COVID-19 mRNA Vaccines During Pregnancy (2024)

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    March 24, 2022

    Elyse O.Kharbanda,MD, MPH1; GabrielaVazquez-Benitez,PhD1

    JAMA. 2022;327(15):1451-1453. doi:10.1001/jama.2022.2459

    visual abstract icon Visual Abstract editorial comment icon Editorial Comment related articles icon Related Articles author interview icon Interviews multimedia icon Multimedia audio icon Listen to this article
    • Original Investigation Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes

      Deshayne B.Fell,PhD; TavleenDhinsa,MSc; Gillian D.Alton,PhD; EszterTörök,PhD; SheryllDimanlig-Cruz,MSc; Annette K.Regan,PhD; Ann E.Sprague,PhD; Sarah A.Buchan,PhD; Jeffrey C.Kwong,MD; Sarah E.Wilson,MD; Siri E.Håberg,MD, PhD; Christopher A.Gravel,PhD; KumananWilson,MD; DarineEl-Chaâr,MD; Mark C.Walker,MD; JonBarrett,MD; Shannon E.MacDonald,PhD; NannetteOkun,MD; Prakesh S.Shah,MD; Shelley D.Dougan,MSc; SandraDunn,PhD; LiseBisnaire,PhD


    • Original Investigation Association of SARS-CoV-2 Vaccination During Pregnancy With Pregnancy Outcomes

      Maria C.Magnus,PhD; Anne K.Örtqvist,MD, PhD; ElisabethDahlqwist,PhD; RickardLjung,MD, PhD; FredrikSkår,MD; LauraOakley,PhD; FerencMacsali,MD, PhD; BjörnPasternak,MD, PhD; Håkon K.Gjessing,PhD; Siri E.Håberg,MD, PhD; OlofStephansson,MD, PhD


    SARS-CoV-2 infection during pregnancy is associated with increased risk for maternal morbidity and adverse birth outcomes.1,2 COVID-19 vaccines are effective for preventing severe disease, including in pregnant populations.3 Although more than 100 countries recommend COVID-19 vaccination during pregnancy,4 COVID-19 vaccination in pregnant people has lagged behind that for age-matched, nonpregnant adults.5,6 As of February 2022, the US Vaccine Safety Datalink estimated that 68% of pregnant individuals have completed the primary COVID-19 vaccine series.6 Persistent wide disparities in COVID-19 vaccination during pregnancy by race or ethnicity are likely to exacerbate longstanding disparities in maternal morbidity and mortality.6

    Vaccine hesitancy during pregnancy was understandable when COVID-19 vaccines were first authorized,7 because pregnant people were excluded from the initial COVID-19 vaccine trials. Thus, initial data on pregnancy or birth outcomes after maternal COVID-19 vaccination were limited to inadvertent exposures among trial participants early in pregnancy. The mRNA vaccines were novel and their safety in pregnancy was presumed, but not yet proven. Over the past 14 months, a substantial body of evidence supporting the safety of the mRNA COVID-19 vaccines in pregnancy has accumulated. Observational studies from Norway, Israel, and the US have reported that the mRNA COVID-19 vaccines administered during pregnancy were not associated with increased risk for miscarriage, preterm birth, or other select obstetric and birth outcomes.8-11

    In this issue of JAMA, 2 population-based observational retrospective studies evaluating outcomes in more than 250 000 pregnancies from 3 countries together provide the strongest evidence to date regarding the safety of COVID-19 vaccines in pregnancy.12,13

    Fell and colleagues12 used data from the Ontario birth registry, linked with the provincial immunization information system, to identify 97 590 pregnancies eligible for COVID-19 vaccination and with an expected delivery date or live birth from December 14, 2020, to September 30, 2021. Of these pregnant individuals, 23% were vaccinated during pregnancy; most were vaccinated in third trimester. Compared with those vaccinated after pregnancy and, in separate analyses, compared with those who were unvaccinated during pregnancy, COVID-19 vaccination during pregnancy was not associated with increased risks for postpartum hemorrhage, chorioamnionitis, cesarean delivery, neonatal care admission, or low Apgar score.

    Magnus and colleagues13 used data from the Pregnancy Register in Sweden and the Medical Birth Registry of Norway, linked with vaccine registries from both countries, to identify 157 521 singleton pregnancies from January 1, 2021, through early January 2022 and reaching 22 weeks’ gestation. In this cohort, 18% of participants received a COVID-19 vaccine during pregnancy; the majority were vaccinated in the second or third trimester of pregnancy. Compared with individuals who remained unvaccinated during pregnancy, COVID-19 vaccination during pregnancy was not associated with increased risk for preterm birth, stillbirth, small-for-gestational age, low Apgar score, or neonatal care admission.

