Perspectives on administration of COVID-19 vaccine to pregnant and lactating women: a challenge for low- and middle-income countries

Geraldo Duarte; Conrado Milani Coutinho; Daniel Lorber Rolnik; Silvana Maria Quintana; Ana Cláudia Rabelo E Silva; Liona C Poon; Fabrício da Silva Costa

doi:10.1016/j.xagr.2021.100020

Perspectives on administration of COVID-19 vaccine to pregnant and lactating women: a challenge for low- and middle-income countries

AJOG Glob Rep. 2021 Nov;1(4):100020. doi: 10.1016/j.xagr.2021.100020. Epub 2021 Sep 3.

Authors

Geraldo Duarte¹, Conrado Milani Coutinho¹, Daniel Lorber Rolnik², Silvana Maria Quintana¹, Ana Cláudia Rabelo E Silva¹, Liona C Poon³, Fabrício da Silva Costa⁴

Affiliations

¹ Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil (Drs Duarte, Coutinho, and Quintana and Ms Silva).
² Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia (Dr Rolnik).
³ Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China (Dr Poon).
⁴ Maternal-Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia (Dr Costa).

Abstract

Women who are in the pregnancy-puerperal cycle or are lactating have been deliberately excluded from participating in COVID-19 vaccine clinical trials that aimed to evaluate either the efficacy of the vaccines in inducing the formation of neutralizing antibodies or the investigational products' safety profile. The exclusion of pregnant and lactating women from such studies certainly and inequitably denies these women access to COVID-19 vaccines, since these products have become increasingly available to nonpregnant people and even to those who are pregnant and are in high-income settings. In this clinical opinion article, we discuss some aspects of the prolonged pandemic, the emergence of viral variants, the risks of severe complications of COVID-19 in pregnant women, and the disproportionate impact of the above on low- and middle-income countries. We argue that the decision to receive the COVID-19 vaccine should be a joint decision between the pregnant or lactating women and the healthcare providers, while considering the available data on vaccine efficacy, safety, the risks of SARS-CoV-2 infection in pregnant women, and the women's individual risks for infection and serious illness. The various types of vaccines that are already in use and their safety, effectiveness, and the potential risks and benefits of their administration to pregnant or lactating women are also reviewed.

Keywords: COVID-19; breastfeeding; coronavirus disease; lactation; pregnancy; pregnancy complications; randomized trials; vaccine.