OBJECTIVE To examine the association between initial COVID‐19 vaccine hesitancy and subsequent vaccination among pregnant and postpartum individuals. DESIGN Prospective cohort SETTING A Midwestern tertiary care academic medical center. Individuals completed a baseline vaccine hesitancy assessment from 03/22/21 to 04/02/21, with subsequent ascertainment of vaccination status at 3 to 6 months follow‐up. METHODS We used multivariable Poisson regression to estimate the relative risk of vaccination by baseline vaccine hesitancy status, and then characteristics associated with vaccination. MAIN OUTCOMES Self‐report of COVID‐19 vaccination, and secondarily, consideration of COVID‐19 vaccination among those not vaccinated. RESULTS Of 456 individuals (93% pregnant, 7% postpartum) initially surveyed, 290 individuals (64%; 23% pregnant, 77% postpartum) provided subsequent vaccination status (median=17 weeks). Forty percent (116/290) reported COVID‐19 vaccine hesitancy at enrollment, of whom 52% reported subsequent vaccination at follow‐up. Few individuals transitioned during the study period from vaccine hesitant to vaccinated (10%); in comparison, 80% of those who were not vaccine hesitant were vaccinated at follow‐up (aRR: 0.19; 95% CI: 0.11, 0.33). Among those who remained unvaccinated at follow‐up, 38% who were vaccine hesitant at baseline were considering vaccination compared to 71% who were not vaccine hesitant (aRR: 0.48; 95% CI: 0.33, 0.67). Individuals who were older, parous, employed, and of higher educational attainment were more likely to be vaccinated, and those who identified as non‐Hispanic Black, were Medicaid beneficiaries, and still pregnant at follow‐up were less likely to be vaccinated. CONCLUSIONS COVID‐19 vaccine hesitancy persisted over time in the peripartum period, and few individuals who reported hesitancy at baseline were later vaccinated. Interventions that address vaccine hesitancy in pregnancy are needed. FUNDING Ms. Germann was supported by the New York Academy of Medicine David E. Rogers Fellowship Program. Dr. Venkatesh was supported by the Care Innovation and Community Improvement Program and the Division of Maternal Fetal Medicine at The Ohio State University Wexner Medical Center.

To evaluate the association between community-level social vulnerability and achieving glycemic control (defined as hemoglobin A 1c [Hb A 1c ] less than 6.0% or less than 6.5%) among individuals with pregestational diabetes. METHODS:We conducted a retrospective cohort of individuals with pregestational diabetes with singleton gestations from 2012 to 2016 at a tertiary care center. Addresses were geocoded using ArcGIS and then linked at the census tract to the Centers for Disease Control and Prevention's 2018 SVI (Social Vulnerability Index), which incorporates 15 Census variables to produce a composite score and four scores across thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). Scores range from 0 to 1, with higher values indicating greater community-level social vulnerability. The primary outcome was Hb A 1c less than 6.0%, and, secondarily, Hb A 1c less than 6.5%, in the second or third trimesters. Multivariable Poisson regression with robust error variance was used to evaluate the association between SVI score as a continuous measure and target Hb A 1c .RESULTS: Among 418 assessed pregnant individuals (33.0% type 1; 67.0% type 2 diabetes), 41.4% (173/418) achieved Hb A 1c less than 6.0%, and 56.7% (237/418) Hb A 1c less than 6.5% at a mean gestational age of 29.5 weeks (SD 5.78). Pregnant individuals with a higher SVI score were less likely to achieve Hb A 1c less than 6.0% compared with those with a lower SVI score. For each 0.1-unit increase in SVI score, the risk of achieving Hb A 1c less than 6.0% decreased by nearly 50% (adjusted risk ratio [aRR] 0.53; 95% CI 0.36-0.77), and by more than 30% for Hb A 1c less than 6.5% (adjusted odds ratio 0.67; 95% CI 0.51-0.88). With regard to specific SVI domains, those who scored higher on socioeconomic status (aRR 0.50; 95% CI 0.35-0.71) as well as on household composition and disability (aRR 0.55; 95% CI 0.38-0.79) were less likely to achieve Hb A 1c less than 6.0%.CONCLUSION: Pregnant individuals with pregestational diabetes living in an area with higher social vulnerability were less likely to achieve glycemic control, as measured by HgbA1c levels. Interventions are needed to assess whether addressing social determinants of health can improve glycemic control in pregnancy.

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