Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August-December 2020

COVID-19 Vaccine Decision-Making Among Black Pregnant and Postpartum Women

INTRODUCTION

The history of biomedical research is marred by racially discriminatory and abusive practices that impacted Black/African Americans. Medical racism impacts the trust and utilization of new medical interventions, such as the COVID-19 vaccine. This study aimed to understand Black pregnant and postpartum women's perspectives and decision-making about the COVID-19 vaccine.

METHODS

We used a qualitative descriptive design and recruited 23 pregnant and postpartum Black women aged 18 years and above. Data was collected using a semi-structured interview guide. Data were analyzed using content analysis.

FINDINGS

The participants described factors influencing their decision to receive or not receive the COVID-19 vaccines. These factors included individual, cultural, ethnicity, religious, and family-related factors (individual-personal beliefs influenced decisions about the vaccine; ethnicity, culture, and religion influenced vaccine decision-making; group-family and friends played a role in decision-making), vaccine or vaccination-related issues (concerns about vaccination and pregnancy outcomes and mistrust in the vaccine information), and contextual influence (sources of vaccine information influenced decision-making and healthcare providers influenced decision-making).

CONCLUSION

Understanding the vaccine decision-making process of underserved populations likely to decline vaccination due to pregnancy, postpartum, and breastfeeding status will help design tailored interventions to improve vaccine acceptance in minority communities, especially for pregnant and postpartum women.

A scoping review of global COVID-19 vaccine hesitancy among pregnant persons

Uptake of the COVID-19 vaccine among pregnant persons is lower than the general population. This scoping review explored pregnant people's attitudes towards the COVID-19 vaccine, reasons for vaccine hesitancy, and whether attitudes about COVID-19 vaccines differ by country of origin. A scoping review was conducted across PubMed, Embase, CINHAL, and Scopus. Inclusion criteria were articles published in English from 2019-2022 focused on attitudes towards COVID-19 vaccination among pregnant persons. Data analysis was done via the 5Cs framework for vaccine hesitancy: Constraints, Complacency, Calculation, Confidence, and Collective Responsibility. 44 articles were extracted. A lack of confidence in vaccine safety was the most prevalent theme of hesitancy among pregnant persons. This was largely driven by a lack of access to information about the vaccine as well as mistrust of the vaccine and medical professionals. Meanwhile, vaccine acceptance was mostly driven by a desire to protect themselves and their loved ones. Overall, COVID-19 vaccine hesitancy among pregnant persons continues to be high. Vaccine hesitancy is primarily driven by fear of the unknown side effects of the vaccine on pregnant persons and their fetuses along with a lack of information and medical mistrust. Some differences can be seen between high income and low- and middle-income countries regarding vaccine hesitancy, showing that a single solution cannot be applied to all who are vaccine hesitant. General strategies, however, can be utilized to reduce vaccine hesitancy, including advocating for inclusion of pregnant persons in clinical trials and incorporating consistent COVID-19 vaccine counseling during prenatal appointments.

Risk and Protective Factors for COVID-19 Infection among Pregnant Women with Sickle Cell Trait

Pregnant women and individuals with sickle cell trait (SCT) and underlying comorbidities are both independently more vulnerable to severe illness from coronavirus disease 2019 (COVID-19) compared to nonpregnant women and those without SCT. However, our understanding of the specific factors influencing susceptibility to COVID-19 infection among pregnant women with SCT is currently constrained by limited available data. This study aims to determine the risk and protective factors that influence the likelihood of COVID-19 infection in this population. A retrospective analysis was done among 151 women with SCT in the reproductive age group. Multivariable analysis was performed to determine the various factors affecting COVID-19 infection among pregnant women with SCT. The study found that COVID-19-vaccinated pregnant women with SCT had a 90% lower risk of contracting COVID-19 and were 9 times more likely to have a COVID-19 infection if they had a history of pulmonary conditions such as asthma or chronic obstructive pulmonary disease. The present study further emphasizes the importance of the COVID-19 vaccine in preventing infection and safeguarding the health of pregnant women with SCT, particularly those with underlying comorbidities.

Disparities in perinatal COVID-19 infection and vaccination

The COVID-19 pandemic exposed and exacerbated persistent health inequities in perinatal populations, resulting in disparities of maternal and fetal complications. In this narrative review, we present an adapted conceptual framework of perinatal social determinants of health in the setting of the COVID-19 pandemic and use this framework to contextualize the literature regarding disparities in COVID-19 vaccination and infection. We synthesize how elements of the structural context, individual socioeconomic position, and concrete intermediary determinants influence each other and perinatal COVID-19 vaccination and infection, arguing that systemic inequities at each level contribute to observed disparities in perinatal health outcomes. From there, we identify gaps in the literature, propose mechanisms for observed disparities, and conclude with a discussion of strategies to mitigate them.

COVID-19 Vaccine Acceptance of Pregnant Women in Thailand

Objective

This study investigated the COVID-19 vaccine acceptance rate among pregnant women in Thailand and explored factors influencing their willingness to receive the vaccine, to enhance vaccine uptake among hesitant pregnant women in the future.

Methods

A prospective study was conducted at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, in October 2022. The data was collected using face-to-face questionnaires comprising 29 closed-end questions. Pregnant women aged 18 years old or over visiting the antenatal care clinic were included.

Results

The study included 200 participants, revealing a COVID-19 vaccine acceptance rate of 17%. Healthcare provider recommendations significantly increased vaccine acceptance by nearly two-fold (30.77%, p-value < 0.01). The major cause of vaccine hesitancy was the concern about vaccine safety that potentially harmed their babies (77.44%).

Conclusion

The COVID-19 vaccine acceptance rate among pregnant women in Thailand was low. Healthcare provider recommendations played a pivotal role in positively impacting vaccine acceptance, highlighting their importance in increasing acceptance rates in the future.

Routine Maternal Vaccine Uptake during the COVID-19 Pandemic

OBJECTIVE

This study examines the impact of the coronavirus disease 2019 (COVID-19) pandemic on influenza and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine uptake in a pregnant, low-income population.

STUDY DESIGN

This retrospective cohort study included women initiating prenatal care before (May-November 2019) or during the COVID-19 pandemic (May-November 2020) at two large Medicaid clinics. All patients entered prenatal care before 20 weeks and delivered full-term. Medical records were reviewed for vaccine uptake and demographic data. Multivariate logistic regression analysis was used to compare vaccination rates prior to and during the COVID-19 pandemic. Additional analysis was performed to identify association of demographic factors with vaccine uptake. IRB approval was obtained for this study.

RESULTS

A total of 939 patients met inclusion criteria, with 462 initiating care prior to and 477 initiating care during the COVID-19 pandemic. Influenza vaccination uptake was 78% (362/462) in the prepandemic group, significantly decreasing to 61% (291/477) in the pandemic group (p <0.01, odds ratio [OR] = 0.38, confidence interval [CI]: 0.26-0.53). Tdap vaccination uptake was 85% (392/462) in the prepandemic group, significantly decreasing to 76% (361/477) in the pandemic group (p <0.01, OR = 0.56, CI: 0.40-0.79). The decrease in influenza vaccine uptake was most significant in non-Hispanic Black patients, decreasing from 64% (73/114) in the prepandemic group to 35% (35/101) in the pandemic group (p <0.01, OR = 0.30, CI: 0.17-0.52), while there was no significant difference in age or parity in relation to vaccination status.

CONCLUSION

Routine vaccination uptake significantly decreased during the COVID-19 pandemic in a low-income population of pregnant women, with decrease more pronounced on influenza vaccine than on Tdap vaccine uptake, especially in non-Hispanic Black patients.

KEY POINTS

· Influenza and Tdap vaccination uptake during pregnancy has decreased during the COVID-19 pandemic.. · Influenza vaccine uptake decreased more than Tdap in pregnancy during the COVID-19 pandemic.. · The greatest decrease was seen in influenza vaccine uptake in non-Hispanic Black patients..

Attitudes Toward COVID-19 Vaccines Among Pregnant and Recently Pregnant Individuals

Importance

Pregnant people and infants are at high risk of severe COVID-19 outcomes. Understanding changes in attitudes toward COVID-19 vaccines among pregnant and recently pregnant people is important for public health messaging.

Objective

To assess attitudinal trends regarding COVID-19 vaccines by (1) vaccination status and (2) race, ethnicity, and language among samples of pregnant and recently pregnant Vaccine Safety Datalink (VSD) members from 2021 to 2023.

Design, Setting, and Participants

This cross-sectional surveye study included pregnant or recently pregnant members of the VSD, a collaboration of 13 health care systems and the US Centers for Disease Control and Prevention. Unvaccinated, non-Hispanic Black, and Spanish-speaking members were oversampled. Wave 1 took place from October 2021 to February 2022, and wave 2 took place from November 2022 to February 2023. Data were analyzed from May 2022 to September 2023.

Exposures

Self-reported or electronic health record (EHR)-derived race, ethnicity, and preferred language.

Main Outcomes and Measures

Self-reported vaccination status and attitudes toward monovalent (wave 1) or bivalent Omicron booster (wave 2) COVID-19 vaccines. Sample- and response-weighted analyses assessed attitudes by vaccination status and 3 race, ethnicity, and language groupings of interest.

