People who are pregnant, breastfeeding or trying to conceive should be offered the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine based on ethical grounds, argue authors of a commentary in CMAJ (Canadian Medical Association Journal).

They discuss how health care providers and patients can use a shared decision-making approach to weigh the risks and benefits to decide on the right action for the individual.

“Core principles of medical ethics hold that medical decisions or interventions should respect individuals’ autonomy, be just, be beneficial (beneficence), and not cause harm (nonmaleficence),” writes Dr. Jonathan Zipursky, Sunnybrook Health Sciences Centre and the University of Toronto, with coauthors. “Excluding individuals who are pregnant or breastfeeding from accessing the SARS-CoV-2 vaccine limits autonomy and lacks consideration of individual factors.”

Although data do not indicate whether the vaccines are safe in this group, there is no evidence to show there are risks to getting vaccinated if pregnant, breastfeeding or trying to conceive. In the 23 participants in the Pfizer-BioNTech trial who conceived after vaccination, no adverse effects were observed. Animal trials also show no adverse effects.

Evidence exists, however, that pregnant individuals are at increased risk of severe COVID-19 and pregnancy complications, including preterm birth. As women are overrepresented in front-line health care and essential service jobs, the risk of contracting SARS-CoV-2 is elevated, and they should be offered protection from the virus.

“We argue that withholding the vaccine is ethically justified only if clear, substantial and imminent maternal or fetal harms are expected,” the authors write.

The authors note that discussions between health care providers and patients about whether to be vaccinated will change as new evidence becomes available.