Safety and Benefits of COVID-19 Vaccination in Pregnancy—Implications for the Maternal Vaccination Platform

The development of safe and effective vaccines against the novel SARS-CoV-2 virus, the cause of COVID-19 pandemic, was justifiably hailed as a major advance in protecting the population against severe and fatal infection. The vaccine rollout was targeted toward recognized communities at risk, including older adults, those with comorbidities, and those who were immunosuppressed. Pregnant women, and by extension, their infants, were included in these high-risk groups for vaccination. The prioritization of pregnant women was justified from historical observations of disproportionate mortality and morbidity during previous influenza pandemics. For example, during the 1918 Spanish influenza pandemic, 50% of infected pregnant women died. Despite advances in public health, intensive care, and therapeutics a century later, during the 2009 H1N1 influenza pandemic, infected pregnant women had a 7-fold higher need of intensive care compared with those who were not pregnant and accounted for 5% of H1N1-associated deaths in the US but only 1% of the population. Increased COVID-19–related maternal and neonatal morbidity and mortality was observed in international longitudinal observational and prospective cohort studies. Similar studies demonstrate the immunogenicity, effectiveness, and infant protection conferred by maternal vaccination. It is, therefore, disappointing that the uptake of COVID-19 vaccination in pregnancy remains suboptimal.