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A reasoned approach towards administering COVID-19 vaccines to pregnant women |
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| Authors: | Angsumita Pramanick Abhiram Kanneganti Jing Lin Jeslyn Wong Sarah Weiling Li Pooja Sharma Dimri Aniza Puteri Mahyuddin Sailesh Kumar Sebastian Enrique Illanes Jerry Kok Yen Chan Lin Lin Su Arijit Biswas Paul Anantharajah Tambyah Ruby Yun-Ju Huang Citra Nurfarah Zaini Mattar Mahesh Choolani |
| Institution: | 1. Department of Obstetrics and Gynaecology, National University Hospital Singapore, Singapore;2. Department of Obstetrics and Gynaecology, National University Hospital Singapore, Singapore
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;3. Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;4. Mater Research Institute-University of Queensland, South Brisbane, Queensland, Australia Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia;5. Department of Obstetrics 6. & Gynaecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile;7. Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore Academic Clinical Program in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore;8. Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;9. School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan |
| Abstract: | There are over 50 SARS-CoV-2 candidate vaccines undergoing Phase II and III clinical trials. Several vaccines have been approved by regulatory authorities and rolled out for use in different countries. Due to concerns of potential teratogenicity or adverse effect on maternal physiology, pregnancy has been a specific exclusion criterion for most vaccine trials with only two trials not excluding pregnant women. Thus, other than limited animal studies, gradually emerging development and reproductive toxicity data, and observational data from vaccine registries, there is a paucity of reliable information to guide recommendations for the safe vaccination of pregnant women. Pregnancy is a risk factor for severe COVID-19, especially in women with comorbidities, resulting in increased rates of preterm birth and maternal morbidity. We discuss the major SARS-CoV-2 vaccines, their mechanisms of action, efficacy, safety profile and possible benefits to the maternal-fetal dyad to create a rational approach towards maternal vaccination while anticipating and mitigating vaccine-related complications. Pregnant women with high exposure risks or co-morbidities predisposing to severe COVID-19 infection should be prioritised for vaccination. Those with risk factors for adverse effects should be counselled accordingly. It is essential to support patient autonomy by shared decision-making involving a risk-benefit discussion with the pregnant woman. |
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