531
Views
10
CrossRef citations to date
0
Altmetric
Review

Efficacy and safety of influenza vaccination during pregnancy: realizing the potential of maternal influenza immunization

&
Pages 649-660 | Received 16 Dec 2020, Accepted 07 Apr 2021, Published online: 22 Apr 2021

References

  • Lindley MC, Kahn KE, Bardenheier BH, et al. Vital Signs: burden and prevention of influenza and pertussis among pregnant women and infants – United States. MMWR Morb Mortal Wkly Rep. 2019;68(40):885–892.
  • Mertz D, Geraci J, Winkup J, et al., Pregnancy as a risk factor for severe outcomes from influenza virus infection: a systematic review and meta-analysis of observational studies. Vaccine. 35(4): 521–528. 2017.
  • Mertz D, Lo CK, Lytvyn L, et al. Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis. BMC Infect Dis. 2019;19(1):683.
  • Omer SB. Maternal immunization. New Engl J Med. 2017;376(13):1256–1267.
  • Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. New Engl J Med. 2014;370(23):2211–2218.
  • Silasi M, Cardenas I, Kwon JY, et al. Viral infections during pregnancy. Am J Reprod Immunol. 2015;73(3):199–213.
  • Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis. 2006;12(11):1638–1643.
  • Vanders RL, Murphy VE, Gibson PG, et al. CD8 T cells and dendritic cells: key players in the attenuated maternal immune response to influenza infection. J Reprod Immunol. 2015;107(1–9):1–9.
  • Forbes RL, Wark PA, Murphy VE, et al. Pregnant women have attenuated innate interferon responses to 2009 pandemic influenza A virus subtype H1N1. J Infect Dis. 2012;206(5):646–653.
  • Forbes RL, Gibson PG, Murphy VE, et al. Impaired type I and III interferon response to rhinovirus infection during pregnancy and asthma. Thorax. 2012;67(3):209–214.
  • Le Gars M, Seiler C, Kay AW, et al. Pregnancy-induced alterations in NK cell phenotype and function. Front Immunol. 2019;10(2469). https://doi.org/10.3389/fimmu.2019.02469
  • Sokolow LZ, Naleway AL, Li DK, et al. Severity of influenza and noninfluenza acute respiratory illness among pregnant women, 2010–2012. Am J Obstet Gynecol. 2015; 212(2):202.e201–11.
  • Dodds L, McNeil SA, Fell DB, et al. Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ. 2007;176(4):463–468.
  • Ohfuji S, Deguchi M, Tachibana D, et al. Estimating influenza disease burden among pregnant women: application of self-control method. Vaccine. 2017;35(36):4811–4816.
  • Vilca LM, Verma A, Bonati M, et al. Impact of influenza on outpatient visits and hospitalizations among pregnant women in Catalonia, Spain. J Infect. 2018;77(6):553–560.
  • Siston AM, Rasmussen SA, Honein MA, et al., Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 303(15): 1517–1525. 2010.
  • Rasmussen SA, Jamieson DJ, Uyeki TM. Effects of influenza on pregnant women and infants. Am J Obstet Gynecol. 2012;207(3 Suppl):S3–8.
  • Centers for Disease Control and Prevention. Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)– United States, April 2009–August 2010. MMWR Morb Mortal Wkly Rep. 2011;60(35):1193–1196.
  • Håberg SE, Trogstad L, Gunnes N, et al. Risk of fetal death after pandemic influenza virus infection or vaccination. New Engl J Med. 2013;368(4):333–340.
  • Fell DB, Savitz DA, Kramer MS, et al. Maternal influenza and birth outcomes: systematic review of comparative studies. BJOG. 2017;124(1):48–59.
  • Littauer EQ, Esser ES, Antao OQ, et al., H1N1 influenza virus infection results in adverse pregnancy outcomes by disrupting tissue-specific hormonal regulation. PLoS Pathog. 13(11): e1006757. 2017.
  • Dawood FS, Kittikraisak W, Patel A, et al., Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries: a multisite prospective longitudinal cohort study. Lancet Infect Dis. 21(1): 97–106. 2021.