    Overall, the findings reported by Fell et al12 and Magnus et al13 are extremely reassuring and consistent with published data on more than 40 000 live births in the US (Vaccine Safety Datalink)9 and from nearly 25 000 live births in Israel (Maccabi Healthcare Services).11 Strengths of these studies include the large and well-defined population-based cohorts, the availability of validated data on vaccine exposures and birth outcomes through regional and national registries, and the thoughtful approaches addressing the following common sources of bias in observational studies of maternal vaccination: healthy vaccinee bias and confounding by indication, immortal time bias, and cohort truncation.14,15

    Healthy vaccinee bias refers to differences between vaccinated and unvaccinated populations attributed to vaccination, including in their health or health-related behaviors, that can bias toward a protective effect. Confounding by indication occurs when vaccination is more common among those at increased risk for adverse outcomes after vaccination due to underlying comorbidities and can bias observational studies of vaccine safety in the opposite direction as healthy vaccinee bias. In the Ontario cohort in the study by Fell et al and in the Swedish and Norwegian cohorts in the study by Magnus et al, individuals vaccinated during pregnancy were older than those who were not vaccinated during pregnancy.12,13 Magnus et al reported that, compared with unvaccinated individuals, those vaccinated during pregnancy had higher levels of education, whereas Fell et al observed that vaccinated individuals resided in higher-income neighborhoods and were less likely to smoke during pregnancy.12,13 In the Vaccine Safety Datalink, compared with unvaccinated individuals, those who received a COVID-19 vaccine during pregnancy were older, less likely to have obesity, and less likely to report ever smoking.9

    To address these potential sources of bias, Magnus et al adjusted analyses for age, parity, and select sociodemographic and clinical factors; Fell et al applied a sophisticated approach to minimize healthy vaccinee bias and confounding by indication, using all data available to calculate propensity to be vaccinated. Inverse probability weighting of the propensity to be vaccinated was then applied in adjusted analyses. When groups differ substantially in their health or health-related behaviors, or when data on key differences between groups are not available, a propensity score cannot fully minimize bias. As such, the comparison of individuals vaccinated during pregnancy vs those vaccinated after pregnancy, conducted by Fell et al, was important.12

    The investigators used different methods to address immortal time bias, another potential source of bias in observational studies of maternal vaccination. Shorter pregnancies have less time (fewer days) while pregnant to be vaccinated. This bias can be exacerbated when vaccines are only available over a short period or when they are indicated during a limited gestational window. Magnus et al appropriately evaluated vaccination as a time-dependent exposure in relation to preterm birth and stillbirth, and the hazard ratios showed neither an increased risk nor a decreased risk associated with vaccination. In contrast, Fell et al focused on peripartum outcomes, assessed at the time of delivery. Outcomes such as chorioamnionitis, low 5-minute Apgar score, and neonatal care admission were presumed to not be affected by length of pregnancy and thus risk ratios were evaluated using Poisson regression models. Magnus et al similarly used logistic regression to evaluate neonatal care admission and low Apgar score, not accounting for potential time-dependency of the vaccine exposure. Compared with full-term births, low Apgar scores and neonatal care admissions are much more common in preterm births. Thus, it is not surprising that in a cohort of nearly 100 000 births, Fell et al reported a statistically significant “protective” association between COVID-19 vaccination in pregnancy and these outcomes. Although Magnus et al did not report a similar “protective” association in the full cohort, this finding was evident in sensitivity analyses restricted to third-trimester vaccination.

    The studies by Fell et al and Magnus et al both included analytic approaches intended to minimize cohort truncation bias, which results from over-selection of pregnancies of shorter or longer intervals based on cohort inclusion criteria. This bias can be avoided by using the expected due date, rather than defining cohort eligibility by the date of birth alone. Fell et al included pregnancies with a birth date or expected due date after the COVID-19 vaccines were introduced in Ontario and excluded individuals who did not have the opportunity to reach 42 weeks’ gestation by the end of the study period, avoiding over-selection of shorter pregnancies. Magnus et al also excluded pregnancies that would not have reached 42 weeks’ gestation by the end of the study period; however, pregnancies at the start of the period with a shorter gestation may have been missed.