Results

There were 1227 respondents; all identified as female, the mean (SD) age was 31.7 (5.6) years, 356 (29.0%) identified as Black race, 555 (45.2%) identified as Hispanic ethnicity, and 445 (36.3%) preferred the Spanish language. Response rates were 43.5% for wave 1 (652 of 1500 individuals sampled) and 39.5% for wave 2 (575 of 1456 individuals sampled). Respondents were more likely than nonrespondents to be White, non-Hispanic, and vaccinated per EHR. Overall, 76.8% (95% CI, 71.5%-82.2%) reported 1 or more COVID-19 vaccinations; Spanish-speaking Hispanic respondents had the highest weighted proportion of respondents with 1 or more vaccination. Weighted estimates of somewhat or strongly agreeing that COVID-19 vaccines are safe decreased from wave 1 to 2 for respondents who reported 1 or more vaccinations (76% vs 50%; χ21 = 7.8; P < .001), non-Hispanic White respondents (72% vs 43%; χ21 = 5.4; P = .02), and Spanish-speaking Hispanic respondents (76% vs 53%; χ21 = 22.8; P = .002).

Conclusions and Relevance

Decreasing confidence in COVID-19 vaccine safety in a large, diverse pregnant and recently pregnant insured population is a public health concern.

COVID-19 Vaccine Hesitancy in the Perinatal Period: A Survey Among Residents of Hawaii

Introduction

This study describes the vaccination status among people in Hawaii who are attempting pregnancy, currently pregnant, recently delivered (<6 months), and/or breastfeeding and documents common concerns and information sources associated with vaccine decision making.

Methods

We conducted a cross-sectional online survey between April and September 2022 throughout Hawaii. The anonymous surveys were disseminated through flyers and online links posted by physician offices and community partners throughout Hawaii.

Results

Final analyses included 165 responses. Almost half of the respondents (n=75, 45%) were unvaccinated, 38% (n=62) were fully vaccinated, and 17% (n=28) were partially vaccinated. The most influential sources for vaccine decision making for vaccinated respondents were their healthcare providers (n=28, 45%) and official healthcare organizations (n=22, 36%), whereas unvaccinated respondents reported friends/family (n=28, 37%) and their healthcare providers (n=26, 35%) as their most influential sources. Top COVID-19 vaccine concerns for unvaccinated individuals were reactions to vaccine (n=78, 76%) and concerns for safety of the vaccine (n=75, 73%).

Conclusions

Efforts should be made to increase and expand vaccine education about the benefits and safety of vaccines during pregnancy beyond the pregnant person to create more supportive social norms for COVID-19 vaccination in the perinatal period. Consistent and unequivocal support across medical specialties, including obstetrics, pediatrics, and family medicine, is also crucial for encouraging the uptake of the vaccine during pregnancy or when breastfeeding.

COVID-19 Vaccine Acceptance in Pregnant Women in the United States: A Systematic Review and Meta-Analysis

Purpose: Pregnant women are vulnerable to Coronavirus Disease 2019 (COVID-19) complications, yet may hesitate to get vaccinated. It is important to identify racial/ethnic and other individual characteristics associated with COVID-19 vaccine acceptance in the United States during pregnancy. Methods: We searched PubMed, Embase, and Web of Science for articles published through January 2023 for keywords/terms related to immunization, COVID-19, and pregnancy, and performed a systematic review and meta-analysis to examine characteristics associated with vaccine acceptance. Results: Of 1,592 articles, 23 met inclusion criteria (focused on pregnant women in the United States, and their willingness or hesitation to vaccinate). Twenty-two of the studies examined receipt of ≥1 COVID-19 vaccine dose and/or intention to vaccinate, while one examined vaccine hesitancy. Vaccine acceptance rates ranged from 7% to 78.3%. Meta-analyses demonstrated that compared with Whites, Hispanics (odds ratios [OR] 0.72; 95% confidence interval [CI] 0.58-0.91) and Blacks (OR 0.44; 95% CI 0.30-0.63) had less COVID-19 vaccine acceptance, while Asians (OR 1.78; 95% CI 1.10-2.88) had greater vaccine acceptance. College graduation or more (OR 3.25; 95% CI 2.53-4.17), receipt or intention to receive the influenza vaccine (OR 3.46; 95% CI 2.22-5.41), and at least part-time employment (OR 2.12; 95% CI 1.66-2.72) were significantly associated with vaccine acceptance. Conclusions: COVID-19 vaccine nonacceptance in pregnant women is associated with Hispanic ethnicity and Black race, while acceptance is associated with Asian race, college education or more, at least part-time employment, and acceptance of the influenza vaccine. Future COVID-19 vaccination campaigns can target identified subgroups of pregnant women who are less likely to accept vaccination.

CDC COVID-19 Vaccine Pregnancy Registry: Design, data collection, response rates, and cohort description

The U.S. Centers for Disease Control and Prevention (CDC) developed and implemented the CDC COVID-19 Vaccine Pregnancy Registry (C19VPR) to monitor vaccine safety. Potential participants who received a COVID-19 vaccine in pregnancy or up to 30 days prior to their pregnancy-associated last menstrual period were eligible to participate in the registry, which monitored health outcomes of participants and their infants through phone interviews and review of available medical records. Data for select outcomes, including birth defects, were reviewed by clinicians. In certain cases, medical records were used to confirm and add detail to participant-reported health conditions. This paper serves as a description of CDC C19VPR protocol. We describe the development and implementation for each data collection aspect of the registry (i.e., participant phone interviews, clinical review, and medical record abstraction), data management, and strengths and limitations. We also describe the demographics and vaccinations received among eligible and enrolled participants. There were 123,609 potential participants 18-54 years of age identified from January 2021 through mid-June 2021; 23,339 were eligible and enrolled into the registry. Among these, 85.3 % consented to medical record review for themselves and/or their infants. Participants were majority non-Hispanic White (79.1 %), residents of urban areas (93.3 %), and 48.3 % were between 30 and 34 years of age. Most participants completed the primary series of vaccination by the end of pregnancy (89.7 %). Many participants were healthcare personnel (44.8 %), possibly due to the phased roll-out of the vaccination program. The registry continues to provide important information about the safety of COVID-19 vaccination among pregnant people, a population with higher risk of poor outcomes from COVID-19 who were not included in pre-authorization clinical trials. Lessons learned from the registry may guide development and implementation of future vaccine safety monitoring efforts for pregnant people and their infants.

Perceptions of the COVID-19 Vaccine and Other Adult Vaccinations in Malawi: A Qualitative Assessment

In Malawi, various brands of the COVID-19 vaccine have been offered to the population, but factors including fear of side effects or other risks, uncertainty about benefits, and misinformation created hesitancy toward them. In early 2022, 4% of Malawians were fully vaccinated for COVID-19. Despite multiple promotion efforts, by August 2022, COVID-19 vaccination nationwide was around 15%. To increase COVID-19 vaccination uptake, the research team collected qualitative data in 4 districts with vaccine coverage levels ranging from 1% to 11%. This data collection happened during a cholera outbreak that began in March 2022 and the vaccination efforts to address it. Study participants included male and female members of the general population, social workers, people with comorbidities, health workers, and community leaders (224 participants total, 47% female). In focus group discussions (n=27) and in-depth interviews (n=17), participants compared COVID-19 vaccines with other adult vaccines, such as cholera and tetanus toxoid. A thematic analysis identified themes related to 3 research questions on COVID-19 vaccine concerns, confidence, and delivery affecting uptake. Differences in promotion, delivery (oral versus injection), COVID-19 vaccine card structure, the various brands and boosters, and vaccines being described as required or optional all played a role in distinguishing COVID-19 vaccines from other vaccines and creating suspicion or indifference. Barriers to vaccination in general, such as rumors or knowledge gaps, were amplified by how novel the COVID-19 vaccines were perceived to be and the changing guidance provided over time. By April 2023, more targeted campaign efforts helped increase vaccination rates to 28%. The findings contribute information about how individuals conceptualize and make decisions about adult vaccination, which can, in turn, inform strategies to integrate COVID-19 promotion and delivery with other disease responses in Malawi as well as routine health services in similar settings.

Coronavirus Disease 2019 (COVID-19) Vaccination and Assisted Reproduction Outcomes: A Systematic Review and Meta-analysis

OBJECTIVE

To assess the association between coronavirus disease 2019 (COVID-19) vaccination and female assisted reproduction outcomes through a systematic review and meta-analysis.

DATA SOURCES

We searched Medline (OVID), EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov on January 11, 2023, for original articles on assisted reproduction outcomes after COVID-19 vaccination. The primary outcome was rates of clinical pregnancy; secondary outcomes included number of oocytes retrieved, number of mature oocytes retrieved, fertilization rate, implantation rate, ongoing pregnancy rate, and live-birth rate.

METHODS OF STUDY SELECTION

Two reviewers independently screened citations for relevance, extracted pertinent data, and rated study quality. Only peer-reviewed published studies were included.

TABULATION, INTEGRATION, AND RESULTS

Our query retrieved 216 citations, of which 25 were studies with original, relevant data. Nineteen studies reported embryo transfer outcomes, with a total of 4,899 vaccinated and 13,491 unvaccinated patients. Eighteen studies reported data on ovarian stimulation outcomes, with a total of 1,878 vaccinated and 3,174 unvaccinated patients. There were no statistically significant results among our pooled data for any of the primary or secondary outcomes: clinical pregnancy rate (odds ratio [OR] 0.94, 95% CI 0.88-1.01, P =.10), number of oocytes retrieved (mean difference -0.26, 95% CI -0.68 to 0.15, P =.21), number of mature oocytes retrieved (mean difference 0.31, 95% CI -0.14 to 0.75, P =.18), fertilization rate (OR 0.99, 95% CI 0.87-1.11, P =.83), implantation rate (OR 0.92, 95% CI 0.84-1.00, P =.06), ongoing pregnancy rate (OR 0.95, 95% CI 0.86-1.06, P =.40), or live-birth rate (OR 0.95, 95% CI 0.78-1.17, P =.63). A subanalysis based on country of origin and vaccine type was also performed for the primary and secondary outcomes and did not change the study results.

CONCLUSION

Vaccination against COVID-19 is not associated with different fertility outcomes in patients undergoing assisted reproductive technologies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42023400023.