  • Nelson EA, Ip M, Tam JS, et al. Burden of influenza infection in hospitalised children below 6 months of age and above in Hong Kong from 2005 to 2011. Vaccine. 2014;32(49):6692–6698.
  • Kollmann TR, Kampmann B, Mazmanian SK, et al. Protecting the newborn and young infant from infectious diseases: lessons from immune ontogeny. Immunity. 2017;46(3):350–363.
  • Jennewein MF, Abu-Raya B, Jiang Y, et al. Transfer of maternal immunity and programming of the newborn immune system. Semin Immunopathol. 2017;39(6):605–613.
  • Fell DB, Johnson J, Mor Z, et al. Incidence of laboratory-confirmed influenza disease among infants under 6 months of age: a systematic review. BMJ Open. 2017;7(9):e016526.
  • Shang M, Blanton L, Brammer L, et al. Influenza-associated pediatric deaths in the United States, 2010–2016. Pediatrics. 2018;141(4):e20172918.
  • Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommend Rep. 2003;52(Rr–8):1–34.
  • Centers for Disease Control and Prevention. Influenza vaccination in pregnancy: practices among obstetrician-gynecologists– United States, 2003–04 influenza season. MMWR Morb Mortal Wkly Rep. 2005;54(41):1050–1052.
  • World Health Organization. Vaccines against influenza WHO position paper – November 2012. Releve epidemiologique hebdomadaire. 2012;87(47):461–466.
  • Ortiz JR, Perut M, Dumolard L, et al., A global review of national influenza immunization policies: analysis of the 2014 WHO/UNICEF Joint Reporting form on immunization. Vaccine. 34(45): 5400–5405. 2016.
  • Principi N, Camilloni B, Esposito S. Influenza immunization policies: which could be the main reasons for differences among countries? Hum Vaccin Immunother. 2018;14(3):684–692.
  • Grohskopf LA, Alyanak E, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices - United States, 2020–21 influenza season. MMWR Recommend Rep. 2020;69(8):1–24.
  • Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation handbook. Canberra: Australian Government Department of Health; 2018.
  • Young K, Gemmill I, Harrison R. Summary of the NACI seasonal influenza vaccine statement for 2020–2021. Canada Comm Dis Rep. 2020;46(5):132–137.
  • European centre for disease prevention and control. Seasonal influenza vaccination and antiviral use in EU/EEA Member States – overview of vaccine recommendations for 2017–2018 and vaccination coverage rates for 2015–2016 and 2016–2017 influenza seasons. European Centre for Disease Prevention and Control, Stockholm (2018).
  • Ministry of Health. Immunisation handbook. Wellington: New Zealand Ministry of Health; 2020.
  • Bischoff AL, Følsgaard NV, Carson CG, et al. Altered response to A(H1N1)pdm09 vaccination in pregnant women: a single blinded randomized controlled trial. PloS One. 2013;8(4):e56700.
  • Jackson LA, Patel SM, Swamy GK, et al. Immunogenicity of an inactivated monovalent 2009 H1N1 influenza vaccine in pregnant women. J Infect Dis. 2011;204(6):854–863.
  • Munoz FM, Jackson LA, Swamy GK, et al. Safety and immunogenicity of seasonal trivalent inactivated influenza vaccines in pregnant women. Vaccine. 2018;36(52):8054–8061.
  • Tsatsaris V, Capitant C, Schmitz T, et al. Maternal immune response and neonatal seroprotection from a single dose of a monovalent nonadjuvanted 2009 influenza A(H1N1) vaccine: a single-group trial. Ann Intern Med. 2011;155(11):733–741.
  • Nunes MC, Cutland CL, Moultrie A, et al. Immunogenicity and safety of different dosing schedules of trivalent inactivated influenza vaccine in pregnant women with HIV: a randomised controlled trial. Lancet HIV. 2020;7(2):e91–103.
  • Eaf S, Nunes MC, Carosone-Link P, et al. Trivalent influenza vaccination randomized control trial of pregnant women and adverse fetal outcomes. Vaccine. 2019;37(36):5397–5403.
