Table 3.

Worldwide updated recommendations from government and professional organizations.

International
World Health Organisation
When the benefits of vaccination to the pregnant woman outweigh the potential dangers, it is recommended that the COVID-19 vaccine be used. Pregnant women should be informed about the dangers of COVID-19 during pregnancy, the likely advantages of vaccination in the local epidemiological environment, and the present limits of safety data in pregnant women to assist them in making this decision. Pregnancy testing is not recommended before vaccination, according to the World Health Organization. The World Health Organization does not advocate delaying or terminating a pregnancy due to immunization [42].
Asia
India
ICMR All pregnant women who come in for antenatal care may be advised about the risks and benefits of the COVID-19 vaccines (Covishield and Covaxin) that are available in the country. A pregnant woman may be offered the COVID-19 vaccination at the nearest centre based on the information provided. During pregnancy, the COVID-19 vaccine can be given at any time. COVID-19 vaccinations are available to all lactating women at any time following delivery [43].
Japan
The Japanese Society of Obstetrics and Gynaecology and the Japanese Society of Infectious Diseases in Obstetrics and Gynaecology have issued recommendations for the inclusion of pregnant women to be vaccinated against COVID-19. Informed consent should be obtained. Healthcare workers and pregnant women with complications such as diabetes, hypertension, or obesity have to be prioritized. Vaccination should be avoided during organogenesis until 12 weeks of pregnancy [44].
Europe
United Kingdom
JCVI advises that vaccination in pregnancy should be considered for women who are offered the Pfizer-BioNTech or AstraZeneca COVID-19 vaccines in cases of high risk of exposure to SARS-CoV2 infection, or if the woman has underlying conditions that put her at greater risk of serious COVID-19 complications. Clinicians should discuss the risks and benefits of vaccination with the woman in these circumstances, as well as the vaccine's lack of adequate data in pregnant women [45]. The Joint Committee on Vaccination and Immunization (JCVI) has recently recommended that COVID-19 vaccines be given to pregnant women at the same time as the rest of the population, following the age group rollout. Women may want to explore the vaccine's benefits and hazards with their healthcare providers and come to a mutual choice based on their unique circumstances. Pregnant women, on the other hand, can receive the COVID-19 vaccine even if they have not discussed it with a healthcare expert as well as breastfeeding women [46].
Netherland
The Dutch public health organization RIVM recommends that pregnant women be provided COVID-19 vaccinations, specifically mRNA vaccines such as Pfizer and Moderna. All four vaccines approved for use in Europe are currently used in the country, including AstraZeneca, Johnson & Johnson, Moderna, and Pfizer-BioNTech products [47].
Austria
For pregnant women, Austrian authorities have stated that mRNA vaccines such as Moderna and Pfizer-BioNtech are preferred. The vaccination committee underlines the benefits of mRNA vaccines in particular [48].
France
The National Academy of Medicine advises to consider pregnancy as a serious risk factor in the event of SARS-CoV-2 infection, and to protect each pregnant woman from any potential source of contamination; to vaccinate any professionally or family-exposed pregnant woman, or pregnant woman with comorbidity (age >35 years, BMI >25, hypertension, diabetes); not to postpone or terminate a pregnancy due to vaccination; to encourage women who have been infected with SARS-CoV2 or vaccinated during their pregnancy to continue breastfeeding, as antibodies delivered through breast milk protect the newborn [49].
Germany
Because pregnant women are often excluded from clinical trials, according to Germany's standing committee on vaccination (STIKO), there is a dearth of data on pregnant women and COVID vaccinations. It's a routine precaution meant to protect both the mother and the child. Saxony has initiated the rollout of vaccinations in pregnant women ahead of STIKO's recommendations [50].
Ireland
Pregnant women are provided mRNA COVID-19 vaccine between 14 and 36 weeks of pregnancy, according to the National Immunisation Advisory Committee (NIAC), after an individual benefit/risk conversation with their obstetric caregiver [51].
North America
United States of India
People who are pregnant and part of a group recommended to receive the COVID-19 vaccine may choose to be vaccinated, according to the US Centres for Disease Control (CDC). A talk with a healthcare expert may help them make an informed decision if they have reservations about getting vaccinated [51]. According to the American College of Obstetricians and Gynaecologists states (ACOG), pregnant women who meet the requirements for vaccination based on ACIP-recommended priority groups should not be denied COVID-19 vaccines. They also declare that “COVID-19 vaccinations should be administered to lactating persons in the same way that non-lactating individuals are offered the vaccine when they fit the criteria for receiving the vaccine based on the ACIP's prioritizing groups. The Society for Maternal-Fetal Medicine (SMFM) states that pregnant, and healthcare personnel would be considered a priority for vaccination. They also suggest that pregnant and breastfeeding women should be administered the vaccine if they are otherwise eligible. American Society for Reproductive Medicine. Because the vaccine does not contain a live virus, there is no need to postpone pregnancy attempts or delay therapy until the second dose has been administered. Patients and clinicians should employ a shared decision-making model that considers the ethical principles of autonomy, beneficence, and nonmaleficence [38].
Canada
Individuals in the permitted age category who are pregnant should be administered a complete immunization series with an mRNA COVID-19 vaccine, according to NACI. If an mRNA vaccination is not recommended, another COVID-19 vaccine that has been approved should be provided. If the conditions outlined in recommendations are met and a risk assessment dictates that the benefits outweigh the potential risks for the individual and the fetus, the pregnant woman can undergo vaccination [52].
Middle East
Israel
Vaccination is advised for all pregnant women in their second or third trimester. It is also suggested that breastfeeding mothers, as well as those contemplating pregnancy or undergoing reproductive treatments, receive the two vaccine doses before the start of the pregnancy [53].