Being Pregnant during COVID-19: Exploring the COVID-19 Related Beliefs, Behaviors, and Birth Outcome among Users of a Pregnancy App

Being pregnant during COVID-19 increases the risk of experiencing severe COVID-19 symptoms, which in turn increases the risk of complications. This study aimed to examine COVID-19-related beliefs, behaviors, and birth outcomes among users of Count the Kicks (CTK), a fetal movement tracking app. This study used the End of Pregnancy Survey data from 1037 CTK users. We used descriptive analyses to analyze COVID-19-related beliefs and behaviors and used the chi-square statistic and Z statistic to examine factors associated with vaccination and birth outcome. Nearly half of the survey respondents reported not being concerned that in-person prenatal visits might lead to COVID-19 exposure. Most respondents (65.9%) had already received the COVID-19 vaccine at the time of the survey. The vaccination rate was statistically significantly lower among African Americans than the remaining race/ethnicity groups (mostly white). The healthy birth rate is lower among respondents with high-risk pregnancies, while the stillbirth rate is highest among Hispanics. Vaccination status was not associated with the likelihood of a healthy birth. Our findings confirmed that vaccination does not compromise birth outcomes, further contributing to the existing evidence of COVID vaccine safety during pregnancy. This study also demonstrates an example of using data from a pregnancy app to facilitate research on app users in real-time.

Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

BACKGROUND

Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada.

METHODS

Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations.

RESULTS

The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information.

DISCUSSION

We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.

"I'd do it for my baby": Lessons learned from qualitative research on COVID-19 vaccination among pregnant women in Côte d'Ivoire

In January 2023, almost two years after the COVID-19 vaccines were authorized for the general Ivorian population, the Government of Côte d'Ivoire authorized the Pfizer vaccine for pregnant women. Qualitative research with 214 adults (including pregnant women) in three Ivorian cities in November 2022 revealed that most participants knew that the COVID-19 vaccine had not been recommended for pregnant women. Some participants felt that the policy change alone would be enough to motivate pregnant women to get vaccinated, but others felt that it would be difficult to convince pregnant women that the vaccine is safe for them and their babies. Pregnant women who participated in the study expressed a preference for waiting until after giving birth to get vaccinated against COVID-19, to be safe. They viewed the COVID-19 vaccine as risky during pregnancy but seemed unaware of the heightened risks that COVID-19 illness poses to pregnant women and babies. Pregnant participants stated that if they believed that the COVID-19 vaccine was good for the baby they would put aside their fears and get vaccinated. Reframing the conversation around the dangers of COVID-19 for pregnant women and their babies and positioning the COVID-19 vaccine as safe during pregnancy and protective, both during pregnancy and afterwards, could encourage uptake among this important segment of the population. Potential strategies to reinforce perceptions of COVID-19 vaccine safety for pregnant women include frequent and consistent messaging through both interpersonal and mass media channels; leveraging prenatal consultations and the relationship between health workers and pregnant women for both counseling and vaccination; and engaging influential others to support pregnant women in the decision to accept vaccination against COVID-19. Positive testimonials may help combat rumors that the vaccine negatively affects fertility and reproductive health, which could help to foster positive attitudes towards the vaccine before a woman even becomes pregnant and encourage broad vaccination among women of reproductive age.

Vaccination, immunity, and the changing impact of COVID-19 on infant health

In utero exposure to COVID-19 infection may lead to large intergenerational health effects. The impact of infection exposure has likely evolved since the onset of the pandemic as new variants emerge, immunity from prior infection increases, vaccines become available, and vaccine hesitancy persists, such that when infection is experienced is as important as whether it is experienced. We examine the changing impact of COVID-19 infection on preterm birth and the moderating role of vaccination. We offer the first plausibly causal estimate of the impact of maternal COVID-19 infection by using population data with no selectivity, universal information on maternal COVID-19 infection, and linked sibling data. We then assess change in this impact from 2020 to 2023 and evaluate the protective role of COVID-19 vaccination on infant health. We find a substantial adverse effect of prenatal COVID-19 infection on the probability of preterm birth. The impact was large during the first 2 y of the pandemic but had fully disappeared by 2022. The harmful impact of COVID-19 infection disappeared almost a year earlier in zip codes with high vaccination rates, suggesting that vaccines might have prevented thousands of preterm births. The findings highlight the need to monitor the changing consequences of emerging infectious diseases over time and the importance of mitigation strategies to reduce the burden of infection on vulnerable populations.

Respiratory Syncytial Virus: Willingness towards a Future Vaccine among Pregnant Women in Italy

BACKGROUND

This cross-sectional survey was designed to evaluate pregnant women's awareness regarding Respiratory Syncytial Virus (RSV) infection and willingness to receive the vaccine during pregnancy and to vaccinate their newborn against RSV.

METHODS

An anonymous survey was administered from 20 April to 30 June 2023, to pregnant women aged ≥ 18 years attending gynecology wards of randomly selected public hospitals in southern Italy. A minimum sample size of 427 participants was calculated. The survey assessed women's socio-demographic characteristics, health-related information, their source(s) of information, and attitudes regarding RSV.

RESULTS

A total of 490 women participated. Those who were married/cohabiting, with a high-school degree compared to those who had a university degree, and those who needed additional information were more concerned that the newborn could acquire the RSV infection. The perceived utility of a future RSV vaccine administered during pregnancy was higher among those who were married/cohabiting, with a university degree, those with very good perceived health status, those who received information from healthcare workers, and those who needed additional information. Only 45.9% were willing to be vaccinated during pregnancy, and this was more likely among those with a university degree, with a very good perceived health status, who had received information from healthcare workers, and who needed more information. Finally, almost two-thirds (61.1%) were willing to vaccinate their newborn, and this was more likely among women with a university degree, with a very good perceived health status, and who needed additional information.

CONCLUSIONS

An education campaign regarding RSV infection and its vaccine is needed in order to improve women's perception and to support healthcare workers in promoting it when it will be available.

COVID-19 disease and vaccination in pregnancy: understanding knowledge, perceptions and experiences among pregnant women and community leaders in Uganda

BACKGROUND

We investigated pregnant women and community leaders' knowledge, perceptions and experiences of the coronavirus disease 2019 (COVID-19) vaccination program during pregnancy in Uganda and how this changed over the course of the pandemic.

METHODS

We conducted 20 in-depth interviews (IDIs) and two group discussions (GDs) with pregnant women and four GDs with community leaders in Kawempe division of Kampala, Uganda. The first round of IDIs/GDs were carried out in March 2021. In July 2021, telephone IDIs were conducted with 7 pregnant women and 10 community leaders randomly selected from first-round interview participants. Themes were analysed deductively drawing codes from the topic guides.

RESULTS

In the first round, the majority of participants thought COVID-19 was not real because of misconceptions around government messaging/motivation and beliefs that Africans would not be affected. In the second round, participants recognised COVID-19 disease, because of rising case numbers and fatalities. There was increased awareness of the benefits of the vaccine. However, pregnant women remained unsure of vaccine safety and quality, citing side effects like fevers and general body weakness. Role models and coherent public health messaging and healthcare workers were key enablers of vaccine uptake.

CONCLUSIONS

Targeted and sustained COVID-19 communication and engagement strategies are needed, especially for pregnant women and others in their communities, to improve vaccine confidence during outbreaks.

Racial and Ethnic Differences in Maternal and Child COVID-19 Vaccination Intent Among Pregnant and Postpartum Women in the USA (April-June 2020): an Application of Health Belief Model

This study investigated racial/ethnic differences in pregnant and postpartum women's intentions to receive the COVID-19 vaccination (maternal COVID-19 vaccination intent) and intentions to vaccinate their children against COVID-19 (child COVID-19 vaccination intent) during the early months of the COVID-19 pandemic (April-June 2020). This study also assessed Health Belief Model constructs to examine their influence on maternal and child COVID-19 vaccination intent by race/ethnicity. This study includes 489 US pregnant and postpartum women (18-49 years) recruited via Prolific Academic to complete a 55-item cross-sectional online survey. Crude and adjusted logistic regression analyses were conducted to determine the associations between race/ethnicity, maternal COVID-19 vaccination intent, and child COVID-19 vaccination intent. Among pregnant women, the odds of maternal COVID-19 vaccination intent (aOR = 2.20, 95% CI: .862, 5.61) and child COVID-19 vaccination intent (aOR = .194, 95% CI: .066, .565) among NH Black women were statistically significantly lower than that of NH White women after adjustment for demographic, health, and health belief model variables. Among postpartum women, although some racial differences in maternal or child COVID-19 vaccination intent were observed, these differences were not statistically significant in unadjusted and adjusted models. The findings have implications for future research and interventions which should adopt a racial health equity lens and identify strategies grounded in institutional trustworthiness and systems perspectives to address racial/ethnic disparities in COVID-19 vaccination intent among pregnant and postpartum women during novel pandemics.

Factors Affecting COVID-19 Vaccine Acceptance among Pregnant Women: A Cross Sectional Study from Abha City, Saudi Arabia

Background: Pregnant women can get infected with COVID-19 with serious sequelae to them and their fetus. Concerns about COVID-19 vaccination safety to mothers and babies, and doubts about its effectiveness, have hindered vaccine acceptance throughout the COVID-19 crisis. The objective of the current investigation was to estimate COVID-19 acceptance rates among pregnant women in Abha city, Aseer region, Saudi Arabia, and determine its clinical and demographic correlates. Method: Descriptive questionnaire-based cross-sectional survey of a sample of pregnant women attending regular antenatal care services in Abha. We used backward stepwise multiple logistic regression analysis to evaluate the predictability of vaccine acceptance in terms of baseline clinical and demographic factors. Results: The survey included 572 pregnant women. The prevalence of acceptance of COVID-19 vaccine was high (93.7%; 95%CI: 91.7-95.7%). University graduates and women with a later gestational age were more likely to accept vaccination (OR = 6.120, p = 0.009), (t = 2.163, p = 0.036), respectively. Confidence in vaccine safety was associated with better acceptance (OR = 3.431, p = 0.001). Conclusions: The acceptance rate for vaccination among pregnant women in Abha, Saudi Arabia, is higher compared to international rate. However, our results indicate that confidence in vaccine safety was associated with better acceptance. Hence, vaccine safety was the overarching predictor for harboring positive attitudes towards it. Public health policies should capitalize on such positive attitudes and aim for total coverage of pregnant women with COVID-19 vaccination including booster dosages.

