COVID-19 vaccination in pregnancy: efficacy of second-generation vaccines, maternal-neonatal safety, and strategies to address vaccine hesitancy.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a profound impact on global public health. The Omicron variant, marked by high transmissibility and pronounced immune evasion capabilities, poses a particularly severe threat. Pregnant women undergo physiological immune modulation during pregnancy, which increases their susceptibility to severe disease following SARS-CoV-2 infection. This heightened risk is evidenced by elevated rates of intensive care unit (ICU) admission and increased maternal mortality. Additional pregnancy-related physiological changes-including heightened oxygen consumption and reduced respiratory reserve-further compromise respiratory function and worsen clinical outcomes in infected individuals. Although robust evidence confirms the efficacy and safety of COVID-19 vaccines, vaccine hesitancy remains prevalent among pregnant women due to concerns about potential adverse effects and fetal safety. This review evaluates current vaccination strategies for pregnant women using second-generation COVID-19 vaccines, with particular emphasis on maternal and neonatal health outcomes. It also analyzes barriers to vaccine uptake and underscores the need for further research to refine vaccination protocols, support equitable access, and ensure the safe and effective deployment of vaccines-ultimately mitigating the risks of SARS-CoV-2 infection during pregnancy.