COVID-19 and COVID-19 Vaccination in Pregnancy: Epidemiology, Pathophysiology, and Clinical Management

Abstract

Pregnant individuals represent a high-risk cohort for severe manifestations of SARS-CoV-2 infection, with epidemiological data indicating elevated rates of maternal morbidity, preterm birth, preeclampsia, and perinatal complications relative to non-infected pregnant populations. Pathophysiological studies highlight altered immune responses and placental ACE2 expression as potential mediators of increased susceptibility and adverse outcomes. Accumulating evidence from large prospective cohorts and meta-analyses demonstrates that administration of COVID-19 vaccines during pregnancy does not increase the incidence of major congenital anomalies, spontaneous abortion, or stillbirth when compared to unvaccinated controls. Moreover, vaccination is associated with significant reductions in the risk of severe maternal COVID-19, hospitalization, and adverse neonatal outcomes. Immunogenicity studies confirm efficient transplacental transfer of SARS-CoV-2 antibodies, conferring passive immunity to the neonate. Collectively, these findings substantiate the safety and efficacy of COVID-19 vaccination in pregnancy, supporting its role as a critical intervention to mitigate maternal and perinatal morbidity during the ongoing pandemic