Effect of COVID-19 vaccination and booster on maternal-fetal outcomes: a retrospective cohort study

BACKGROUND

COVID-19 in pregnant people increases the risk for poor maternal-fetal outcomes. However, COVID-19 vaccination hesitancy remains due to concerns over the vaccine's potential effects on maternal-fetal outcomes. Here we examine the impact of COVID-19 vaccination and boosters on maternal SARS-CoV-2 infections and birth outcomes.

METHODS

This was a retrospective multicentre cohort study on the impact of COVID-19 vaccination on maternal-fetal outcomes for people who delivered (n=106 428) at Providence St Joseph Health across seven western US states from Jan 26, 2021 to Oct 26, 2022. Cohorts were defined by vaccination status at delivery: vaccinated (n=35 926; two or more doses of mRNA-1273 Moderna or BNT162b2 Pfizer-BioNTech), unvaccinated (n=55 878), unvaccinated propensity score matched (n=16 771), boosted (n=10 927; three or more doses), vaccinated unboosted (n=13 243; two doses only), and vaccinated unboosted with propensity score matching (n=4414). We built supervised machine learning classification models, which we used to determine which people were more likely to be vaccinated or boosted at delivery. The primary outcome was maternal SARS-CoV-2 infection. COVID-19 vaccination status at delivery, COVID-19-related health care, preterm birth, stillbirth, and very low birthweight were evaluated as secondary outcomes.

FINDINGS

Vaccinated people were more likely to conceive later in the pandemic, have commercial insurance, be older, live in areas with lower household composition vulnerability, and have a higher BMI than unvaccinated people. Boosted people were more likely to have more days since receiving the second COVID-19 vaccine dose, conceive earlier in the pandemic, have commercial insurance, be older, and live in areas with lower household composition vulnerability than vaccinated unboosted people. Vaccinated pregnant people had lower rates of COVID-19 during pregnancy (4·0%) compared with unvaccinated matched people (5·3%; p<0·0001). COVID-19 rates were even lower in boosted people (3·2%) compared with vaccinated unboosted matched people (5·6%; p<0·0001). Vaccinated people were also less likely to have a preterm birth (7·9%; p<0·0001), stillbirth (0·3%; p<0·0002), or very low birthweight neonate (1·0%; p<0·0001) compared with unvaccinated matched people (preterm birth 9·4%; stillbirth 0·6%; very low birthweight 1·5%). Boosted people were less likely to have a stillbirth (0·3%; p<0·025) and have no differences in rates of preterm birth (7·6%; p=0·090) or very low birthweight neonates (0·8%; p=0·092) compared with vaccinated unboosted matched people (stillbirth 0·5%; preterm birth 8·4%; very low birthweight 1·1%).

INTERPRETATION

COVID-19 vaccination protects against adverse maternal-fetal outcomes, with booster doses conferring additional protection. Pregnant people should be high priority for vaccination and stay up to date with their COVID-19 vaccination schedule.

FUNDING

National Institute for Child Health & Human Development and the William O and K Carole Ellison Foundation.

COVID-19 knowledge, attitudes, and practices among Iranian pregnant and postpartum women: A national study

BACKGROUND

To control the spread of COVID-19, Iran has adopted rigorous precautionary and preventive measures, particularly for vulnerable groups. Considering the effects of knowledge and attitudes about COVID-19 on adherence to preventive measures, we examined women's knowledge, attitudes, and practices (KAP) from pregnancy to 6 weeks postpartum about COVID-19 during this pandemic.

METHODS

In a cross-sectional study, 7363 women were recruited via an online questionnaire between June 23, 2021 and July 7, 2021. The questionnaire consisted of 27 questions, measuring KAP.

RESULTS

Most of the participants had a good understanding of COVID-19 (Mean: 7.30 out of 9, standard deviation [SD]: 1.27), but the knowledge of the disease's main symptoms and modes of transmission was at the lowest levels. The mean attitudes score was 31.47 out of 50 (SD: 7.70). The participants had good practices against COVID-19 with a mean score of 35.48 out of 40 (SD: 3.94). To reduce anxiety and fear during the pandemic, half of our participants strongly emphasized the role of family emotional support. Income status and educational levels were the most significant variables influencing KAP (p-value ≤0.001). A correlation was found between knowledge and practice scores (r = 0.205, p-value = 0.001).

CONCLUSION

Our findings may serve to formulate awareness-raising interventions and can be a guide to health policymakers and workers such as obstetricians, clinicians, and midwives for more effective educational communication emphasizing the COVID-19 symptoms and transmission modes and rendering appropriate counseling, particularly on the importance of emotional family support during the pandemic.

COVID-19 Vaccines and Assisted Reproductive Techniques: A Systematic Review

Objective: To review the current knowledge concerning COVID-19 vaccination and assisted reproductive techniques (ART). Methods: A systematic review in Pubmed-Medline, the Cochrane Database, the Web of Science, and the National Guideline was performed. Studies were selected if they were primary studies, included vaccinated (case) and unvaccinated (control) patients, and described fertility treatment response. Results: A total of 24 studies were selected. Outcomes related to the association between COVID-19 vaccination and ART were collected. The vast majority of studies found no statistical differences concerning oocyte stimulation response, embryo quality, implantation rates, or pregnancy outcome (clinical or biochemical pregnancy rates and losses) when comparing cases and controls. Similarly, no differences were found when comparing different types of vaccines or distinct ART (artificial insemination, in vitro fertilization, and embryo transfer of frozen embryos). Conclusions: Patients receiving ART and health care professionals should be encouraged to complete and recommend COVID-19 vaccination, as the available evidence regarding assisted reproductive outcomes is reassuring.

Survey of COVID-19 Vaccine Attitudes in Predominately Minority Pregnant Women

OBJECTIVES

Despite recommendations for coronavirus disease (COVID-19) vaccination during pregnancy, some pregnant women are concerned about COVID-19 vaccines and decline to be vaccinated. This study focuses on attitudes in a sample of mostly minority pregnant Hispanic and Black women that may influence vaccine hesitancy.

METHODS

This was a cross-sectional survey of 400 pregnant women. Participants were provided with a one-page information sheet on pregnancy health, COVID-19 health, and COVID-19 vaccines. They were then asked to complete a survey on attitudes about these topics.

RESULTS

We found that attitudes for knowing about the health topics were in the range from agree to strongly agree, whereas attitudes for knowing about topics pertaining to COVID-19 messenger RNA (mRNA) vaccines were in a lower-level range from neutral to agree. Negative vaccine attitudes were significantly associated with decreased agreement for knowing about health attitudes, but not significantly associated with COVID-19 mRNA vaccine attitudes.

CONCLUSIONS

COVID-19 vaccine mRNA technology was a lesser understood topic than attitudes for knowing about other health topics. This finding suggests the need for physician intervention and that further education about COVID-19 vaccine mRNA technology may influence patient attitudes toward acceptance of the COVID-19 mRNA vaccine in pregnancy.

A Mother's Dilemma: The 5-P Model for Vaccine Decision-Making in Pregnancy

Pregnant women are a highly vaccine-resistant population and face unique circumstances that complicate vaccine decision-making. Pregnant women are also at increased risk of adverse maternal and neonatal outcomes to many vaccine-preventable diseases. Several models have been proposed to describe factors informing vaccine hesitancy and acceptance. However, none of these existing models are applicable to the complex decision-making involved with vaccine acceptance during pregnancy. We propose a model for vaccine decision-making in pregnancy that incorporates the following key factors: (1) perceived information sufficiency regarding vaccination risks during pregnancy, (2) harm avoidance to protect the fetus, (3) relationship with a healthcare provider, (4) perceived benefits of vaccination, and (5) perceived disease susceptibility and severity during pregnancy. In addition to these factors, the availability of research on vaccine safety during pregnancy, social determinants of health, structural barriers to vaccine access, prior vaccine acceptance, and trust in the healthcare system play roles in decision-making. As a final step, the pregnant individual must balance the risks and benefits of vaccination for themselves and their fetus, which adds greater complexity to the decision. Our model represents a first step in synthesizing factors informing vaccine decision-making by pregnant women, who represent a highly vaccine-resistant population and who are also at high risk for adverse outcomes for many infectious diseases.

COVID-19 vaccine acceptance among pregnant women: a hospital-based cross-sectional study in Sudan

Introduction

Pregnancy increases the risk of developing a severe illness due to COVID-19 infection. To the best of our knowledge, no previous study has been conducted on COVID-19 vaccine acceptance among pregnant women in Sudan. Hence, this study aimed to determine COVID-19 vaccination acceptance and its predictors among pregnant women.

Methods

A cross-sectional study was conducted among 623 pregnant women attending Gadarif maternity hospital in eastern Sudan through a structured questionnaire. Data were obtained on sociodemographic characteristics, obstetric and health-related characteristics, COVID-19 infection, and vaccination-related information, as well as beliefs about and acceptance of COVID-19 vaccination.

