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.

中文翻译：

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为孕妇接种 COVID-19 疫苗的合理方法

有超过 50 种 SARS-CoV-2 候选疫苗正在进行 II 期和 III 期临床试验。多种疫苗已获得监管机构批准并在不同国家推广使用。由于担心潜在的致畸性或对母体生理的不利影响，怀孕一直是大多数疫苗试验的具体排除标准，只有两项试验不排除孕妇。因此，除了有限的动物研究、逐渐出现的发育和生殖毒性数据以及疫苗登记处的观察数据外，缺乏可靠的信息来指导孕妇安全接种疫苗的建议。怀孕是严重 COVID-19 的危险因素，尤其是患有合并症的女性，导致早产率和孕产妇发病率增加。我们讨论了主要的 SARS-CoV-2 疫苗、其作用机制、功效、安全性以及对母胎二人可能的益处，以制定合理的孕产妇疫苗接种方法，同时预测和减轻疫苗相关并发症。具有高暴露风险或易患严重 COVID-19 感染的合并症的孕妇应优先接种疫苗。那些有不良反应危险因素的人应该得到相应的咨询。通过与孕妇进行风险收益讨论的共同决策来支持患者的自主权至关重要。