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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.

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