COVID-19 vaccination in pregnancy: views and vaccination uptake rates in pregnancy, a mixed methods analysis from SAIL and the Born-In-Wales Birth Cohort

Abstract

Background Vaccine hesitancy amongst pregnant women has been found to be a concern during past epidemics. This study aimed to (1) estimate COVID-19 vaccination rates among pregnant women in Wales and their association with age, ethnicity, and area of deprivation, using electronic health record (EHR) data linkage, and (2) explore pregnant women’s views on receiving the COVID-19 vaccine during pregnancy using data from a survey recruiting via social media (Facebook, Twitter), through midwives, and posters in hospitals (Born-In-Wales Cohort). Methods This was a mixed-methods study utilising routinely collected linked data from the Secure Anonymised Information Linkage (SAIL) Databank (Objective 1) and the Born-In-Wales Birth Cohort participants (Objective 2). Pregnant women were identified from 13th April 2021 to 31st December 2021. Survival analysis was utilised to examine and compare the length of time to vaccination uptake in pregnancy, and variation in uptake by; age, ethnic group, and deprivation area was examined using hazard ratios (HR) from Cox regression. Survey respondents were women who had a baby during the COVID-19 pandemic or were pregnant between 1st November 2021 and 24th March 2022 and participating in Born-In-Wales. Codebook thematic analysis was used to generate themes from an open-ended question on the survey. Results Population-level data linkage (objective 1): Within the population cohort, 8203 (32.7%) received at least one dose of the COVID-19 vaccine during pregnancy, 8572 (34.1%) remained unvaccinated throughout the follow-up period, and 8336 (33.2%) received the vaccine postpartum. Younger women (< 30 years) were less likely to have the vaccine, and those living in areas of high deprivation were also less likely to have the vaccine (HR = 0.88, 95% CI 0.82 to 0.95). Asian and Other ethnic groups were 1.12 and 1.18 times more likely to have the vaccine in pregnancy compared with White women (HR = 1.12, 95% CI 1.00 to 1.25) and (HR = 1.18, 95% CI 1.03 to 1.37) respectively. Survey responses (objective 2): 207 (69%) of participants stated that they would be happy to have the vaccine during pregnancy. The remaining 94 (31%) indicated they would not have the vaccine during pregnancy. Reasons for having the vaccine included protecting self and baby, perceived risk level, and receipt of sufficient evidence and advice. Reasons for vaccine refusal included lack of research about long-term outcomes for the baby, anxiety about vaccines, inconsistent advice/information, and preference to wait until after the pregnancy. Conclusion Potentially only 1 in 3 pregnant women would have the COVID-19 vaccine during pregnancy, even though 2 in 3 reported they would have the vaccination, thus it is critical to develop tailored strategies to increase its acceptance rate and decrease vaccine hesitancy. A targeted approach to vaccinations may be required for groups such as younger people and those living in higher deprivation areas.

The Influence of the Perception, Attitude and Level of Trust on the Uptake of Covid-19 Vaccinations Among Pregnant Women Attending Antenatal Care Clinic in Mbeya Urban, Tanzania

“…The data in this study suggest that the proportion of pregnant women attending ANC clinic who had been vaccinated for COVID 19 vaccine was 27% lower compared to some other countries like the United States (40%), England (53.1%) and Saudi Arabia (57.1%) 13,15 . Low vaccine uptake might be a result of late launch of COVID 19 vaccine usage among pregnant women in Tanzania compared to other countries.…”

COVID-19 Vaccination in Pregnancy: The Impact of Multimorbidity and Smoking Status on Vaccine Hesitancy, a Cohort Study of 25,111 Women in Wales, UK

“…Caribbean, Any Other Mixed/Multiple Ethnic Background. 4 Comprises of African, Any Other Black Background, Caribbean 5 Comprises of Any Other Ethnic Group, Arab, Chinese.…”

“…Due to the lack of information and changes in guidance and recommendations surrounding vaccination in pregnancy during the COVID-19 pandemic, this eventually resulted in some hesitancy among expectant mothers to receive vaccinations [4]. Although there is growing evidence that COVID-19 vaccine is safe and effective for pregnant women, vaccine hesitancy is still a signi cant issue [5].…”

“…[7]. In Wales, A mixed methods analysis of routinely collected linked data extracted from the Secure Anonymised Information Linkage (SAIL) Databank and the Born in Wales Birth Cohort found that only one in three pregnant women would receive the COVID-19 vaccine during pregnancy, despite two in three reported that they would receive the vaccine [5]. Even though coverage has increased overall, pregnant women's uptake remains lower than the general population of the same age group [7].…”

Psychosocial Predictors of COVID-19 Vaccine Uptake among Pregnant Women: A Cross-Sectional Study in Greece

“…Moreover, it is interesting to highlight the fact that the vaccination rate is much higher in Israel (43.3%) than in the USA (27.3%) and other countries (12.8%) [ 58 ]. Additionally, several other studies found a lower vaccination rate among pregnant women in Italy (49.4%) [ 44 ], Spain (56%) [ 45 ], Wales (32.7%) [ 59 ], Canada (42.4%) [ 41 ], and the USA (44%) [ 60 ]. The higher vaccination rate in our study may be due to the fact that the studies in the meta-analysis were conducted from December 2020 to September 2021, while our study was conducted from December 2021 to March 2022.…”