{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:06:58Z","timestamp":1788516418487,"version":"build-2803163510"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pregnancy represents a physiological state associated with increased vulnerability to severe outcomes from infectious diseases, both for the pregnant person and developing infant. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic may have important health consequences for pregnant individuals, who may also be more reluctant than nonpregnant people to accept vaccination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We sought to estimate the degree to which increased severity of SARS-CoV-2 outcomes can be attributed to pregnancy using a population-based SARS-CoV-2 case file from Ontario, Canada. Because of varying propensity to receive vaccination, and changes in dominant circulating viral strains over time, a time-matched cohort study was performed to evaluate the relative risk of severe illness in pregnant women with SARS-CoV-2 compared to other SARS-CoV-2 infected women of childbearing age (10\u201349 years old). Risk of severe SARS-CoV-2 outcomes was evaluated in pregnant women and time-matched nonpregnant controls using multivariable conditional logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with the rest of the population, nonpregnant women of childbearing age had an elevated risk of infection (standardized morbidity ratio, 1.28), whereas risk of infection was reduced among pregnant women (standardized morbidity ratio, 0.43). After adjustment for confounding, pregnant women had a markedly elevated risk of hospitalization (adjusted odds ratio, 4.96; 95% confidence interval, 3.86\u20136.37) and intensive care unit admission (adjusted odds ratio, 6.58; 95% confidence interval, 3.29\u201313.18). The relative increase in hospitalization risk associated with pregnancy was greater in women without comorbidities than in those with comorbidities (P for heterogeneity, .004).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Given the safety of SARS-CoV-2 vaccines in pregnancy, risk-benefit calculus strongly favors SARS-CoV-2 vaccination in pregnant women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciac544","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T09:17:06Z","timestamp":1657099026000},"page":"e200-e206","source":"Crossref","is-referenced-by-count":7,"title":["Severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Pregnancy in Ontario: A Matched Cohort Analysis"],"prefix":"10.1093","volume":"76","author":[{"given":"Kiera R","family":"Murison","sequence":"first","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia A","family":"Grima","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison E","family":"Simmons","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashleigh R","family":"Tuite","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada"},{"name":"Centre for Immunization Readiness, Public Health Agency of Canada , Ottawa, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N","family":"Fisman","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"2023020817085090300_ciac544-B1","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.3201\/eid1211.060152","article-title":"Emerging infections and pregnancy","volume":"12","author":"Jamieson","year":"2006","journal-title":"Emerg Infect Dis"},{"key":"2023020817085090300_ciac544-B2","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1080\/08830180215017","article-title":"Immunological relationship between the mother and the fetus","volume":"21","author":"Szekeres-Bartho","year":"2002","journal-title":"Int Rev Immunol"},{"key":"2023020817085090300_ciac544-B3","doi-asserted-by":"crossref","first-page":"391","DOI":"10.3855\/jidc.3777","article-title":"Immune responses during gestational malaria: a review of the current knowledge and future trend of research","volume":"8","author":"Maestre","year":"2014","journal-title":"J Infect Dev Ctries"},{"issue":"1","key":"2023020817085090300_ciac544-B4","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1128\/CMR.00062-13","article-title":"Host immune status and response to hepatitis E virus infection","volume":"27","author":"Krain","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"2023020817085090300_ciac544-B5","doi-asserted-by":"crossref","first-page":"431","DOI":"10.4103\/0970-9185.194779","article-title":"Acute respiratory failure and mechanical ventilation in pregnant patient: a narrative review of literature","volume":"32","author":"Bhatia","year":"2016","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2023020817085090300_ciac544-B6","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/9781444316780.ch9","volume-title":"Critical Care Obstetrics","author":"Pacheco","year":"2010","edition":"5 ed"},{"key":"2023020817085090300_ciac544-B7","first-page":"626","volume-title":"Critical Care Obstetrics","author":"Yankowitz","year":"2010","edition":"5 ed"},{"key":"2023020817085090300_ciac544-B8","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1002\/ijgo.14008","article-title":"Systematic review of the safety, immunogenicity, and effectiveness of COVID-19 vaccines in pregnant and lactating individuals and their infants","volume":"156","author":"Fu","year":"2022","journal-title":"Int J Gynaecol Obstet"},{"key":"2023020817085090300_ciac544-B9","doi-asserted-by":"crossref","first-page":"3371","DOI":"10.1080\/21645515.2021.1924018","article-title":"\u201cThis choice does not just affect me.\u201d Attitudes of pregnant women toward COVID-19 vaccines: a 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COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)"},{"key":"2023020817085090300_ciac544-B12","first-page":"1640","article-title":"Risk for stillbirth among women with and without COVID-19 at delivery hospitalization - United States, March 2020-September 2021","volume-title":"MMWR Morb Mortal Wkly Rep","author":"DeSisto","year":"2021"},{"key":"2023020817085090300_ciac544-B13","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.15585\/mmwr.mm6944e3","article-title":"Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020","volume":"69","author":"Zambrano","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023020817085090300_ciac544-B14","doi-asserted-by":"crossref","first-page":"769","DOI":"10.15585\/mmwr.mm6925a1","article-title":"Characteristics of women of reproductive age with 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