Protecting pregnancy during pandemics: What recent outbreaks teach us.

Public health emergences often place pregnant people at a greater risk of severe disease. In this commentary, we highlight some of the insights from recent public health emergencies, spanning the 2009 influenza A/H1N1 pandemic to the recent mpox outbreaks. These epidemics have resulted in a large amount of perinatal pharmacovigilance expertise and capacity, improving the ability to conduct post-authorization evaluation of the safety of vaccines and other therapeutics during pregnancy. Although pregnant people have not historically been included in the clinical development of vaccines and other therapeutics intended for the general population, experiences from more recent public health emergencies show this trend is changing, with ongoing clinical trials either including or specifically targeting pregnant people. Pandemics and other public health emergencies that strain the healthcare system can disrupt routine prenatal care, birthing, and post-delivery care practices and this should be considered as part of pandemic planning. Finally, experiences from several epidemics show that vaccination during pregnancy is achievable, but vaccination rates during pregnancy are often suboptimal. A better understanding of vaccine hesitancy and acceptance during pregnancy and evidence-based strategies to address such hesitancy remain needed to better protect pregnant people against emerging infectious disease threats.