In this retrospective cohort study, the implications of the COVID-19 vaccination on obstetric and neonatal outcomes for singleton pregnancies have been studied. No discernible differences were discovered for any of the negative outcomes examined between the vaccinated and unvaccinated groups, thus reaffirming the initial assumption of administering the COVID-19 vaccine. At the same time, pregnancy is safe and does not raise the danger of unfavorable perinatal or neonatal outcomes..

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Literature dictates that there is a risk of developing severe COVID-19 disease during pregnancy, causing physiological changes that affect obstetric and neonatal outcomes.6,10,11 However, at least based on the current study, the COVID-19 vaccination looks to be efficient and safe for use during pregnancy. A prior study on a larger cohort of 3,240 vaccinated pregnant women reported no negative effect on pregnancy outcome after receiving the COVID-19 vaccine during pregnancy, which is consistent with the findings of this study.12-18 Moreover, studies have also shown that vaccination of mothers may provide immunity against COVID-19 in their offspring in addition to the vaccine's protective effects on the mothers.19-20

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Two retrospective cohorts, including the larger cohort, found that the risk for meconium-stained amniotic fluid was lower in the vaccinated group, suggesting a protective effect against it.12,18 At the same time, another study, including ours, found no association between the two. Thus, displaying contradicting results.21 Additionally, it has been observed that mothers who test positive for SARS-CoV-2 infection are more likely to have meconium-stained amniotic fluid than those who test negative. Therefore, in order to confirm whether COVID-19 immunization is effective at preventing this neonatal outcome. More research is needed in this area before any definitive conclusions can be drawn about its effectiveness in preventing this neonatal outcome.22,23

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In contrast to our findings, Rottenstreich et al. observed that 712 pregnant women who received two doses of the COVID-19 vaccination during the third trimester had an increased rate of elective cesarean birth and a decreased risk of severe newborn outcomes.21 

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The discussion of the findings of this cohort study on maternal COVID-19 vaccination and pregnancy outcomes in Georgia highlights several significant limitations. Firstly, the overall vaccination rate in Georgia for both COVID-19 and seasonal flu is relatively low: only 34.4% of the overall population is fully vaccinated against coronavirus, with many individuals remaining unvaccinated due to the stigmatization of vaccines in the country.24 The low vaccination rate among the general population may have influenced the results of our study and may not be representative of other areas with higher vaccination rates.

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Another limitation of this study is the sample size, which was relatively small, with only 229 participants. While this sample size was sufficient to provide valuable data, similar studies have utilized larger sample sizes, providing a more comprehensive analysis. Furthermore, the participant's medical records did not include information on their vaccination status, which required contacting each participant individually to obtain consent and clarify their immunization status.

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Despite these limitations, the findings of this study provide important insights into the potential effects of COVID-19 vaccination on pregnancy outcomes in Georgia. Additionally, in order to increase vaccination rates in Georgia, particularly among pregnant women, there is a need for further exploration of the potential benefits of maternal COVID-19 vaccination.

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From a medical standpoint, this research clarifies the safety of administering vaccines to pregnant women since the vaccination was not associated with an increased risk of adverse outcomes. It also increases awareness among women who are either already pregnant or plan to conceive because it increases the perceived reliability of vaccines, as the local community may respond better to the data collected from their immediate environment. Given that many pregnant women are hesitant to receive the vaccine due to safety concerns, caregivers must provide accurate information about its safety and efficacy to increase vaccine acceptance rates among pregnant populations. With such awareness, more people may be prone to get vaccinated, which decreases the burden on the economy caused by the pandemic.

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From a medical standpoint, this research clarifies the safety of administering vaccines to pregnant women since the vaccination was not associated with an increased risk of adverse outcomes. It also increases the awareness in women who are either already pregnant or plan to conceive because it increases the perceived reliability of vaccines, as the local community may respond better to the data collected from their immediate environment. Given that many pregnant women are hesitant to receive the vaccine due to safety concerns, caregivers must provide accurate information about its safety and efficacy to increase vaccine acceptance rates among pregnant populations. With such awareness, more people may be prone to get vaccinated, which decreases the burden on the economy caused by the pandemic.

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Potential confounding factors, such as obesity/high BMI status, smoking, and diabetes, were not considered in the analysis and may have impacted our findings. It has been established that obesity before pregnancy may be associated with an increased risk of hypertensive disorders, for example, preeclampsia.25 Thus, future studies should include adjusting and eliminating any known clinically relevant confounding variables via multivariable regression analysis.

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The scope of the study should be expanded. Namely, bigger population size would increase the statistical power needed to detect clinically relevant and statistically significant differences, thus making the results more reliable. Future studies should focus on larger cohort sizes and longer-term follow-up data to further evaluate the potential benefits and risks of COVID-19 vaccination during pregnancy. Additionally, there is little evidence of innate immunity in a neonate acquired from the mother for COVID-19, making it a significant area for future study.