    Although these studies thoughtfully addressed these common sources of bias, both studies also have limitations. First, there were few first trimester vaccinations in these cohorts. To date, only 1 published study from Israel has described birth outcomes after first-trimester vaccination.11 Second, although the findings regarding maternal COVID-19 vaccination and low Apgar score or neonatal care admission are reassuring, future studies are needed to assess outcomes beyond the immediate perinatal period, including infant morbidity, growth, and development. Third, too few individuals received a viral vector vaccine to comment on the safety of this type of vaccine. Although many countries recommend mRNA vaccines in pregnant populations, others have financial barriers and limited supply. For example, in India, a country with one-sixth of the world’s births, the mRNA vaccines are not currently available and viral vector-based or inactivated virus vaccines are used in pregnancy.4

    The reports by Fell et al and Magnus et al, with their large study populations, thoughtful analytic approach, and lack of any suggestion of safety concerns, are reassuring, especially for pregnant individuals with access to mRNA vaccines in their second or third trimester. However, the question remains whether the evidence from these 2 studies will convince those who remain unvaccinated to receive a COVID-19 vaccine during pregnancy. More work is needed to achieve equity in the availability, acceptance, and administration of life-saving interventions such as the COVID-19 vaccines. Studies of vaccine safety during pregnancy, similar to the studies reported in this issue of JAMA, should be replicated in countries or regions where the viral vector vaccine or inactivated vaccine are the primary COVID-19 vaccines used in pregnant populations. Generation of further evidence should be coupled with effective strategies for disseminating evidence regarding the benefits and safety of COVID-19 vaccination during pregnancy.

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    Article Information

    Corresponding Author: Elyse O. Kharbanda, MD, MPH, 8170 33rd Ave S, Mail stop 21112R, Minneapolis, MN 55425 (

    Published Online: March 24, 2022. doi:10.1001/jama.2022.2459

    Conflict of Interest Disclosures: None reported.



    Magnus MC, Oakley L, Gjessing HK, et al. Pregnancy and risk of COVID-19: a Norwegian registry-linkage study. BJOG. 2022;129(1):101-109. doi:10.1111/1471-0528.16969PubMedGoogle ScholarCrossref


    Ellington S, Strid P, Tong VT, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status: United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):769-775. doi:10.15585/mmwr.mm6925a1PubMedGoogle ScholarCrossref


    Dagan N, Barda N, Biron-Shental T, et al. Effectiveness of the BNT162b2 mRNA COVID-19 vaccine in pregnancy. Nat Med. 2021;27(10):1693-1695. doi:10.1038/s41591-021-01490-8PubMedGoogle ScholarCrossref


    Berman Institute of Bioethics Center for Immunization Research. COVID-19 maternal immunization tracker. Accessed February 15, 2022.


    Stock SJ, Carruthers J, Calvert C, et al. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland. Nat Med. Published online January 13, 2022. doi:10.1038/s41591-021-01666-2PubMedGoogle Scholar


    Centers for Disease Control and Prevention. COVID-19 vaccination among pregnant people aged 18-49 years overall, by race/ethnicity, and date reported to CDC - Vaccine Safety Datalink, United States. Accessed March 1, 2022.


    Battarbee AN, Stockwell MS, Varner M, et al. Attitudes toward COVID-19 illness and COVID-19 vaccination among pregnant women: a cross-sectional multicenter study during August-December 2020. Am J Perinatol. 2022;39(1):75-83. doi:10.1055/s-0041-1735878PubMedGoogle Scholar


    Magnus MC, Gjessing HK, Eide HN, Wilcox AJ, Fell DB, Håberg SE. COVID-19 vaccination during pregnancy and first-trimester miscarriage. N Engl J Med. 2021;385(21):2008-2010. doi:10.1056/NEJMc2114466PubMedGoogle ScholarCrossref


    Lipkind HS, Vazquez-Benitez G, DeSilva M, et al. Receipt of COVID-19 vaccine during pregnancy and preterm or small-for-gestational-age at birth: eight integrated health care organizations, United States, December 15, 2020-July 22, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(1):26-30. doi:10.15585/mmwr.mm7101e1PubMedGoogle ScholarCrossref


    Kharbanda EO, Haapala J, DeSilva M, et al. Spontaneous abortion following COVID-19 vaccination during pregnancy. JAMA. 2021;326(16):1629-1631. doi:10.1001/jama.2021.15494PubMedGoogle ScholarCrossref