  • Omer SB, Clark DR, Madhi SA, et al., Efficacy, duration of protection, birth outcomes, and infant growth associated with influenza vaccination in pregnancy: a pooled analysis of three randomised controlled trials. Lancet Respir Med. 8(6): 597–608. 2020.
  • Zaman K, Roy E, Arifeen SE, et al., Effectiveness of maternal influenza immunization in mothers and infants. New Engl J Med. 359(15): 1555–1564. 2008.
  • Madhi SA, Cutland CL, Kuwanda L, et al., Influenza vaccination of pregnant women and protection of their infants. New Engl J Med. 371(10): 918–931. 2014.
  • Tapia MD, Sow SO, Tamboura B, et al. Maternal immunisation with trivalent inactivated influenza vaccine for prevention of influenza in infants in mali: a prospective, active-controlled, observer-blind, randomised phase 4 trial. Lancet Infect Dis. 2016;16(9):1026–1035.
  • Steinhoff MC, Katz J, Englund JA, et al. Year-round influenza immunisation during pregnancy in Nepal: a phase 4, randomised, placebo-controlled trial. Lancet Infect Dis. 2017;17(9):981–989.
  • Mutsaerts E, Madhi SA, Cutland CL, et al. Influenza vaccination of pregnant women protects them over two consecutive influenza seasons in a randomized controlled trial. Expert Rev Vaccines. 2016;15(8):1055–1062.
  • Molgaard-Nielsen D, Fischer TK, Krause TG, et al. Effectiveness of maternal immunization with trivalent inactivated influenza vaccine in pregnant women and their infants. J Intern Med. 2019;286(4):469–480.
  • Thompson MG, Li DK, Shifflett P, et al. Effectiveness of seasonal trivalent influenza vaccine for preventing influenza virus illness among pregnant women: a population-based case-control study during the 2010–2011 and 2011–2012 influenza seasons. Clin Infect Dis. 2014;58(4):449–457.
  • Quach THT, Mallis NA, Cordero JF. Influenza vaccine efficacy and effectiveness in pregnant women: systematic review and meta-analysis. Matern Child Health J. 2020;24(2):229–240.
  • Nunes MC, Madhi SA. Influenza vaccination during pregnancy for prevention of influenza confirmed illness in the infants: a systematic review and meta-analysis. Hum Vaccin Immunother. 2018;14(3):758–766.
  • Buchwald AG, Tamboura B, Haidara FC, et al. Maternal influenza vaccination and the risk of laboratory-confirmed influenza among household contacts under the age of five in mali. Am J Trop Med Hyg. 2019;100(1):159–164.
  • Nunes MC, Cutland CL, Jones S, et al., Efficacy of maternal influenza vaccination against all-cause lower respiratory tract infection hospitalizations in young infants: results from a randomized controlled trial. Clin Infect Dis. 65(7): 1066–1071. 2017.
  • Steinhoff MC, Omer SB, Roy E, et al. Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial. CMAJ. 2012;184(6):645–653.
  • Kozuki N, Katz J, Englund JA, et al. Impact of maternal vaccination timing and influenza virus circulation on birth outcomes in rural Nepal. Int J Obstet Gynecol. 2018;140(1):65–72.
  • Omer SB, Clark DR, Aqil AR, et al. Maternal influenza immunization and prevention of severe clinical pneumonia in young infants: analysis of randomized controlled trials conducted in Nepal, Mali and South Africa. Pediatr Infect Dis J. 2018;37(5):436–440.
  • Mazagatos C, Godoy P, Muñoz Almagro C, et al. Effectiveness of influenza vaccination during pregnancy to prevent severe infection in children under 6 months of age, Spain, 2017–2019. Vaccine. 2020;38(52):8405–8410.
  • Benowitz I, Esposito DB, Gracey KD, et al. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis. 2010;51(12):1355–1361.
  • Poehling KA, Szilagyi PG, Staat MA, et al. Impact of maternal immunization on influenza hospitalizations in infants. Am J Obstet Gynecol. 2011;204(6 Suppl 1):S141–8.
