Accommodating vaccine preferences among women of childbearing age

Initial trials of the COVID-19 vaccines excluded pregnant persons, which later caused their emergency use authorizations in the United States. Gray et al. demonstrated robust vaccine-induced immune responses among pregnant women following COVID-19 messenger RNA (mRNA) vaccination (Pfizer-BioNTech and Moderna), with placental and breastmilk immune transfer to neonates. Unfortunately, women of childbearing age experienced rare clotting events following Janssen and AstraZeneca COVID-19 vaccination, which dampened their enthusiasm for these vaccines. 

Improving vaccine uptake among pregnant women is important as the recent evidence suggests that pregnant women with SARS-CoV-2 infection have a markedly increased risk of adverse maternal and neonatal health outcomes, including 22 times the risk of maternal mortality and twice the risk of both severe neonatal morbidity and perinatal morbidity and mortality than do pregnant women without SARS-CoV-2 infection.

So, it is crucial to tailor education and vaccine deployment efforts to prioritize pregnant persons to mitigate newly recognized maternal and neonatal health risks following SARS-CoV-2 infection. Further, it is also important to respect patients’ right to make voluntary and informed healthcare decisions by providing a choice among the available COVID-19 vaccines.

Czeisler ME, Rajaratnam SMW, Howard ME, Czeisler CA. Accommodating vaccine preferences among women of childbearing age. American Journal of Obstetrics and Gynecology. 2021;225(6):697-699.