Abstract
Maternal immunization against some infectious diseases can offer significant advantages for women, preventing maternal morbidity and mortality, or for offspring, preventing fetal disease and conferring passive immunity to neonates. Recently, clinical trials specifically to evaluate the immunogenicity, safety, and tolerability of some of the available coronavirus disease 2019 (COVID-19) vaccines in pregnant and lactating women have been planned, initiated and, in some cases, completed. This paper discusses whether the immunization of pregnant women against COVID-19 is justified and presents knowledge about the immunogenicity and safety of mRNA COVID-19 vaccines for these subjects. The results of recent studies indicate that pregnant women are at increased risk of developing severe disease compared with nonpregnant women of the same age. Studies carried out with mRNA vaccines indicate that the immunogenicity, safety and tolerability of these preventive measures in pregnant women are not different from those in nonpregnant women of the same age. Moreover, antibodies are efficiently transferred through the placenta and can be detected in breastmilk, suggesting a potential prevention of infection in the child. All these findings authorize the use of mRNA vaccines in pregnant women to protect both the mother and the child. However, further studies with larger sample size and with follow-up of the pregnant women vaccinated during different periods of pregnancy and their children are needed to better characterize the immune response of pregnant women, to define when these vaccines should be administered to obtain the best protection, and to measure vaccine efficacy against virus variants in both mothers and infants. COVID-19 vaccines based on different technological platforms cannot presently be used, and their role in pregnant women should be clarified.
Highlights
COVID-19 vaccines based on different technological platforms cannot presently be used, and their role in pregnant women should be clarified
To strongly recommend early vaccination of pregnant women regardless of whether or not they have an underlying diseases, evidence should be available that pregnant women infected by SARS-CoV-2 are at increased risk of developing a more severe disease and/or that pregnancy can be characterized by a higher incidence of complications and/or that the fetus and/or the neonate can have a number of relevant clinical problems
The results of studies carried out in the year following the declaration of the COVID-19 pandemic indicate that pregnant women are at increased risk of developing severe disease compared with nonpregnant women of the same age
Summary
Pregnancy occurs in a period of life during which SARS-CoV-2 infection is generally asymptomatic or associated with mild disease. It is suggested that these vaccines are given to young, healthy adults only after older people and the population of any age at risk, because of more frequent exposure to the virus or suffering from a chronic severe disease, have already been immunized [21,22,23]. To strongly recommend early vaccination of pregnant women regardless of whether or not they have an underlying diseases, evidence should be available that pregnant women infected by SARS-CoV-2 are at increased risk of developing a more severe disease and/or that pregnancy can be characterized by a higher incidence of complications and/or that the fetus and/or the neonate can have a number of relevant clinical problems
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