    Goldshtein I, Steinberg DM, Kuint J, et al. Association of BNT162b2 COVID-19 vaccination during pregnancy with neonatal and early infant outcomes. JAMA Pediatr. Published online February 10, 2022. doi:10.1001/jamapediatrics.2022.0001PubMedGoogle Scholar


    Fell DB, Dhinsa T, Alton GD, et al. Association of COVID-19 vaccination in pregnancy with adverse peripartum outcomes. JAMA. Published online March 24, 2022. doi:10.1001/jama.2022.4255Google Scholar


    Magnus MC, Örtqvist AK, Dahlqwist E, et al. Association of SARS-CoV-2 vaccination during pregnancy with subsequent pregnancy outcomes. JAMA. Published online March 24, 2022. doi:10.1001/jama.2022.3271Google Scholar


    Fell DB, Dimitris MC, Hutcheon JA, et al. Guidance for design and analysis of observational studies of fetal and newborn outcomes following COVID-19 vaccination during pregnancy. Vaccine. 2021;39(14):1882-1886. doi:10.1016/j.vaccine.2021.02.070PubMedGoogle ScholarCrossref


    Vazquez-Benitez G, Kharbanda EO, Naleway AL, et al. Risk of preterm or small-for-gestational-age birth after influenza vaccination during pregnancy: caveats when conducting retrospective observational studies. Am J Epidemiol. 2016;184(3):176-186. doi:10.1093/aje/kww043PubMedGoogle ScholarCrossref


    3 Comments for this article


    May 6, 2022

    Why Encourage COVID-19 Vaccine Use in Early Weeks of Pregnancy Without Data?

    Dorothy Levine, MD | Connecticut Children's Medical Center; NY Presbyterian Medical Center

    Drs. Kharbanda and Vazquez-Benitez reveal the truth of the current state of US efforts to protect pregnant individuals from serious illness due to COVID-19. They point out the almost complete lack of safety data on COVID-19 mRNA vaccination during the first trimester. Refreshingly, they postulate that a significant and understandable reason that people may not follow the official recommendations is that confirmatory data has neither been collected nor shared.

    In fact, the failure to collect this critical data is often admitted by the authors writing about the safety of vaccination in pregnancy, albeit buried in the

    fine print of the limitations sections of articles. Review of the current literature confirms that the vast majority of pregnant patients analyzed received vaccinations in the second and third trimester. In fact, those articles discussing effects in "early pregnancy" sometimes define that period as under 20 weeks. In other studies of early vaccination, data from patients whose miscarriages occur before 10 weeks is excluded.

    Inexplicably unconcerned, the CDC on its website states that COVID-19 vaccination is recommended for people who are pregnant or trying to get pregnant now..."

    This is in contrast to the approach taken by many European experts and regulatory agencies who state clearly and for the record that due to insufficient information they discourage vaccination in the first trimester except when serious maternal co-morbidities exist.

    The CDC approach seems even more incongruous given the efforts going into identifying a safe and effective mRNA dose for our smallest children. A 3 microgram dose protected the 6 month olds to 2 year olds. Yet the CDC, through its current stance, is recommending 30-50 microgram mRNA dose for women during the potential period of uterine embryo implantation.

    It is time to re-consider the current risk-benefit. Booster doses of mRNA vaccine appear not to provide long-term protection against infection with current variants. Is the unknown risk in the peri-conceptual and earliest weeks of pregnancy of this heightened immunologic environment worthwhile? It will take years to accumulate the data necessary to prove vaccination is safe and non-teratogenic during this early critical time period. Will Institutional Review Boards approve such studies?

    I applaud the recent CDC decision to exclude people in childbearing years from receiving a fourth shot. I believe it is time for the agency to change their stance on COVID-19 vaccination in the earliest weeks of pregnancy. Teens and adults should be strongly encouraged to receive their Covid-19 shots well before becoming pregnant, protecting that critical period of development.



    May 11, 2022

    Author Response

    Elyse Olshen Kharbanda, MD, MPH; Gabriela Vazquez-Benitez, PhD | HealthPartners Institute, Minneapolis, Minnesota

    Dr. Levine’s comment includes several inaccurate statements which we address below.