Results

COVID-19 vaccine acceptance among the pregnant women was 2.7%. The vaccine acceptance was higher if their husband's education was secondary school or higher [adjusted odds ratio [AOR] 4.30, 95% confidence interval (CI) 1.11-16.65, p = 0.035] and discussion of COVID-19 vaccine with the pregnant women by a health care professional in the hospital (AOR 5.46, 95% CI 1.94-15.35, p < 0.001). The most common reasons for resistance to the vaccine were concerns about the side effects of the vaccine for the mother and her baby.

Conclusion

Acceptance of the COVID-19 vaccination among the pregnant women was very low. Discussions with pregnant women and their husbands by health care professionals regarding the safety of COVID-19 vaccine for the mother and her baby are highly recommended.

COVID-19 Vaccine Hesitancy among English-Speaking Pregnant Women Living in Rural Western United States

This mixed-method study investigated vaccine hesitancy among pregnant women living in rural western United States and their response to social media ads promoting COVID-19 vaccine uptake. Thirty pregnant or recently pregnant participants who live in rural zip codes in Washington, Oregon, California, and Idaho were interviewed between November 2022 and March 2023. Interviews were transcribed and coded, while the ad ratings were analyzed using linear mixed models. The study identified five main themes related to vaccine uptake, including perceived risk of COVID, sources of health information, vaccine hesitancy, and relationships with care providers. Participants rated ads most highly that used peer-based messengers and negative outcome-based content. Ads with faith-based and elder messengers were rated significantly lower than peer messengers (p = 0.04 and 0.001, respectively). An activation message was also rated significantly less favorably than negative outcome-based content (p = 0.001). Participants preferred evidence-based information and the ability to conduct their own research on vaccine safety and efficacy rather than being told to get vaccinated. Primary concerns of vaccine-hesitant respondents included the short amount of time the vaccine had been available and perceived lack of research on its safety during pregnancy. Our findings suggests that tailored messaging using peer-based messengers and negative outcome-based content can positively impact vaccine uptake among pregnant women living in rural areas of the Western United States.

Vaccine hesitancy in pregnant Women: A narrative review

Pregnant women are often at higher risk for morbidity and mortality due to contracting vaccine-preventable diseases that result in adverse pregnancy outcomes such as spontaneous abortion, preterm births, and congenital fetal defects. For example, health care provider recommendation is correlated with maternal acceptance of influenza vaccination, however, up to 33 % of pregnant women remain unvaccinated irrespective of provider recommendation. Vaccine hesitancy is a multifactorial problem that both the medical and public health systems need to address synergistically. Vaccine education should incorporate balanced perspectives to deliver vaccine education. This narrative review addresses four questions: 1) what are the primary concerns of pregnant women that lead them to be hesitant about receiving vaccinations; 2) to what extent does the source (e.g. provider, friend, family) of vaccine advice and information influence a pregnant person's decision to accept a vaccine; 3) how does the delivery method of vaccine education influence their decision; 4) how can categorizing patients into four distinct groups based on their opinions and behavior regarding vaccines be used to improve provider-patient communication and increase vaccine acceptance. Results from the literature show that the three most common reasons for vaccine hesitancy include: i.) fear of side effects or adverse events; ii.) lack of confidence in vaccine safety; iii.) low perception of being at high risk of infection during pregnancy and/or not having previously received the vaccination when not pregnant. We conclude that vaccine hesitancy is dynamic therefore people do not always hold a static level of vaccine hesitancy. People may move between a continuum of vaccine hesitancy for a multifactorial reasons. A framework, characterized by levels of vaccine hesitancy before and during pregnancy, was constructed to help providers find balance between promoting individual health and public health while providing vaccine education.

Hesitant adopters: COVID-19 vaccine hesitancy among diverse vaccinated adults in the United States

Background

Despite the United States (US) having an abundant supply of COVID-19 vaccines, vaccination rates lag behind other high-income countries, suggesting that vaccine hesitancy and attitudes play a greater role in public health measures than pure supply and access. With the acknowledgment that vaccination attitudes and status may or may not be correlated, this study examined COVID-19 vaccine hesitancy among vaccinated US adults by asking: 1) What is the prevalence of COVID-19 vaccine hesitancy among the vaccinated? 2) Does COVID-19 vaccine hesitancy vary across sociodemographic characteristics? 3) Does COVID-19 vaccine hesitancy vary by healthcare access and influenza vaccination over the past 5 years?

Methods

Data were collected through an online survey of 2022 US adults with a final analytic sample of 1383 vaccinated respondents.

Results

Overall, 48.8% of vaccinated adults reported some level of hesitancy, while a slight majority reported they were "not at all hesitant". Younger respondents, women, and Black and American Indian or Alaska Native participants had greater adjusted odds of being more hesitant towards receiving the COVID-19 vaccine. Respondents who had a primary care physician had greater adjusted odds than those who did not have a primary care physician of being more hesitant towards receiving the COVID-19 vaccine.

Conclusions

This is the first population-based national sample study examining COVID-19 vaccine hesitancy among vaccinated individuals from subgroups of distinctive backgrounds in order to inform targeted strategies for reducing vaccine hesitancy. Findings can assist in efforts to increase vaccination rates and also decrease vaccine hesitancy at the national level.

Vaccine Hesitancy in Women's Health

The development of vaccines is considered one of the greatest breakthroughs of modern medicine, saving millions of lives around the world each year. Despite vaccines' proven success, vaccine hesitancy remains a major issue affecting vaccine uptake. Common themes exist in patients' apprehension to receive vaccines. Women's health providers possess an important role in addressing these concerns and dispelling common misconceptions that may increase vaccine hesitancy thereby reduce vaccine uptake. This review aims to explore many of these topics as they are related to women's health and provide strategies for providers to implement which may reduce vaccine hesitancy among our patients.

Maternal Vaccination and Vaccine Hesitancy

The American College of Obstetrics and Gynecology recommends influenza vaccine annually, Tdap with each pregnancy, and COVID-19 vaccine for those not previously vaccinated or who are due for boosters. The influenza and COVID-19 vaccines are safe during pregnancy and are effective in reducing morbidity in both the pregnant person and infant. The Tdap vaccine is given primarily to protect the newborn from pertussis through transplacental antibody transfer. Methods to enhance vaccination rates include stocking and giving vaccines in the obstetric office, recommending eligible vaccines at each visit, and focusing on the health of the infant in conversations with patients.

Barriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years: An umbrella review

BACKGROUND

Vaccination during pregnancy has been repeatedly demonstrated to be safe and effective in protecting against infection and associated harms for the mother, developing baby, and subsequent infant. However, maternal vaccination uptake remains low compared to the general population.

OBJECTIVES

An umbrella review to explore the barriers and facilitators to Influenza, Pertussis and COVID-19 vaccination during pregnancy and within 2 years after childbirth, and to inform interventions to encourage uptake (PROSPERO registration number: CRD42022327624).

METHODS

Ten databases were searched for systematic reviews published between 2009 and April 2022 exploring the predictors of vaccination or effectiveness of interventions to improve vaccination for Pertussis, Influenza, or COVD-19. Both pregnant women and mothers of infants under two years were included. Barriers and facilitators were organised using the WHO model of determinants of vaccine hesitancy through narrative synthesis, the Joanna Briggs Institute checklist assessed review quality, and the degree of overlap of primary studies was calculated.

RESULTS

19 reviews were included. Considerable overlap was found especially for intervention reviews, and the quality of the included reviews and their primary studies varied. Sociodemographic factors were specifically researched in the context of COVID-19, exerting a small but consistent effect on vaccination. Concerns around the safety of vaccination particularly for the developing baby were a main barrier. While key facilitators included recommendation from a healthcare professional, previous vaccination, knowledge around vaccination, and communication with and support from social groups. Intervention reviews indicated multi-component interventions involving human interaction to be most effective.

CONCLUSION

The main barriers and facilitators for Influenza, Pertussis and COVID-19 vaccination have been identified and constitute the foundation for policy development at the international level. Ethnicity, socioeconomic status, concerns about vaccine safety and side effects, and lack of healthcare professionals' recommendations, are the most relevant factors of vaccine hesitancy. Adapting educational interventions to specific populations, person-to-person interaction, healthcare professionals' involvement, and interpersonal support are important strategies to improve uptake.

Global Cross-Sectional Study Evaluating the Attitudes towards a COVID-19 Vaccine in Pregnant and Postpartum Women

Pregnant and postpartum women have an increased risk of severe complications from COVID-19. Many clinical guidelines recommend vaccination of these populations, and it is therefore critical to understand their attitudes toward COVID-19 vaccines. We conducted a cross-sectional online survey in November 2020 of currently pregnant and ≤1-year postpartum women in Brazil, India, the United Kingdom (UK), and the United States (US) that assessed their openness to COVID-19 vaccines and reasons for vaccine hesitancy. Logistic regression analyses were conducted to evaluate openness to receiving a vaccine. Out of 2010 respondents, 67% were open to receiving a COVID-19 vaccine themselves. Among pregnant and postpartum participants, 72% and 57% were willing to receive a vaccine, respectively. Vaccine openness varied significantly by country: India (87%), Brazil (71%), UK (59%), and US (52%). Across all participants, among the 33% who were unsure/not open to receiving a COVID-19 vaccine, the most common reason cited was safety/side effect concerns (51%). Participants were similarly open to their children/other family members receiving a COVID-19 vaccine. Presence of a comorbidity, a positive COVID-19 test result, and pregnancy were all significantly associated with positive vaccine acceptance. Targeted outreach to address pregnant and postpartum women's concerns about the COVID-19 vaccine is needed.

"I was having an internal conflict with myself." COVID-19 vaccination decision-making processes among pregnant women

BACKGROUND

Vaccination serves as an efficient primary means of control for infectious diseases. However, in the case of the COVID-19 pandemic, pregnant women within the United States had the lowest rates of COVID-19 vaccination and reported the lowest intent to vaccinate.

