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Review
. 2022 Apr;226(4):459-474.
doi: 10.1016/j.ajog.2021.10.041. Epub 2021 Nov 11.

Maternal vaccination: a review of current evidence and recommendations

Melanie Etti  1 , Anna Calvert  2 , Eva Galiza  2 , Suzy Lim  2 , Asma Khalil  3 , Kirsty Le Doare  2 , Paul T Heath  4
Affiliations
Review

Maternal vaccination: a review of current evidence and recommendations

Melanie Etti et al. Am J Obstet Gynecol. 2022 Apr.

Abstract

Maternal vaccination is an effective means of protecting pregnant women, their fetuses, and infants from vaccine-preventable infections. Despite the availability of sufficient safety data to support the use of vaccines during pregnancy, maternal immunization remains an underutilized method of disease prevention, often because of concerns from both healthcare providers and pregnant women about vaccine safety. Such concerns have been reflected in the low uptake of the COVID-19 vaccine among pregnant women seen in many parts of the world. Here, we present an update of the current recommendations for the use of vaccines during pregnancy, including the evidence supporting the use of novel vaccine platforms. We also provide an overview of the data supporting the use of COVID-19 vaccines in pregnancy and an update of the status of vaccines that are currently under development for use in pregnant women.

Keywords: COVID-19 vaccination; immunogenicity; maternal vaccination; neonates; safety.

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Figures

Figure 1
Figure 1
Placental transfer of IgG antibodies from maternal to fetal circulation Maternal IgG antibodies are taken up into endosomes within the syncytiotrophoblast cells of the placenta and bind to the FcRn. Following acidification of the endosome, the IgG antibodies are then transcytosed to the fetal side of the syncytiotrophoblast. The endosome fuses with the syncytiotrophoblast membrane, and the IgG antibodies are then released into the fetal circulation. The higher physiological pH within the fetal circulation promotes dissociation of the IgG from the FcRn (adapted from Palmeria et al). Figure created with BioRender.com, exported with publication and licensing rights. Original figure held under a Creative Commons license. FcRn, neonatal Fc receptors; IgG, immunoglobulin G. Etti. Maternal vaccination. Am J Obstet Gynecol 2022.
Figure 2
Figure 2
Transfer of secretory IgA antibodies from maternal breast tissue to breast milk Dimeric IgA molecules attach to the pIgR on the basolateral membrane of the mammary gland epithelium and are transcytosed through epithelial cells. At the apical cell membrane, the IgA dimer is released into the breast milk with a portion of the pIgR molecule (the secretory chain) still attached (adapted from Albrecht and Arck). Figure created with BioRender.com, exported with publication and licensing rights. Original figure held under a Creative Commons license. IgA, immunoglobulin A; pIgR, polymeric Ig-receptors. Etti. Maternal vaccination. Am J Obstet Gynecol 2022.
Figure 3
Figure 3
Global elimination status of maternal and neonatal tetanus As of December 2020, 12 out of 59 “at-risk” countries identified by the WHO in 2000 had not yet eliminated the disease. Figure reproduced with permission from the World Health Organization. Countries shaded in green represents maternal and neonatal tetanus eliminated between 2000 and December 2020 Countries shaded in red represents maternal and neonatal tetanus not eliminated. WHO, World Health Organization. Etti. Maternal vaccination. Am J Obstet Gynecol 2022.
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