    First, Dr. Levine reports that in our editorial we note “an almost complete lack of safety data on COVID-19 mRNA vaccination during the first trimester.” Rather, in the editorial we reported that there have been few studies that report on birth outcomes following first trimester vaccination. Birth outcomes refers to outcomes occurring in a live birth (e.g. in relation to gestational age or birth weight). Several groups, including the Centers for Disease Control and Prevention (CDC)-funded Vaccine Safety Datalink, and the CDC funded v-safe pregnancy registry, have evaluated

    first trimester COVID-19 vaccination and risks for miscarriage and found no elevated risks following first trimester COVID-19 mRNA vaccination (1-3).

    Second, Dr. Levine mistakenly presumes there is a “failure to collect … critical data” on early pregnancy mRNA COVID-19 vaccine exposures. Comprehensive and sufficiently powered studies of first trimester vaccination and birth outcomes take time - time for the exposures to occur, the pregnancies to continue through delivery, and finally for the data to be available in vaccine safety surveillance systems. In the U.S., vaccination of pregnant persons increased substantially starting in April 2021, when vaccines were recommended and became widely available in the general adult population (4). Those vaccinated early in pregnancy in April 2021 or thereafter would be expected to deliver in January 2022 or later. So for U.S.-based studies, data on these exposures is now accumulating and additional studies on COVID-19 mRNA vaccine safety in first trimester are forthcoming. In Israel, where widespread vaccination in pregnant people began earlier than in the U.S., Goldshtein and colleagues reported on a population-based cohort of over 24,000 newborns, including 2134 infants born to pregnant persons who received an mRNA COVID-19 vaccine in first trimester and found no association between first trimester vaccination and preterm birth, small-for-gestational age birth, congenital anomalies, or all-cause hospitalization (5).

    Third, Dr. Levine mistakenly states that “safe” dosing of mRNA vaccines during pregnancy should be similar to the dose administered to infants and young children. This is not consistent with how influenza, hepatitis B, or other vaccines are dosed in pregnant versus infant populations. The comment also does not account for what is known about the pharmaco*kinetics of the mRNA vaccines. A key breakthrough in the development of the mRNA vaccines was enveloping the mRNA in a lipid nanoparticle as naked mRNA rapidly degrades. As administered, mRNA vaccines are adsorbed by the intramuscular cells near the injection site. Although it would not be safe to assay amniotic fluid or fetal tissue for evidence of mRNA vaccine following maternal vaccination, it has been demonstrated that mRNA vaccines are not detected in breast milk 4 to 48 hours after vaccination (6).

    Throughout the pandemic the CDC has supported research to evaluate the safety of COVID-19 vaccines in pregnant populations. To date, there is no data demonstrating that COVID-19 vaccination in pregnancy has been harmful to pregnant populations while there is ample evidence of the risks of COVID-19 infection during pregnancy, supporting the current CDC recommendations. We trust that the CDC and other regulatory bodies will continue to review data as they become available and that recommendations will be updated or modified if there is ever a shift in the risk-benefit profile of COVID-19 vaccination in pregnancy.


    1. Kharbanda EO, Haapala J, DeSilva M, Vazquez-Benitez G, Vesco KK, Naleway AL, Lipkind HS. Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy. JAMA. 2021 Oct 26;326(16):1629-1631. doi: 10.1001/jama.2021.15494. Erratum in: JAMA. 2021 Sep 10;:null. PMID: 34495304; PMCID: PMC8427483.

    2. Magnus MC, Gjessing HK, Eide HN, Wilcox AJ, Fell DB, Håberg SE. Covid-19 Vaccination during Pregnancy and First-Trimester Miscarriage. N Engl J Med. 2021 Nov 18;385(21):2008-2010. doi: 10.1056/NEJMc2114466. Epub 2021 Oct 20. PMID: 34670062; PMCID: PMC8552533.

    3. Zauche LH, Wallace B, Smoots AN, Olson CK, Oduyebo T, Kim SY, Petersen EE, Ju J, Beauregard J, Wilcox AJ, Rose CE, Meaney-Delman DM, Ellington SR; CDC v-safe Covid-19 Pregnancy Registry Team. Receipt of mRNA Covid-19 Vaccines and Risk of Spontaneous Abortion. N Engl J Med. 2021 Oct 14;385(16):1533-1535. doi: 10.1056/NEJMc2113891. Epub 2021 Sep 8. PMID: 34496196; PMCID: PMC8451181.

    4. Centers for Disease Control and Prevention. COVID-19 vaccination among pregnant people aged 18-49 years overall, by race/ethnicity, and date reported to CDC - Vaccine Safety Datalink, United States. Accessed May 10, 2022.