OBJECTIVES

To explore the decision-making process for COVID-19 vaccination for people pregnant during the pandemic.

DESIGN

A secondary analysis of data from a mixed-methods study that examined the impact of COVID-19 on experiences of prenatal care, birth support, and delivery in the Southern United States.

METHODS

This study used a descriptive phenomenological approach to thematically analyze in-depth interviews (n = 20) with adult women who were pregnant by January 2020 and had their prenatal care and delivery during the pandemic beginning in March 2020. The transcripts were de-identified, coded, and thematically analyzed to saturation to identify drivers of COVID-19 vaccine decision-making based on COVID-19 vaccination status and timing. Comparative analyses were conducted to assess differences in decision-making processes based on race/ethnicity and parity. Participants also completed a sociodemographic survey that included their COVID-19 vaccination status.

RESULTS

Two themes emerged, the weighing of parallel risks and priorities from different sources resulting in vaccine decisional conflict and the need to reconcile that conflict via multiple strategies. All participants weighed priorities and risks from multiple areas of their lives and described internal conflict around vaccination. Participants described tailoring decisions to household dynamics, reconciling public and private values around vaccination, and the impact of their identities on the decision-making process. While many described concerns over vaccine safety and fetal health, uniquely, many highlighted weighing the impact of prior pregnancy loss history, with some choosing other preventive measures like social distancing or mask-wearing, which they deemed less risky.

CONCLUSION

Pregnant people make complex COVID-19 vaccination decisions, which must be considered in future vaccine messaging and advocacy for this group.

COVID-19 Vaccine Uptake, Acceptance, and Reasons for Vaccine Hesitancy: A Cross-Sectional Study Among Pregnant Women in Trinidad, West Indies

Purpose

Pregnant women are at greater risk for severe COVID-19 disease and are a priority group for vaccination. Trinidad and Tobago (TTO) introduced COVID-19 vaccination for pregnancy in August 2021, however uptake is presumed to be low. The objective was to determine the COVID-19 vaccine acceptance and uptake rates among pregnant women in TTO and reasons for vaccine hesitancy.

Patients and Methods

This was a cross-sectional study on 448 pregnant women conducted at specialized antenatal clinics within the largest Regional Health Authority in TTO, and at one private institution from February 1 to May 6, 2022. Participants completed an adapted WHO questionnaire on reasons for COVID-19 vaccine hesitancy. Logistic regression was used to assess factors affecting vaccination decisions.

Results

The vaccine acceptance and uptake rates in pregnancy were 26.4% and 23.6%, respectively. The main reason for vaccine hesitancy was lack of research on the COVID-19 vaccine in pregnancy (70.2%), where 75.5% of women believed the vaccine would harm their babies and 71.2% believed there was not enough data. Women seeking care in the private sector (OR: 5.24, 95% CI: 1.41-19.43) and who had comorbidities (OR: 3.72, 95% CI: 11.57-8.83) were more likely to take the vaccine, while Venezuelan non-nationals (OR: 0.09, 95% CI: 0.01-0.71) were less likely to take the vaccine. Older women (OR: 1.80, 95% CI: 1.12-2.89), women with tertiary education (OR: 1.99, 95% CI: 1.25-3.19), and women seeking care in the private sector (OR: 9.45, 95% CI: 4.36-20.48) were more likely to accept the vaccine.

Conclusion

Lack of confidence in the vaccine was the main reason for hesitancy, which may reflect paucity of research, lack of knowledge or misinformation of the vaccine in pregnancy. This highlights the need for more targeted public education campaigns and promotion of the vaccine by health institutions. The knowledge, attitudes, and beliefs of pregnant women obtained from this study can guide the development of vaccination programs in pregnancy.

Knowledge and attitudes of pregnant women about Coronavirus vaccines in Turkiye

The aim of this cross-sectional study was to determine pregnant women's knowledge and attitudes regarding coronavirus vaccines in Turkiye. The research population consisted of 400 pregnant women who applied to a public hospital in this city. The data of the study was collected with the 'Personal Information Form' and 'Attitudes Towards COVID-19 Vaccine Scale'. Only 2% of the pregnant women stated that they wanted to receive coronavirus vaccines in their current pregnancy and 9.5% wanted it during the postpartum period. It has been concluded that the vast majority of pregnant women have insufficient knowledge and negative thoughts about coronavirus vaccines and the place where they live and their thoughts on the safety of coronavirus vaccines affect their positive attitudes about coronavirus vaccines.IMPACT STATEMENTWhat is already known on this subject? Many epidemics in history have been controlled or eliminated with vaccines. However, there is still insufficient evidence about the effects of coronavirus infection and vaccines on pregnant women.What do the results of this study add? As a result, it was found that the vast majority of pregnant women had insufficient knowledge and negative thoughts about coronavirus vaccines and very few of them wanted to receive the coronavirus vaccine during pregnancy and the postpartum period.What are the implications of these findings for clinical practice and/or further research? In the light of these findings, it is recommended that increase the vaccination rates in pregnant women by turning existing negative attitudes towards coronavirus vaccines in pregnant women into positive ones, providing accurate and effective information by health professionals and the media to eliminate negative attitudes caused by lack of information in pregnant women, conducting more studies on obstacles to increasing vaccine acceptance during pregnancy, and conducting studies on the subject with wider audiences and regions.

Knowledge, attitudes, and practices of pregnant women regarding COVID-19 vaccination in pregnancy in 7 low- and middle-income countries: An observational trial from the Global Network for Women and Children's Health Research

OBJECTIVES

We sought to determine the knowledge, attitudes and practices of pregnant women regarding COVID-19 vaccination in pregnancy in seven low- and middle-income countries (LMIC).

DESIGN

Prospective, observational, population-based study.

SETTINGS

Study areas in seven LMICs: Bangladesh, India, Pakistan, Guatemala, Democratic Republic of the Congo (DRC), Kenya and Zambia.

POPULATION

Pregnant women in an ongoing registry.

METHODS

COVID-19 vaccine questionnaires were administered to pregnant women in the Global Network's Maternal Newborn Health Registry from February 2021 through November 2021 in face-to-face interviews.

MAIN OUTCOME MEASURES

Knowledge, attitude and practice regarding vaccination during pregnancy; vaccination status.

RESULTS

No women were vaccinated except for small proportions in India (12.9%) and Guatemala (5.5%). Overall, nearly half the women believed the COVID-19 vaccine is very/somewhat effective and a similar proportion believed that the COVID-19 vaccine is safe for pregnant women. With availability of vaccines, about 56.7% said they would get the vaccine and a 34.8% would refuse. Of those who would not get vaccinated, safety, fear of adverse effects, and lack of trust predicted vaccine refusal. Those with lower educational status were less willing to be vaccinated. Family members and health professionals were the most trusted source of information for vaccination.

CONCLUSIONS

This COVID-19 vaccine survey in seven LMICs found that knowledge about the effectiveness and safety of the vaccine was generally low but varied. Concerns about vaccine safety and effectiveness among pregnant women is an important target for educational efforts to increase vaccination rates.

Association between social vulnerability and COVID-19 vaccination hesitancy and vaccination in pregnant and postpartum individuals

OBJECTIVE

To evaluate the association of community-level social vulnerability with COVID-19 vaccine hesitancy and vaccination among pregnant and postpartum individuals.

METHODS

Prospective cohort study assessing COVID-19 vaccine hesitancy among pregnant and postpartum individuals. We performed a baseline survey on COVID-19 vaccine hesitancy from 03/22/21 to 04/02/21, and a follow-up survey on COVD-19 vaccination status 3- to 6-months later. The primary exposure was the Centers for Disease Control and Prevention SVI (Social Vulnerability Index), measured in quartiles. Higher SVI quartiles indicated greater community-level social vulnerability with the lowest quartile (quartile 1) as the referent group. The primary outcome was COVID-19 vaccine hesitancy on the baseline survey (uncertainty or refusal of the vaccine), and the secondary outcome was self-report of not being vaccinated (unvaccinated) for COVID-19 on the follow-up survey.

RESULTS

Of 456 assessed individuals, 46% reported COVID-19 vaccine hesitancy on the baseline survey; and of 290 individuals (290/456, 64%) who completed the follow-up survey, 48% (140/290) were unvaccinated. The frequency of baseline vaccine hesitancy ranged from 25% in quartile 1 (low SVI) to 68% in quartile 4 (high SVI), and being unvaccinated at follow-up ranged from 29% in quartile 1 to 77% in quartile 4. As social vulnerability increased, the risk of COVID-19 vaccine hesitancy at baseline increased (quartile 2 aRR (adjusted relative risk): 1.46; 95% CI:0.98 to 2.19; quartile 3 aRR: 1.86; 95% CI:1.28 to 2.71; and quartile 4 aRR: 2.24; 95% CI:1.56 to 3.21), as did the risk of being unvaccinated at follow-up (quartile 2 aRR: 1.00; 95% CI:0.66 to 1.51; quartile 3 aRR: 1.68; 95% CI:1.17 to 2.41; and quartile 4 aRR: 1.82; 95% CI:1.30 to 2.56).

CONCLUSIONS

Pregnant and postpartum individuals living in an area with higher community-level social vulnerability were more likely to report COVID-19 vaccine hesitancy and subsequently to be unvaccinated at follow-up.

Peripartum Outcomes Associated With COVID-19 Vaccination During Pregnancy: A Systematic Review and Meta-analysis

Importance

The risk and benefits of COVID-19 vaccination during pregnancy are under investigation. Pooled evidence regarding neonatal and maternal outcomes in association with COVID-19 vaccination during pregnancy is scarce.

Objective

To evaluate the association between COVID-19 vaccination during pregnancy and peripartum outcomes.

Data Sources

PubMed and EMBASE databases were searched on April 5, 2022. Language restrictions were not applied.

