeSilva","sequence":"additional","affiliation":[{"name":"HealthPartners Institute, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather S.","family":"Lipkind","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Romitti","sequence":"additional","affiliation":[{"name":"College of Public Health, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyi","family":"Zhu","sequence":"additional","affiliation":[{"name":"HealthPartners Institute, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly K.","family":"Vesco","sequence":"additional","affiliation":[{"name":"Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G.","family":"Boyce","sequence":"additional","affiliation":[{"name":"Marshfield Clinic Research Institute, Marshfield, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F.","family":"Daley","sequence":"additional","affiliation":[{"name":"Institute for Health Research, Kaiser Permanente Colorado, Denver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candace C.","family":"Fuller","sequence":"additional","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darios","family":"Getahun","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Southern California and Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua T. 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