  • Thompson MG, Kwong JC, Regan AK, et al., Influenza vaccine effectiveness in preventing influenza-associated hospitalizations during pregnancy: a multi-country retrospective test negative design study, 2010–2016. Clin Infect Dis. 68(9): 1444–1453. 2019.
  • Katz J, Englund JA, Steinhoff MC, et al. Impact of timing of influenza vaccination in pregnancy on transplacental antibody transfer, influenza incidence, and birth outcomes: a randomized trial in rural Nepal. Clin Infect Dis. 2018;67(3):334–340.
  • Cuningham W, Geard N, Fielding JE, et al. Optimal timing of influenza vaccine during pregnancy: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2019;13(5):438–452.
  • Jarvis JR, Dorey RB, Warricker FDM, et al. The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: systematic review and meta-analysis. Vaccine. 2020;38(7):1601–1613.
  • Regan AK, De Klerk N, Moore HC, et al. Effect of maternal influenza vaccination on hospitalization for respiratory infections in newborns: a retrospective cohort study. Pediatr Infect Dis J. 2016;35(10):1097–1103.
  • Regan AK, Tracey L, Blyth CC, et al. A prospective cohort study comparing the reactogenicity of trivalent influenza vaccine in pregnant and non-pregnant women. BMC Pregnancy Childbirth. 2015;15(61). https://doi.org/10.1186/s12884-015-0495-2
  • Regan AK, Tracey LE, Blyth CC, et al. A prospective cohort study assessing the reactogenicity of pertussis and influenza vaccines administered during pregnancy. Vaccine. 2016;34(20):2299–2304.
  • Glover C, Crawford N, Leeb A, et al. Active SMS-based surveillance of adverse events following immunisation with influenza and pertussis-containing vaccines in Australian pregnant women using AusVaxSafety. Vaccine. 2020;38(31):4892–4900.
  • Regan AK, Blyth CC, Effler PV. Using SMS technology to verify the safety of seasonal trivalent influenza vaccine for pregnant women in real time. Med J Austr. 2013;199(11):744–746.
  • Leeb A, Regan AK, Peters IJ, et al. Using automated text messages to monitor adverse events following immunisation in general practice. Med J Austr. 2014;200(7):416–418.
  • Pillsbury A, Quinn H, Cashman P, et al. Active SMS-based influenza vaccine safety surveillance in Australian children. Vaccine. 2017;35(51):7101–7106.
  • Fell DB, Platt RW, Lanes A, et al. Fetal death and preterm birth associated with maternal influenza vaccination: systematic review. BJOG. 2015;122(1):17–26.
  • Macias Saint-Gerons D, Solà Arnau I, De Mucio B, et al. Adverse events associated with the use of recommended vaccines during pregnancy: an overview of systematic reviews. Vaccine. 2020. in press. https://doi.org/10.1016/j.vaccine.2020.07.048
  • Giles ML, Krishnaswamy S, Macartney K, et al. The safety of inactivated influenza vaccines in pregnancy for birth outcomes: a systematic review. Hum Vaccin Immunother. 2019;15(3):687–699.
  • Bratton KN, Wardle MT, Orenstein WA, et al. Maternal influenza immunization and birth outcomes of stillbirth and spontaneous abortion: a systematic review and meta-analysis. Clin Infect Dis. 2015;60(5):e11–9.
  • Nunes MC, Aqil AR, Omer SB, et al. The effects of influenza vaccination during pregnancy on birth outcomes: a systematic review and meta-analysis. Am J Perinatol. 2016;33(11):1104–1114.
  • McMillan M, Porritt K, Kralik D, et al. Influenza vaccination during pregnancy: a systematic review of fetal death, spontaneous abortion, and congenital malformation safety outcomes. Vaccine. 2015;33(18):2108–2117.
  • Clark DR, Omer SB, Tapia MD, et al. Influenza or meningococcal immunization during pregnancy and mortality in women and infants: a pooled analysis of randomized controlled trials. Pediatr Infect Dis J. 2020;39(7):641–644.