Study Selection

Prospective trials and observational studies comparing the individuals who received at least 1 COVID-19 vaccination during pregnancy with those who did not and reporting the neonatal outcomes, including preterm birth, small for gestational age, low Apgar score, neonatal intensive care units (NICU) admission, and intrauterine fetal death (IFD).

Data Extraction and Synthesis

Two independent investigators extracted relevant data from each study. Odds ratios (ORs) were calculated using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.

Main Outcomes and Measures

The primary outcomes were the neonatal outcomes, including preterm birth, small for gestational age, low Apgar score, NICU admission, and IFD. The secondary outcomes were maternal outcomes, including maternal SARS-CoV-2 infection, cesarean delivery, postpartum hemorrhage, and chorioamnionitis.

Results

Nine observational studies involving 81 349 vaccinated (mean age, 32-35 years) and 255 346 unvaccinated individuals during pregnancy (mean age, 29.5-33 years) were included. COVID-19 vaccination during pregnancy was associated with lower risk of NICU admission (OR, 0.88; 95% CI, 0.80-0.97) and IFD (OR, 0.73; 95% CI, 0.57-0.94), whereas there was no statistically significant association with preterm birth (OR, 0.89; 95% CI, 0.76-1.04), small for gestational age (OR, 0.99; 95% CI, 0.94-1.04), and low Apgar score (OR, 0.94; 95% CI, 0.87-1.02). COVID-19 vaccination during pregnancy was associated with a lower risk of maternal SARS-CoV-2 infection (OR, 0.46; 95% CI, 0.22-0.93), whereas it was not associated with increased risk of cesarean delivery (OR, 1.05; 95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95; 95% CI, 0.83-1.07), and chorioamnionitis (OR, 0.95; 95% CI, 0.83-1.07).

Conclusions and Relevance

COVID-19 vaccination during pregnancy was not associated with an increase in the risk of peripartum outcomes, was associated with a decreased risk of NICU admission, IFD, and maternal SARS-CoV-2 infection. Thus, COVID-19 vaccination should be encouraged for pregnant individuals.

COVID-19 vaccine acceptance and coverage among pregnant persons in the United States

Pregnant persons are at higher risk of severe COVID-19. Although vaccination is recommended, COVID-19 vaccination rates are lower among pregnant persons compared to the non-pregnant population. We aimed to evaluate acceptance of any dose of COVID-19 vaccine during pregnancy. A national online cross-sectional survey of US adults who were pregnant between December 2020 and July 2021 was used to measure COVID-19 vaccine behaviors, attitudes, and beliefs. Post-stratification weighting was used to ensure representativeness to the US population. Marginal log-binomial models were used to estimate adjusted prevalence ratios (aPR) of COVID-19 vaccine acceptance, accounting for sociodemographic factors. Of 5,660 who responded to survey advertisements, 2,213 met eligibility criteria and completed the survey; 55.4% of respondents received or planned to receive COVID-19 vaccine prior to or during pregnancy, 27.0% planned to vaccinate after pregnancy, 8.8% were unsure and 8.7% had no plans to vaccinate. Individuals were more likely to receive or plan to receive COVID-19 vaccine if they had group prenatal care (aPR 1.57; 95% CI 1.40, 1.75), were employed in a workplace with a policy recommending vaccination (aPR 1.15; 95% CI 1.06, 1.26), and believed COVID-19 vaccines are safe (aPR 2.86; 95% CI 2.49, 3.29). Pregnant persons who were recommended COVID-19 vaccination by their healthcare provider less commonly reported concerns about vaccine safety (35.5% vs 55.9%) and were more likely to accept COVID-19 vaccines (aPR 1.52; 95% CI 1.31, 1.76). COVID-19 vaccine acceptance during pregnancy is not universal and public health intervention will be needed to continue to increase vaccine coverage.

Perceptions and Attitudes toward COVID-19 Vaccination among Pregnant and Postpartum Individuals

OBJECTIVE

This study aimed to characterize attitudes toward novel coronavirus disease 2019 (COVID-19) vaccination and to evaluate factors associated with vaccine uptake among pregnant individuals.

STUDY DESIGN

An anonymous survey was distributed to a convenience sample of pregnant individuals receiving prenatal care at two large urban academic hospitals in a single health care network in Massachusetts. Individual demographic variables were included in the survey along with questions assessing attitudes toward COVID-19 and vaccination in pregnancy. Data were analyzed using parametric or nonparametric tests when appropriate, and associated odds ratios (OR) were calculated via univariable logistic regression.

RESULTS

There were 684 surveys distributed, and 477 pregnant and postpartum individuals completed the survey, for a response rate of 69.7%. Overall, 233 (49.3%) had received or were scheduled to receive a COVID-19 vaccine. Age, White race, non-Hispanic or Latinx ethnicity, working from home, and typical receipt of the influenza vaccine were associated with COVID-19 vaccination. Further, 276 respondents (58.4%) reported that their provider recommended the COVID-19 vaccine in pregnancy; these participants were more likely to have received a vaccine (OR = 5.82, 95% confidence interval [CI]: 3.68-9.26, p < 0.005). Vaccinated individuals were less likely to be worried about the effects of the vaccine on themselves (OR = 0.18, 95% CI: 0.12-0.27, p < 0.005) or their developing babies (OR = 0.17, 95% CI: 0.11-0.26, p < 0.005). Unvaccinated individuals were less likely to report that it is easy to schedule a COVID-19 vaccine (OR = 0.56, 95% CI: 0.34-0.93, p = 0.02), to travel to receive a vaccine (OR = 0.19, 95% CI: 0.10-0.36, p < 0.005), and to miss work to receive a vaccine (OR = 0.30, 95% CI: 0.18-0.48, p < 0.005).

CONCLUSION

Strategies are needed to improve patient education regarding vaccine side effects and safety in pregnancy. Policy changes should focus on making it feasible for patients to schedule a vaccine and miss work without loss of pay to get vaccinated.

KEY POINTS

· There were racial and ethnic disparities in COVID-19 vaccination.. · Unvaccinated respondents were more likely to be concerned about vaccine effects for themselves or their growing babies.. · Unvaccinated respondents cited work and scheduling-related barriers to vaccination, indicating areas for advocacy..

COVID-19 Vaccine Acceptance during Pregnancy and Influencing Factors in South Korea

Pregnant women were excluded from vaccination against Coronavirus 2019 (COVID-19) until September 2021 in South Korea. Although vaccination for pregnant women started in October 2021, vaccine acceptance in pregnant women is yet unknown. This cross-sectional study aimed to investigate COVID-19 vaccine acceptance during pregnancy and influencing factors. An anonymous survey was distributed in obstetrics departments to all pregnant or postpartum women, during the prenatal or postpartum visit. The proportion of self-reported COVID-19 vaccination during pregnancy among 436 women was 26.6%. Pregnancy-related independent factors influencing maternal COVID-19 vaccination were “received vaccine information about from obstetrics and gynecology (OBGYN) doctors” (OR 3.41, 95% CI 2.05–5.65), “cohabitant COVID-19 vaccination” (OR 2.43, 95% CI 1.06–5.59), and “second trimester” (OR 7.35, 95% CI 1.54–35.15). In women who did not want to get vaccinated, the most common reason for COVID-19 vaccination hesitancy was concern that COVID-19 vaccine might affect the fetus (91.7%, 243/266), followed by distrust in COVID-19 vaccine effectiveness (42.6%, 113/266). This study showed that providing information about maternal COVID-19 vaccination, especially by OBGYN doctors, is crucial for increasing vaccination coverage in pregnant women. Providing updated evidence of COVID-19 vaccine efficacy and safety in pregnant women may be also helpful for increasing vaccine acceptance.

Barriers and facilitators to vaccination for COVID-19, pertussis, and influenza during pregnancy: Protocol for an umbrella review

Pregnant women are particularly vulnerable to infection. Furthermore, infection from pertussis, influenza and COVID-19 increases the likelihood of adverse consequences to the mother and developing baby such as stillbirth, ICU admission, and pre-term caesarean birth. Increased rates of transmission and risk of adverse consequences from infection justifies the provision of national maternal vaccination programmes. Additionally, maternal vaccination helps protect the infant until they are able to receive their own vaccinations; a time when they are most at risk of mortality from influenza and pertussis. Vaccination during pregnancy has been repeatedly demonstrated as safe and effective in reducing harm, although rates of uptake remain low compared to the general population. The current protocol describes the methodology for an umbrella review aiming to explore the barriers and facilitators of vaccination during pregnancy for pertussis, influenza, and COVID-19. Systematic reviews that investigate the barriers and facilitators of at least one of either pertussis, influenza, or COVID-19 will be included in this review. Multiple databases will be searched, and included reviews assessed for quality (using the Joanna Briggs Institute (JBI) quality assessment for systematic reviews) and degree of overlap of included primary studies. Included reviews will be analysed according to the WHO SAGE model of determinants of vaccine hesitancy and separated by whether these explore influenza and pertussis, or COVID-19. The outcomes of this review will help inform the development of interventions to increase uptake of vaccination during pregnancy, and on whether interventions need to be tailored depending on the infectious disease. The key findings will identify the specific barriers and facilitators of vaccination hesitancy by considering contextual influences (e.g. sociodemographic variables), individual/social group influences (e.g. trust in the institutions), and vaccine-specific issues (e.g. safety and recommendations).

