Pregnant women are at higher risk of severe COVID-19 compared with women of childbearing age who are not pregnant, and COVID-19 has been associated with an increased risk of preterm birth. This document offers some preliminary recommendations on the use of the Janssen Ad26.COV2.S (COVID-19) vaccine in pregnant or lactating women in the context of the Sisonke trial and in the future national rollout of the Janssen COVID-19 vaccine. These recommendations consider the safety of the vaccine including the recent reports of Vaccine induced Thrombotic Thrombocytopaenia (VITT).