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Pregnant women are vulnerable to COVID-19, with increased risk of more severe illness and pregnancy compli cations, particularly if infected during the third trimester. 1 Based on prior experience with vaccines in pregnancy, and with no hypothesised mechanisms for fetal harm, similar efficacy and side-effects to the nonpregnant population were anticipated with vaccination against SARS-CoV-2 in pregnancy. Current, albeit limited, data support this; no major safety signals were observed in animal reproductive toxicology studies or with post-marketing surveillance. However, until recently, there was little consensus regarding routine vaccination in pregnancy, and vaccine hesitancy in pregnant women remains high. 2

Informed health-care decision making requires balancing of benefits and risks. This is challenging when considering COVID-19 vaccination and pregnancy because of variations in individual risk of …