The prevalence of COVID vaccine acceptance among pregnant women: A systematic review and meta-analysis

COVID pandemic has massively hit every nook of the world. Millions of people were infected and lost their lives to the deadly pandemic. This novel virus destroyed the essential healthcare service globally. Mass vaccination is the only option to halt the virus transmission. This study aimed to estimate the acceptance of the COVID vaccine among pregnant women and breastfeeding mothers. Method: We followed Cochrane collaboration guidelines and the PRISMA reporting system. Studies were identified through a systematic search of indexed articles in Medline (PubMed), Clinical key, Google Scholar, Cochrane Library, and CINAHL databases until March 10, 2022, 26,995 articles were identified in the initial search and 24 articles were included in the review. Result: Twenty four studies comprise 22,947 pregnant and 11,022 breastfeeding women. About 54% of pregnant women and 59% of breastfeeding mothers intended to take the COVID vaccination. Among the pregnant mothers, 21% with comorbidities, 14% in the first trimester, 34% in the second trimester, and 51% in the third trimester were willing to take the COVID vaccine. Risks of infections and comorbidities were the reasons for acceptance of the COVID vaccine in pregnant women. Similarly, adverse effects and safety concerns were top indicators for the rejection of the COVID vaccine. Conclusion: The acceptance of COVID vaccination among pregnant women and breastfeeding mothers are not satisfactory. Therefore, timely guidance would help to address the negative perceptions of vaccines among pregnant women.

The effect of COVID-19 vaccination and booster on maternal-fetal outcomes: a retrospective multicenter cohort study

Background

COVID-19 infection in pregnant people has previously been shown to increase the risk for poor maternal-fetal outcomes. Despite this, there has been a lag in COVID-19 vaccination in pregnant people due to concerns over the potential effects of the vaccine on maternal-fetal outcomes. Here we examine the impact of COVID-19 vaccination and booster on maternal COVID-19 breakthrough infections and birth outcomes.

Methods

This was a retrospective multicenter cohort study on the impact of COVID-19 vaccination on maternal-fetal outcomes for people that delivered (n=86,833) at Providence St. Joseph Health across Alaska, California, Montana, Oregon, New Mexico, Texas, and Washington from January 26, 2021 through July 11, 2022. Cohorts were defined by vaccination status at time of delivery: unvaccinated (n=48,492), unvaccinated propensity score matched (n=26,790), vaccinated (n=26,792; two doses of mRNA-1273 Moderna or BNT162b2 Pfizer-BioNTech), and/or boosted (n=7,616). The primary outcome was maternal COVID-19 infection. COVID-19 vaccination status at delivery, COVID-19 infection-related health care, preterm birth (PTB), stillbirth, very low birth weight (VLBW), and small for gestational age (SGA) were evaluated as secondary outcomes.

Findings

Vaccinated pregnant people were significantly less likely to have a maternal COVID-19 infection than unvaccinated matched (p<0.0001) pregnant people. During a maternal COVID-19 infection, vaccinated pregnant people had similar rates of hospitalization (p=0.23), but lower rates of supplemental oxygen (p<0.05) or vasopressor (p<0.05) use than those in an unvaccinated matched cohort. Compared to an unvaccinated matched cohort, vaccinated people had significantly lower stillbirth rate (p<0.01) as well as no difference in rate of PTB (p=0.35), SGA (p=0.79), or rate of VLBW (>1,500 g; 0.31). Vaccinated people who were boosted had significantly lower rates of maternal COVID-19 infections (p<0.0001), COVID-19 related hospitalization (p<0.05), PTB (p<0.05), stillbirth (p<0.01), SGA (p<0.05), and VLBW (p<0.01), compared to vaccinated people that did not receive a third booster dose five months after completing the initial vaccination series.

Interpretation

COVID-19 vaccination protects against adverse maternal-fetal outcomes with booster doses conferring additional protection against COVID-19 infection. It is therefore important for pregnant people to have high priority status for vaccination, and for them to stay current with their COVID-19 vaccination schedule.

Funding

This study was funded by the National Institute for Child Health & Human Development and the William O. and K. Carole Ellison Foundation.

Covid-19 vaccination in pregnancy

Pregnancy is an independent risk factor for severe covid-19. Vaccination is the best way to reduce the risk for SARS-CoV-2 infection and limit its morbidity and mortality. The current recommendations from the World Health Organization, Centers for Disease Control and Prevention, and professional organizations are for pregnant, postpartum, and lactating women to receive covid-19 vaccination. Pregnancy specific considerations involve potential effects of vaccination on fetal development, placental transfer of antibodies, and safety of maternal vaccination. Although pregnancy was an exclusion criterion in initial clinical trials of covid-19 vaccines, observational data have been rapidly accumulating and thus far confirm that the benefits of vaccination outweigh the potential risks. This review examines the evidence supporting the effectiveness, immunogenicity, placental transfer, side effects, and perinatal outcomes of maternal covid-19 vaccination. Additionally, it describes factors associated with vaccine hesitancy in pregnancy. Overall, studies monitoring people who have received covid-19 vaccines during pregnancy have not identified any pregnancy specific safety concerns. Additional information on non-mRNA vaccines, vaccination early in pregnancy, and longer term outcomes in infants are needed. To collect this information, vaccination during pregnancy must be prioritized in vaccine research.

Hesitancy about COVID-19 vaccination among pregnant women: a cross-sectional study based on the health belief model

BACKGROUND

Pregnant women are at high risk for affliction by coronavirus disease 2019 (COVID-19). Vaccination is a main strategy to prevent and manage the COVID-19 pandemic. However, hesitancy about COVID-19 vaccination (HACV) is a major public health threat and a major barrier to herd immunity. The aim of the study was to evaluate pregnant women's HACV based on the Health Belief Model (HBM).

METHODS

This cross-sectional study was conducted in 2021-2022. Participants were 352 pregnant women selected from several healthcare centers in the north of Iran. Instruments for data collection were a demographic questionnaire, a COVID-19 Knowledge Questionnaire, a COVID-19 Health Belief Questionnaire, and a question about HACV. Logistic regression analysis was used to assess the effects of the study variables on HACV.

RESULTS

The rate of HACV was 42.61%. In the regression model, the three factors of perceived benefits (aOR: 0.700; 95% CI: 0.594 to 0.825), cues to action (aOR: 0.621; 95% CI: 0.516 to 0.574), and history of reproductive problems (aOR: 2.327; 95% CI: 0.1.262 to 4.292) had significant effects on HACV (P <  0.001).

CONCLUSION

HACV is highly prevalent among pregnant women. The perceived benefits and cues to action components of HBM have significant effects on pregnant women's HACV, while the perceived threat component has no significant effect on it. HBM is a good model to explain HACV among pregnant women. Educational interventions are necessary to improve pregnant women's awareness of the risks of COVID-19 for them and their fetus.

COVID-19 vaccine uptake and intention during pregnancy in Canada

Objective

To investigate COVID-19 vaccine uptake and intent among pregnant people in Canada, and determine associated factors.

Methods

We conducted a national cross-sectional survey among pregnant people from May 28 through June 7, 2021 (n = 193). Respondents completed a questionnaire to determine COVID-19 vaccine acceptance (defined as either received or intend to receive a COVID-19 vaccine during pregnancy), factors associated with vaccine acceptance, and rationale for accepting/not accepting the vaccine.

Results

Of 193 respondents, 57.5% (n = 111) reported COVID-19 vaccine acceptance. Among those who did not accept the vaccine, concern over vaccine safety was the most commonly cited reason (90.1%, n = 73), and 81.7% (n = 67) disagreed with receiving a vaccine that had not been tested in pregnant people. Confidence in COVID-19 vaccine safety (aOR 16.72, 95% CI: 7.22, 42.39), Indigenous self-identification (aOR 11.59, 95% CI: 1.77, 117.18), and employment in an occupation at high risk for COVID-19 exposure excluding healthcare (aOR 4.76, 95% CI: 1.32, 18.60) were associated with vaccine acceptance. Perceived personal risk of COVID-19 disease was not associated with vaccine acceptance in the multivariate model.

Conclusion

Vaccine safety is a primary concern for this population. Safety information should be communicated to this population as it emerges, along with clear messaging on the benefits of vaccination, as disease risk is either poorly understood or poorly valued in this population.

COVID-19 vaccine uptake and associated factors among pregnant women attending antenatal care in Debre Tabor public health institutions: A cross-sectional study

Background

Vaccination is the best means of reducing the increased risk of severe COVID-19 during pregnancy. Data on COVID-19 vaccine uptake among pregnant women in Ethiopia is scarce. Thus, this study aimed to assess COVID-19 vaccine uptake and associated factors among pregnant women.

Method

An institution-based cross-sectional study was conducted among 634 pregnant women attending antenatal care in Debre Tabor public health institutions from March 14 to 30, 2022. Participants were recruited using a multistage sampling technique and data were collected via face-to-face interviews using a pre-tested structured questionnaire. Stata version 16.0 software was used for data analysis. Multiple logistic regression analysis was used to assess factors associated with COVID-19 vaccine uptake, with a p-value&lt; 0.05 considered statistically significant.

Result

Only 14.4% (95% CI: 11.7%-17.3%) of participants had received at least one dose of COVID-19 vaccines. The main reasons for declining vaccination were fear that the COVID-19 vaccine may have harmful side effects on the fetus or the mother. Being 45 or older (AOR: 1.75, 95%CI: 1.01–2.95), being married (AOR: 1.26, 95%CI: 1.12, 2.96), having good knowledge (AOR:3.52, 95%CI:1.83–3.87), and a positive attitude (AOR:4.81, 95% CI: 1.42–7.33) were positive predictors of COVID-19 vaccine uptake. But attaining a college or university education (AOR: 0.43, 95%CI: 0.12–0.69) was found to be a barrier to vaccine uptake by pregnant women.

Conclusion

COVID-19 vaccination among pregnant women was substantially low. Old age, being married, low education, good knowledge, and a positive attitude were significant predictors of COVID-19 vaccine uptake. To enhance the COVID-19 vaccine uptake, the government should improve the knowledge and attitude of pregnant women toward the COVID-19 vaccine.