COVID-19 Vaccination During Pregnancy

Abstract

To the Editor In their article, Watanabe and colleagues 1 reported that COVID-19 vaccination during pregnancy was not associated with an increased risk of peripartum outcomes and was associated with a decreased risk of neonatal intensive care unit admission, intrauterine fetal death, and maternal SARS-CoV-2 infection.Several issues need to be clarified before a more robust conclusion can be made. Vaccination hesitancy during pregnancy was closely associated with safety and efficacy concern as well as the lack of vaccine knowledge. 2 Active recommendation by health care professionals and accurate cognition promoted the COVID-19 vaccination during pregnancy. In this sense, the pregnant people accepting the COVID-19 vaccination were more likely to be concerned with the impact of the vaccine and health themselves, leading to more frequent follow-up visits and intensive intervention for possible disorders. On the other hand, pregnant people with some comorbidities were more likely to refuse the vaccine due to the health concerns, which indicated that the pregnant people receiving the COVID-19 vaccination may be less likely to be with complications themselves. The participants included in this meta-analysis were largely from high-income countries. The financial status and educational background may also play a role in the efficacy of the COVID-19 vaccination. 3 All these factors may contribute to the good peripartum outcomes of COVID-19 vaccination during pregnancy. Further studies should be performed adjusted for these confounding factors, such as health status, race and ethnicity, income, and educational background.The timing and doses of COVID-19 vaccination during pregnancy may affect the peripartum outcomes. The study by Watanabe et al 1 showed that COVID-19 vaccination during the second or third trimester was associated with lower risks of preterm birth and small for gestational age vs those who did not receive COVID-19 vaccination during pregnancy. Multiple doses of the COVID-19 vaccine provided better preventive effect of COVID-19 and increased the immunological effect. Maternal antibodies transferred through the placenta from the 17th and 18th week of pregnancy, which indicated that maternal vaccination during the early second trimester of gestation may be helpful for the neonate. 4 Whereas the first 3 months were vital for embryonic development, 5 pregnant women themselves also need the protection of antibodies as soon as possible, and the immunological effect of COVID-19 vaccination may also play a role in the neonate.Hence, a comprehensive comparison among different timing and doses of COVID-19 vaccination during pregnancy may be needed to elucidate the optimal timing and doses for providing a better peripartum outcomes with less complications.