    5. Goldshtein I , Steinberg DM , Kuint J , et al. Association of BNT162b2 COVID-19 vaccination during pregnancy with neonatal and early infant outcomes. JAMA Pediatr. Published online February 10, 2022. doi:10.1001/jamapediatrics.2022.0001

    6. Golan Y, Prahl M, Cassidy A, et al. Evaluation of Messenger RNA From COVID-19 BTN162b2 and mRNA-1273 Vaccines in Human Milk. JAMA Pediatr. 2021;175(10):1069–1071. doi:10.1001/jamapediatrics.2021.1929



    November 13, 2022

    Covid-19 mRNA Vaccines During Pregnancy

    Ediriweera Desapriya, PhD | Department of Pediatrics, Faculty of Medicine, UBC, BC Children Hospital

    A recent meta-analysis that compared outcomes for pregnant patients with COVID-19 vs age and sex-matched non-pregnant patients with COVID-19 found that pregnancy increases the risk of needing intensive care (OR 2.13, 95% (CI) 1.54–2.95) (1). A more recent meta-analysis, which compared outcomes for pregnant patients infected with COVID-19 with those who were not infected, found that infection significantly increased the odds of premature delivery and stillbirth (OR 2.36, CI 1.24–4.46), neonatal mortality (OR 3.35, CI 1.07–10.5) and maternal mortality (OR 3.08, CI 1.5–6.3) (2).

    Despite heightened safety concerns in this population, pregnant women have long been left out of

    therapeutic and vaccine research. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine encouraged the Food and Drug Administration to include pregnant women in the COVID-19 vaccine emergency use authorization (EUA). Although pregnant mothers were excluded from the first trials of COVID-19 vaccines, we now have extensive real-world data confirming the safety and effectiveness of the vaccines during pregnancy; a recent study reported that vaccine-induced immune responses were statistically significantly greater than the response to natural infection (3). More importantly the results showed immune transfer to neonates via placenta and breastmilk. Vaccine-generated antibodies were also present in all umbilical cord blood and breast milk samples taken, showing the transfer of antibodies from mothers to newborns (3, 4). Encouraging evidence further asserts that receiving a booster dose has the potential to augment maternal and neonatal immunity (5). Therefore, study results on vaccine efficacy is encouraging news for pregnant and breastfeeding mothers who may enhance protection of the mother and infant against Omicron. We now have extensive data confirming the safety and efficacy of COVID-19 vaccination during pregnancy. Dissemination of best evidence to empower pregnant mothers and their families to make informed decision making is timely and important.


    1. Allotey J, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320. d

    2. Marchand G, et al. Review and meta-analysis of COVID maternal and neonatal clinical features and pregnancy outcomes to June 3rd 2021. AJOG Glob. Rep. 2021;3:100049.

    (3). Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, Baez AM, Shook LL, Cvrk D, James K, De Guzman RM, Brigida S, Diouf K, Goldfarb I, Bebell LM, Yonker LM, Fasano A, Rabi SA, Elovitz MA, Alter G, Edlow AG. COVID-19 vaccine response in pregnant and lactating women: a cohort study. medRxiv [Preprint]. 2021 Mar 8:2021.03.07.21253094. doi: 10.1101/2021.03.07.21253094. Update in: Am J Obstet Gynecol. 2021 Mar 24;

    (4). Male V. SARS-CoV-2 infection and COVID-19 vaccination in pregnancy. Nat Rev Immunol. 2022 May;22(5):277-282. doi: 10.1038/s41577-022-00703-6. Epub 2022 Mar 18. PMID: 35304596;

    (5). Atyeo C, Shook LL, Nziza N, Deriso EA, Muir C, Baez AM, Lima RS, Demidkin S, Brigida S, De Guzman RM, Burns MD, Balazs AB, Fasano A, Yonker LM, Gray KJ, Alter G, Edlow AG. COVID-19 booster dose induces robust antibody response in pregnant, lactating, and nonpregnant women. Am J Obstet Gynecol. 2022 Jul 19:S0002-9378(22)00562-2. doi: 1



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    Kharbanda EO, Vazquez-Benitez G. COVID-19 mRNA Vaccines During Pregnancy: New Evidence to Help Address Vaccine Hesitancy. JAMA. 2022;327(15):1451–1453. doi:10.1001/jama.2022.2459

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