3Shanghai Municipal Key Clinical Specialty,
Shanghai, China
Correspondence: Rui-Hong Xue, MD. E-mail:wfmcxrh@alumni.sjtu.edu.cn;
Postal address: No.910 Hengshan Road, Shanghai, China. Postal
code: 200030. Work phone: +86-021-64070434
The author report no conflict of interest.
Word Count: 428
Funding: None
Dear editor,
A recent article published in New England Journal of Medicine entitled
“Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant
Persons”(DOI: 10.1056/NEJMoa2104983), which has aroused heated
discussion. The study includes 35,691 v-safe participants aged from 16
to 54, who identified as pregnant and the first 3958 participants who
enrolled in the v-safe pregnancy registry(54% received the
Pfizer–BioNTech vaccine and 46% received the Moderna vaccine). This
study provided preliminary data on the safety of mRNA vaccines in
pregnancy, and found no obvious side effects among pregnant persons who
received mRNA Covid-19 vaccines. We would like to congratulate the
authors for providing the important information, a leap for mankind to
have promoted the use of Covid-19 vaccines in pregnancy. However, we
would like to address some point that merit further attention.
Covid-19 characters as strong infectivity, rapid and wide-spread, with
millions of people losing lives. Pregnant women suffered from Covid-19
mean worse pregnancy outcomes, including miscarriage, intrauterine
growth restriction, and preterm birth. What was worse, more depression
and anxiety symptoms were also reported in the infected pregnant women
than that before the pandemic. In the 1902 paper, as Ballantyne said,
for the premature delivery, the ideal plan of procedure is prevention,
we think the same principle should be applied to Covid-19 prevention.
Vaccines have been considered as the promising way to effectively
control the virus, however, the effectiveness and safety of vaccines in
pregnant women have been reported very limited. More longitudinal
follow-up, including follow-up of large numbers of women vaccinated
earlier in pregnancy, is necessary to inform maternal, pregnancy, and
infant outcomes.
In obstetrics, that the intrauterine environment can affect the
long-term health of the offspring has been widely accepted. COVID-19 has
been reported as a vascular disease with perivascular damage, and
histologic analysis of pulmonary vessels in patients with Covid-19
showed widespread thrombosis with microangiopathy. Pregnancy is the
window for the future. We should not only focus on short-term risks, but
ignore long-term adventures, such as the potential metabolic adventures
of the neonates when they grow up. The ongoing clinical trials around
the world should collect data on the safety of Covid-19 vaccines in
different periods of gestation, and focus attention on persistent
follow-ups of long-term outcomes of the neonates.
There’s nothing wrong with a brave step into the great unknown, while
the doctors should weigh the pros and cons. Although persons at the
highest risk for coronavirus disease 2019 (Covid-19)–related illness
and death were prioritized for vaccination, we should also take
a prudent attitude along with the updated safety information in this
process.