Studies done during the coronavirus pandemic have indicated that pregnant women are a high-risk group for COVID-19 infection.
In countries such as the United States, the United Kingdom, Israel and Belgium, expectant mothers have even been moved up vaccination priority lists.
In Germany, meanwhile, experts say the advice is less clear. A group of gynecological associations and practitioners have published a public statement calling on Germany's independent Standing Committee on Vaccination (STIKO) to take a clearer stand — and advise that all pregnant women should be vaccinated.
So far, the standing committee has said that vaccination against COVID-19 in pregnancy can only be recommended in some individual cases. But STIKO has said it does not want to recommend COVID vaccination for pregnant women in general, pointing out that there is just not enough data to support such a move as being safe.
But in the state of Saxony, health authorities have decided not to wait for STIKO to recommend vaccination during pregnancy. The state has its own Vaccination Commission, SIKO, which has independently decided to recommend COVID-19 vaccination for pregnant women, said Cornelia Hösemann, a gynecologist and SIKO member.
In the rest of the country, the task of weighing up the risks and benefits of vaccination is left to gynecologists and pregnant women themselves, making it all the more important that parents-to-be know a few facts.
How dangerous is a COVID-19 infection during pregnancy?
"In principle, pregnant women are more susceptible to all infectious diseases," said Hösemann, who also chairs Saxony's state-level Professional Association of Gynecologists (Landesverbandes des Berufsverbandes der Frauenärzte).
"During pregnancy, a mother's immune system virtually shuts down to stop [the body] rejecting the baby," said Hösemann. Half of the baby's genetic material comes from the father and is essentially foreign to the mother's body, and that may otherwise cause it to be rejected.
In their public statement, 11 professional associations in Germany called for the preferential vaccination of pregnant women because, they say, there is sufficient data to show that a COVID-19 infection is dangerous for both mother and child.
"Many pregnant women are rightly worried that they could become infected and get seriously ill," Christian Albring, a practicing gynecologist and president of the federal Professional Association of Gynecologists (BVF), told DW.
"Gynecologists at university hospitals have reported that there are more seriously ill pregnant women in intensive care units, in this current wave of infections, than last year," said Albring, who was involved in drafting the public statement.
The statement said that pregnant women need intensive care six times more often than non-pregnant women who get infected.
A study published in the American scientific journal, JAMA Pediatrics, in April found that the disease took a more severe course in pregnant women compared to non-pregnant women. The researchers also found a higher mortality rate for mother-to-be and their babies.
However, German virologist Christian Drosten, who has a regular podcast on public broadcaster NDR, points out that the study includes countries where poor health care systems makes pregnancy riskier in general, even without a COVID-19 infection.
Why are pregnant women vaccinated in some countries, but not in Germany?
"Since vaccination has been available in Germany, pregnant women have been coming to my practice and asking: Why not us as well?" said Hösemann.
Germany's standing committee on vaccination has said there is a lack of data on pregnant women and COVID vaccines because pregnant women tend to be excluded from clinical trials. It's a standard precautionary measure intended to protect mother and child.
But that's changing. In February, the developers behind the BioNTech-Pfizer vaccine said they had started a clinical trial to test the efficacy of their jab on pregnant women. They said they were doing so precisely because of the high risk of severe COVID-19 for pregnant women.
Can vaccination be harmful for the mother and child?
Experts say there is no data to suggest that COVID-19 vaccines are harmful in pregnancy.
In the US, more than 106,000 people who stated they were pregnant during vaccination have reported their experiences for a database called "V-Safe COVID-19 Vaccine Pregnancy Registry." It's run by the Centers for Disease Control and Prevention (CDC), and as of May 3 no safety concerns had been reported.
"The analyses did not reveal any safety concerns for pregnant people who were vaccinated, or [safety concerns] for their babies," the CDC said.
Nevertheless, further examinations are necessary, especially for women who are vaccinated during the first and second trimesters of pregnancy.
A risk of miscarriage is particularly high in the first three months of pregnancy, but data out of the US suggests that the risk of miscarriage has not increased among women vaccinated against COVID-19.
In France, however, experts have been reluctant to take any risks. There, pregnant women can only get vaccinated against COVID-19 after the first trimester. Virologist Drosten describes the French approach as a "good, cautious compromise."
Hösemann told DW that Saxony's Vaccination Commission has now also decided to recommend vaccination for pregnant women from the 13th week of pregnancy.
"We've taken the decision based on data from the US and other countries, where they recommend vaccination and have found it to be safe," she said.
Which vaccine is suitable?
The advice is that pregnant women should only be given mRNA vaccines, such as those offered by BioNTech-Pfizer and Moderna.
Most pregnant women in the US and Israel have been given mRNA vaccines, and the available data suggests that the vaccine is effective and safe.
"It has also been proven that the [necessary] antibodies reach the child via the placenta," said Hösemann. Antibodies against a virus are produced in the body after vaccination.
A study published in the American Journal of Obstetrics & Gynecology in March also found vaccine-induced antibodies in breast milk.
Hösemann said she knows of a woman who got a vaccine made by AstraZeneca before she knew she was pregnant.
The AstraZeneca vaccine is what's called a "live attenuated" vaccine, which uses a weakened version of a common cold virus to spark an immune reaction to COVID-19. Live attenuated vaccines are common, also for other diseases, but they work differently from the more novel mRNA vaccines.
In any case, there was no reason for panic, said Hösemann. "If you don't show symptoms for several weeks after the vaccination and you feel well, then you've tolerated the vaccination well."
Your second vaccine dose would then be a mRNA vaccine.
If STIKO still doesn't recommend vaccination, how can I get vaccinated?
For all gynecologists and pregnant women in Saxony, this question has just been settled. But in the rest of Germany, vaccination remains an individual risk-benefit analysis.
"Currently, this can be done in individual cases after a very detailed consultation and if the risks of infection and a severe course are considered to be very high," said BVF President Christian Albring.
Pregnant women whose risk is increased by obesity or preexisting conditions, for example, have a better chance of receiving a vaccine because their doctors will be more likely to prioritize them.
As for other pregnant women, for whom doctors are still advising against vaccination, they are allowed to select or appoint two close contacts to be vaccinated. Those people would then act as an indirect protection for the expectant mother — a kind of barrier.
But Hösemann is cautiously optimistic that STIKO will change its position soon, and that it will follow Saxony's lead.
The only thing missing then will be enough vaccines to go around.