  • Sukumaran L, McCarthy NL, Kharbanda EO, et al., Infant hospitalizations and mortality after maternal vaccination. Pediatrics. 141(3): e20173310. 2018.
  • Foo DYP, Sarna M, Pereira G, et al., Early childhood health outcomes following in utero exposure to influenza vaccines: a systematic review. Pediatrics. 146(2): e20200375. 2020.
  • Nunes MC, Cutland CL, Dighero B, et al. Kinetics of hemagglutination-inhibiting antibodies following maternal influenza vaccination among mothers with and those without HIV infection and their infants. J Infect Dis. 2015;212(12):1976–1987.
  • Nunes MC, Weinberg A, Cutland CL, et al. Neutralization and hemagglutination-inhibition antibodies following influenza vaccination of HIV-infected and HIV-uninfected pregnant women. PloS One. 2018;13(12):e0210124.
  • Ahmad SM, Alam MJ, Khanam A, et al. Vitamin A supplementation during pregnancy enhances pandemic H1N1 vaccine response in mothers, but enhancement of transplacental antibody transfer may depend on when mothers are vaccinated during pregnancy. J Nutr. 2018;148(12):1968–1975.
  • Siddiqua TJ, Ahmad SM, Ahsan KB, et al. Vitamin B12 supplementation during pregnancy and postpartum improves B12 status of both mothers and infants but vaccine response in mothers only: a randomized clinical trial in Bangladesh. Eur J Nutr. 2016;55(1):281–293.
  • Ortiz JR, Neuzil KM. Influenza immunization of pregnant women in resource-constrained countries: an update for funding and implementation decisions. Curr Opin Infect Dis. 2017;30(5):455–462.
  • Katz MA, Gessner BD, Johnson J, et al. Incidence of influenza virus infection among pregnant women: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):155.
  • Dawa J, Chaves SS, Ba Nguz A, et al. Developing a seasonal influenza vaccine recommendation in Kenya: process and challenges faced by the National Immunization Technical Advisory Group (NITAG). Vaccine. 2019;37(3):464–472.
  • McMorrow ML, Emukule GO, Obor D, et al. Maternal influenza vaccine strategies in Kenya: which approach would have the greatest impact on disease burden in pregnant women and young infants? PloS One. 2017;12(12):e0189623.
  • Krishnaswamy S, Lambach P, Giles ML. Key considerations for successful implementation of maternal immunization programs in low and middle income countries. Hum Vaccin Immunother. 2019;15(4):942–950.
  • Debellut F, Hendrix N, Ortiz JR, et al. Forecasting demand for maternal influenza immunization in low- and lower-middle-income countries. PloS One. 2018;13(6):e0199470.
  • Larson Williams A, Mitrovich R, Mwananyanda L, et al. Maternal vaccine knowledge in low- and middle-income countries-and why it matters. Hum Vaccin Immunother. 2019;15(2):283–286.
  • Amirthalingam G, Letley L, Campbell H, et al. Lessons learnt from the implementation of maternal immunization programs in England. Hum Vaccin Immunother. 2016;12(11):2934–2939.
  • Ortiz JR. Implementation of maternal influenza immunization programs. Vaccine. 2018;36(25):3571.
  • Razzaghi H, Kahn KE, Black CL, et al. Influenza and Tdap vaccination coverage among pregnant women – United States, April 2020. MMWR Morb Mortal Wkly Rep. 2020;69(39):1391–1397.
  • Howe AS, Pointon L, Gauld N, et al. Pertussis and influenza immunisation coverage of pregnant women in New Zealand. Vaccine. 2020;38(43):6766–6776.
  • Offeddu V, Tam CC, Yong TT, et al. Coverage and determinants of influenza vaccine among pregnant women: a cross-sectional study. BMC Public Health. 2019;19(1):890.
  • Descamps A, Launay O, Bonnet C, et al. Seasonal influenza vaccine uptake and vaccine refusal among pregnant women in France: results from a national survey. Hum Vaccin Immunother. 2020;16(5):1093–1100.
  • Laenen J, Roelants M, Devlieger R, et al. Influenza and pertussis vaccination coverage in pregnant women. Vaccine. 2015;33(18):2125–2131.
