COVID-19 Vaccination Status among Pregnant and Postpartum Women—A Cross-Sectional Study on More Than 1000 Individuals

Abstract

Pregnancy is a well-known factor for vaccine hesitancy and immunization remains the most effective form of prevention against coronavirus disease (COVID-19) related complications. The objective was to estimate vaccine uptake and hesitancy rate, characteristics, and factors contributing to a decision-making process among pregnant and postpartum individuals. This was a prospective cross-sectional study on 1033 pregnant (54.1%) and postpartum (45.9%) women conducted between December 2021 and March 2022 in a tertiary center for maternal–fetal medicine. Logistic regression was used to assess characteristics related to the vaccination decision process. Among responders, 74% were vaccinated and 26% were hesitant (9% planning to vaccinate and 17% totally opposed). Only 59.8% were offered a vaccine by healthcare professionals. Women with higher levels of education (OR 2.26, p < 0.0001), who received positive feedback about vaccination (OR 2.74, p = 0.0172), or were informed about COVID-19 complications in pregnancy (OR 2.6, p < 0.0001) were most likely to accept the vaccination. Hesitancy was associated with multiparity (≥3, OR 4.76, p = 0.006), worse educational status (OR 2.29, p < 0.0001), and lack of previous COVID-19 infection (OR 1.89, p < 0.0001). The most common reason for rejection was insufficient safety data (57%). Understanding factors behind vaccination status is crucial in lowering complications in mothers and newborns and targeted action may facilitate the uptake.

The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes

“…Vaccine hesitancy in the pregnant population was high in the months leading up to and following the release of COVID-19 vaccines with 22.6-86.2% of expectant mothers expressing hesitancy or refusal towards COVID-19 vaccination ( Table 3 ). [61] , [62] , [63] , [64] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] Vaccine hesitancy has also been reported to be higher in pregnant people than non-pregnant women of reproductive age. [82] This hesitancy is understandable given the lack of safety and efficacy data and mixed messaging from health agencies during the first few months of COVID-19 vaccines becoming available.…”

“… [41] , [61] , [62] , [64] , [72] , [77] , [79] , [89] Consistently the most common concern amongst pregnant people that were vaccine hesitant was the vaccine potentially causing harmful side effects to their developing baby and another common concern was the lack of safety and efficacy data of the COVID-19 vaccine during pregnancy. [61] , [62] , [63] , [64] , [73] , [74] , [77] , [78] , [80] , [84] , [85] , [86] Despite this, pregnant people report lower rates of common side effects after both first and second doses of COVID-19 vaccines compared to matched non-pregnant female controls. [90] This discrepancy in expectations versus reality may partially be explained due to prevalent lack of knowledge about COVID-19 vaccines amongst vaccine hesitant pregnant people.…”

“… [72] , [74] , [76] , [79] , [85] , [86] Fortunately, being informed about COVID-19 complications in pregnancy was positively associated with COVID-19 vaccination. [80] Together this suggests an opportunity to reduce vaccine hesitancy in the pregnant population through COVID-19 vaccine educational campaigns.…”

“…Younger age, living in more rural areas, lower educational attainment, and unemployment, were significantly associated with vaccine hesitancy. [62] , [63] , [74] , [76] , [77] , [78] , [79] , [80] An exception in these reports was a study out of mainland China which reported higher vaccine acceptance in people with lower educational attainment and younger age. [73] Another concern that is unique to pregnant people and women of reproductive age is that the COVID-19 vaccine may lead to infertility.…”

“…This should provide reassurance for concerns about COVID-19 vaccination impact on the developing baby, one of the most commonly stated reasons for COVID-19 vaccine hesitancy. [61] , [62] , [63] , [64] , [73] , [74] , [77] , [78] , [80] , [84] , [85] , [86] …”