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COVID-19 vaccination in pregnancy

Journal

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Volume 227, Issue 2, Pages 136-147

Publisher

MOSBY-ELSEVIER
DOI: 10.1016/j.ajog.2022.05.020

Keywords

antibodies; COVID-19; immunogenicity; maternal immunization; pandemic; pregnancy; reactogenicity; SARS-CoV-2; side effects; vaccine

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Despite official and professional endorsements, pregnant individuals still exhibit vaccine hesitancy towards COVID-19 vaccination. Accumulated evidence highlights that pregnant individuals are at special risk for COVID-19 with increased risks of severe complications. However, vaccination reduces these risks and does not pose harm to pregnancy or newborns. Observational studies and data from vaccinated individuals indicate that immunization with mRNA vaccines is safe and highly effective in preventing severe COVID-19 infections in pregnant individuals. Ensuring unrestricted access to COVID-19 vaccination for pregnant individuals should be a global priority.
Despite a recent endorsement from official and professional bodies unequivocally recommending COVID-19 vaccination, vaccine hesitancy among pregnant people remains high. The accumulated evidence demonstrates that pregnant people are a special risk group for COVID-19, with an increased risk of intensive care unit admission, extracor-poreal membranous oxygenation requirement, preterm birth, and perinatal death. These risks are further increased with some variants of concern, and vaccination of pregnant people reduces the COVID-19-related increase in maternal or fetal morbidity. Data from more than 180,000 vaccinated persons show that immunization against COVID-19 with an mRNA vaccine is safe for pregnant people. Many observational studies comparing perinatal outcomes between vaccinated and unvaccinated pregnant people have had reassuring findings and did not demonstrate harmful effects on pregnancy or the newborn. Immunization with mRNA vaccines does not increase the risk of miscarriage, preterm delivery, low birthweight, maternal or neonatal intensive care unit admission, fetal death, fetal abnormality, or pulmonary embolism. Moreover, observational data corroborate the findings of randomized trials that mRNA vaccination is highly effective at preventing severe SARS-CoV-2 infection in pregnant people, emphasizing that the potential maternal and fetal benefits of vaccination greatly outweigh the potential risks of vaccination. Ensuring pregnant people have unrestricted access to COVID-19 vaccination should be a priority in every country worldwide.

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