  • Mak DB, Regan AK, Vo DT, et al. Antenatal influenza and pertussis vaccination in Western Australia: a cross-sectional survey of vaccine uptake and influencing factors. BMC Pregnancy Childbirth. 2018;18(1):416.
  • Kilich E, Dada S, Francis MR, et al. Factors that influence vaccination decision-making among pregnant women: a systematic review and meta-analysis. PloS One. 2020;15(7):e0234827.
  • Arnold LD, Luong L, Rebmann T, et al. Racial disparities in U.S. maternal influenza vaccine uptake: results from analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2012–2015. Vaccine. 2019;37(18):2520–2526.
  • Yuen CY, Tarrant M. Determinants of uptake of influenza vaccination among pregnant women - a systematic review. Vaccine. 2014;32(36):4602–4613.
  • Myers KL. Predictors of maternal vaccination in the United States: an integrative review of the literature. Vaccine. 2016;34(34):3942–3949.
  • Frew PM, Owens LE, Saint-Victor DS, et al. Factors associated with maternal influenza immunization decision-making. Evidence of immunization history and message framing effects. Hum Vaccin Immunother. 2014;10(9):2576–2583.
  • MacDougall DM, Halperin SA. Improving rates of maternal immunization: challenges and opportunities. Hum Vaccin Immunother. 2016;12(4):857–865.
  • Wong VWY, Fong DYT, Lok KYW, et al. Brief education to promote maternal influenza vaccine uptake: a randomized controlled trial. Vaccine. 2016;34(44):5243–5250.
  • Meharry PM, Cusson RM, Stiller R, et al. Maternal influenza vaccination: evaluation of a patient-centered pamphlet designed to increase uptake in pregnancy. Matern Child Health J. 2014;18(5):1205–1214.
  • Frew PM, Kriss JL, Chamberlain AT, et al. A randomized trial of maternal influenza immunization decision-making: a test of persuasive messaging models. Hum Vaccin Immunother. 2016;12(8):1989–1996.
  • O’Leary ST, Pyrzanowski J, Brewer SE, et al. Effectiveness of a multimodal intervention to increase vaccination in obstetrics/gynecology settings. Vaccine. 2019;37(26):3409–3418.
  • Bisset KA, Paterson P. Strategies for increasing uptake of vaccination in pregnancy in high-income countries: a systematic review. Vaccine. 2018;36(20):2751–2759.
  • Stockwell MS, Westhoff C, Kharbanda EO, et al. Influenza vaccine text message reminders for urban, low-income pregnant women: a randomized controlled trial. Am J Public Health. 2014;104(Suppl 1):e7–12.
  • Jordan ET, Bushar JA, Kendrick JS, et al. Encouraging influenza vaccination among Text4baby pregnant women and mothers. Am J Prev Med. 2015;49(4):563–572.
  • Yudin MH, Mistry N, De Souza LR, et al. Text messages for influenza vaccination among pregnant women: a randomized controlled trial. Vaccine. 2017;35(5):842–848.
  • Moniz MH, Hasley S, Meyn LA, et al. Improving influenza vaccination rates in pregnancy through text messaging: a randomized controlled trial. Obstet Gynecol. 2013;121(4):734–740.
  • Regan AK, Bloomfield L, Peters I, et al. Randomized controlled trial of text message reminders for increasing influenza vaccination. Ann Fam Med. 2017;15(6):507–514.
  • Zambrano LD, Ellington S, Strid P, et al. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status – United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1641–1647.
  • Woodworth KR, Olsen EO, Neelam V, et al. Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy - SET-NET, 16 Jurisdictions, March 29-October 14, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1635–1640.
  • Rimmer MP, Al Wattar BH. Provision of obstetrics and gynaecology services during the COVID-19 pandemic: a survey of junior doctors in the UK National Health Service. BJOG. 2020;127(9):1123–1128.
  • Farrell R, Michie M, Pope R. Pregnant women in trials of COVID-19: a critical time to consider ethical frameworks of inclusion in clinical trials. Ethics Hum Res. 2020;42(4):17–23.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.