Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA. USA.
Departments of Pediatrics and Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA.
BMJ. 2022 Aug 10;378:e069741. doi: 10.1136/bmj-2021-069741.
Pregnancy is an independent risk factor for severe covid-19. Vaccination is the best way to reduce the risk for SARS-CoV-2 infection and limit its morbidity and mortality. The current recommendations from the World Health Organization, Centers for Disease Control and Prevention, and professional organizations are for pregnant, postpartum, and lactating women to receive covid-19 vaccination. Pregnancy specific considerations involve potential effects of vaccination on fetal development, placental transfer of antibodies, and safety of maternal vaccination. Although pregnancy was an exclusion criterion in initial clinical trials of covid-19 vaccines, observational data have been rapidly accumulating and thus far confirm that the benefits of vaccination outweigh the potential risks. This review examines the evidence supporting the effectiveness, immunogenicity, placental transfer, side effects, and perinatal outcomes of maternal covid-19 vaccination. Additionally, it describes factors associated with vaccine hesitancy in pregnancy. Overall, studies monitoring people who have received covid-19 vaccines during pregnancy have not identified any pregnancy specific safety concerns. Additional information on non-mRNA vaccines, vaccination early in pregnancy, and longer term outcomes in infants are needed. To collect this information, vaccination during pregnancy must be prioritized in vaccine research.
妊娠是发生严重 COVID-19 的独立危险因素。接种疫苗是降低 SARS-CoV-2 感染风险、限制其发病率和死亡率的最佳方法。目前世界卫生组织、美国疾病预防控制中心和专业组织的建议是让孕妇、产后和哺乳期妇女接种 COVID-19 疫苗。妊娠特有的考虑因素包括疫苗对胎儿发育、胎盘抗体转移和母亲接种疫苗安全性的潜在影响。尽管 COVID-19 疫苗的最初临床试验将妊娠排除在外，但观察性数据正在迅速积累，迄今为止证实接种疫苗的益处超过了潜在风险。本综述探讨了支持母体 COVID-19 疫苗接种有效性、免疫原性、胎盘转移、副作用和围产期结局的证据。此外，还描述了与妊娠期间疫苗犹豫相关的因素。总体而言，监测妊娠期间接种 COVID-19 疫苗人群的研究未发现任何妊娠特异性安全性问题。需要更多关于非 mRNA 疫苗、妊娠早期接种疫苗以及婴儿长期结局的信息。为了收集这些信息，必须在疫苗研究中优先考虑妊娠期间接种疫苗。
