Sir,

We agree that tracking changes in vaccination patterns over time in the peripartum period is critical.¹ The follow up in our cohort² was relatively short (6 months), and further follow up is needed. Such data may highlight how pregnancy and the postpartum period, including breastfeeding, may impact coronavirus disease 2019 (COVID-19) vaccination relative to other less transient factors, including adverse social determinants of health, such as minority race and ethnicity, lower educational attainment and inadequate insurance coverage, as well as chronic comorbidities.

In addition to changes over time, local context matters. We agree that the relative impact of risk factors for vaccination in the peripartum period are likely to vary by regional setting. In addition to local viral dynamics, the local political milieu and social mores also impact COVID-19 vaccine uptake. Ongoing international collaborations conducted in the peripartum period that importantly also include low- and-middle-income countries, such as INTERCOVID^{3, 4} and the NICHD Global Network,⁵ will be critical to understanding regional variation in COVID-19 vaccination.

Finally, we agree that continuing to track high-risk groups, including pregnant and lactating individuals, is critical. Pregnancy itself is a risk factor for increased COVID-19 severity. Individuals in the peripartum period were originally excluded from COVID-19 vaccine clinical trials, but since then, observational data have supported the safety and efficacy of vaccination in this population, and clinical trials in pregnancy are ongoing. In addition, innovative strategies to increase COVID-19 vaccine uptake in pregnant and postpartum individuals will likely be necessary that engage community stakeholders and healthcare systems through provider dashboards and patient mobile applications.

先生，

我们同意在围产期跟踪疫苗接种模式随时间的变化至关重要。^{1我们队列2}的随访时间相对较短（6 个月），需要进一步随访。此类数据可能突出显示怀孕和产后期间（包括母乳喂养）如何影响 2019 年冠状病毒病 (COVID-19) 疫苗接种相对于其他不太短暂的因素，包括不利的健康社会决定因素，例如少数种族和民族、较低的教育程度和保险覆盖面不足，以及慢性合并症。

除了随时间的变化外，本地环境也很重要。我们同意围产期疫苗接种风险因素的相对影响可能因地区环境而异。除了当地的病毒动态外，当地的政治环境和社会习俗也会影响 COVID-19 疫苗的使用。围产期正在进行的国际合作也包括中低收入国家，如 INTERCOVID ^3、4和 NICHD 全球网络⁵ ，这对于了解 COVID-19 疫苗接种的区域差异至关重要。

最后，我们同意继续追踪高危人群，包括孕妇和哺乳期个体，这一点至关重要。怀孕本身就是 COVID-19 严重程度增加的一个风险因素。围产期个体最初被排除在 COVID-19 疫苗临床试验之外，但从那时起，观察数据支持了该人群接种疫苗的安全性和有效性，并且正在进行妊娠期临床试验。此外，通过提供者仪表板和患者移动应用程序让社区利益相关者和医疗保健系统参与进来，可能需要采取创新策略来增加孕妇和产后个体的 COVID-19 疫苗接种率。