1
|
Young AM, Stoner MCD, Mathebula F, Mohuba R, Baez A, Seyama L, Mutero P, Etima J, Fabiano Z, Fairlie L, Mayo AJ, Balkus JE, Song M, Bunge K, Piper J, Balan IC, van der Straten A, Montgomery ET. Acceptability of the Dapivirine Vaginal Ring and Daily Oral Pre-exposure Prophylaxis (PrEP) during Pregnancy in Malawi, South Africa, Uganda, and Zimbabwe. AIDS Behav 2024:10.1007/s10461-024-04421-z. [PMID: 39052199 DOI: 10.1007/s10461-024-04421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/27/2024]
Abstract
Pregnant and lactating persons in sub-Saharan Africa face a heightened risk of HIV acquisition, due to biological and behavioral factors, combined with limited access to prevention and treatment services. Oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring are promising tools for HIV prevention, and the ring's recent approval in multiple African countries represents a significant advancement in expanding access to HIV prevention. In a nested qualitative study within the MTN-042 trial, we explored the acceptability of study products among pregnant persons in the second and early third trimesters. Interviews were conducted privately, using a semi-structured guide with 77 participants, in participants' preferred language. Topics explored included product acceptability (using the theoretical framework of acceptability), user experience, satisfaction, disclosure, community attitudes, and sexual activity during pregnancy. Interview transcripts were analyzed using Dedoose software. We observed positive attitudes among participants towards the study products, which they found generally user-friendly, despite the added complexities of using them during pregnancy. Participants recognized that consistent and correct use would provide protection for both them and their unborn children. Although initial concerns existed, most of these worries dissipated over time, with study staff support and increased product use experience. These findings emphasize the importance of continued surveillance, support, and education to ensure the successful rollout of new HIV prevention measures during pregnancy.
Collapse
Affiliation(s)
- Alinda M Young
- Women's Global Health Imperative at RTI International, 2150 Shattuck Avenue, Berkeley, CA, 94104, USA.
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Marie C D Stoner
- Women's Global Health Imperative at RTI International, 2150 Shattuck Avenue, Berkeley, CA, 94104, USA
| | - Florence Mathebula
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebone Mohuba
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alejandro Baez
- Women's Global Health Imperative at RTI International, 2150 Shattuck Avenue, Berkeley, CA, 94104, USA
| | - Linly Seyama
- Johns Hopkins Project - Kamuzu University of Health Science, Blantyre, Malawi
| | - Prisca Mutero
- University of Zimbabwe - Clinical Trials Research Centre, 15 Phillips Road, Belgravia, Harare, Zimbabwe
| | - Juliane Etima
- Makerere University - Johns Hopkins University Research Collaboration, Upper Mulago Hill Road Kampala, Kampala, Uganda
| | - Zayithwa Fabiano
- Johns Hopkins Project - Kamuzu University of Health Science, Blantyre, Malawi
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashley J Mayo
- FHI 360, 359 Blackwell St., Suite 200, Durham, NC, USA
| | - Jennifer E Balkus
- Department of Epidemiology, University of Washington School of Public Health, Seattle, USA
- Vaccine and Infectious Disease Division, Fred Hutch Cancer Center, Seattle, USA
| | - Mei Song
- Magee-Women's Hospital of UPMC, 300 Halket Street, Pittsburgh, PA, USA
| | | | | | - Ivan C Balan
- Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Ariane van der Straten
- ASTRA consulting, 256 Stanford Avenue, Kensington, CA, USA
- Center for AIDS Prevention Studies (CAPS) UCSF, San Franscico, CA, USA
| | - Elizabeth T Montgomery
- Women's Global Health Imperative at RTI International, 2150 Shattuck Avenue, Berkeley, CA, 94104, USA
| |
Collapse
|
2
|
Casubhoy I, Kretz A, Tan HL, St Clair LA, Parish M, Golding H, Bersoff-Matcha SJ, Pilgrim-Grayson C, Berhane L, Pekosz A, Mostafa HH, Cox AL, Burd I, Klein SL, Morgan R. A scoping review of global COVID-19 vaccine hesitancy among pregnant persons. NPJ Vaccines 2024; 9:131. [PMID: 39033194 PMCID: PMC11271279 DOI: 10.1038/s41541-024-00913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Imaima Casubhoy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alyssa Kretz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heang-Lee Tan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura A St Clair
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maclaine Parish
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hana Golding
- Division of Viral Products, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Catherine Pilgrim-Grayson
- Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine-Division of Urology, Obstetrics, and Gynecology, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Leah Berhane
- Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine-Division of Urology, Obstetrics, and Gynecology, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heba H Mostafa
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea L Cox
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sabra L Klein
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
3
|
Comparcini D, Tomietto M, Pastore F, Nichol B, Miniscalco D, Flacco ME, Stefanizzi P, Tafuri S, Cicolini G, Simonetti V. Factors Influencing COVID-19 Vaccine Hesitancy in Pregnant and Breastfeeding/Puerperium Women: A Cross-Sectional Study. Vaccines (Basel) 2024; 12:772. [PMID: 39066410 PMCID: PMC11281372 DOI: 10.3390/vaccines12070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Vaccination among pregnant and breastfeeding women is critical for protecting this vulnerable population and their children. COVID-19 vaccination is recommended both during pregnancy and breastfeeding; however, we still do not fully understand the determinants that influence hesitancy towards COVID-19 vaccination. This study aimed to identify the determinants of vaccine hesitancy in pregnant and breastfeeding, puerperium women. A multicenter, cross-sectional study, involving 435 pregnant and breastfeeding women, was conducted. Vaccination hesitancy was evaluated by administering the Vaccination Attitudes (VAX) Scale and the Zung Anxiety Self-Assessment Scale (SAS) was adopted to measure anxiety levels. Overall, 14% of the participants reported that they did not receive the COVID-19 vaccine, and 78.3% received their first dose during pregnancy or while breastfeeding. The descriptive statistics for the VAX scale showed a total mean score of 3.35 (±1.6), and 75% of participants reported an anxiety index equal to or lower than the threshold. Vaccine hesitancy increased as "adverse events after vaccination" increased (p < 0.01), while SAS levels positively correlated with the participants' mean age (p < 0.05). Investigating the factors influencing vaccine hesitancy enables the development of targeted health policies and SARS-CoV-2 vaccination programs.
Collapse
Affiliation(s)
- Dania Comparcini
- Interdisciplinary Department of Medicine, “Aldo Moro”, University of Bari, 70121 Bari, Italy; (P.S.); (S.T.)
| | - Marco Tomietto
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Francesco Pastore
- Department of Biomedicine and Prevention, TorVergata University, 00133 Roma, Italy;
| | - Bethany Nichol
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | | | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, “Aldo Moro”, University of Bari, 70121 Bari, Italy; (P.S.); (S.T.)
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, “Aldo Moro”, University of Bari, 70121 Bari, Italy; (P.S.); (S.T.)
| | - Giancarlo Cicolini
- Department of Innovative Technologies in Medicine and Dentistry, “Gabriele D’Annunzio” University of Chieti, 66100 Chieti, Italy; (G.C.); (V.S.)
| | - Valentina Simonetti
- Department of Innovative Technologies in Medicine and Dentistry, “Gabriele D’Annunzio” University of Chieti, 66100 Chieti, Italy; (G.C.); (V.S.)
| |
Collapse
|
4
|
Tsiaousi I, Psarris A, Theodora M, Antsaklis P, Sindos M, Koutroumanis P, Zacharakis D, Daskalakis G. COVID-19 Vaccination Acceptance During Pregnancy in Europe. Cureus 2024; 16:e63562. [PMID: 39087190 PMCID: PMC11289694 DOI: 10.7759/cureus.63562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Pregnant women have been shown to have a higher risk of SARS-CoV-2 infection. Vaccination against the infection is the most effective strategy for preventing both severe disease and related complications. Nevertheless, vaccination hesitancy among pregnant women is an important issue affecting vaccine uptake and a major challenge for Public Health, as high rates of hesitancy can lead to complete refusal of vaccination, with health implications not only for the mother but also for the fetus. Based on the above, this review aims to capture the rates of vaccination against COVID-19 in pregnancy among European countries, from August 2020 to May 2022, as well as to highlight the predictive factors of its acceptance among pregnant women in these countries. The review of the available literature found that in Europe the acceptance of vaccination against COVID-19 among pregnant women varies with rates ranging from 21.3% to 87% for at least one dose and from 29.5% to 82.7%, for two doses of vaccine. Higher maternal education level, older age at pregnancy, previous vaccination against influenza and pertussis, positive attitude towards vaccines, and acceptance of vaccines during pregnancy are the most frequently reported positive predictors that are associated with higher vaccination rates. The information obtained from this study can contribute in the future, during epidemics or pandemics that may occur, to the development of targeted medical and communication strategies for the effective promotion of vaccination programs and the greatest possible coverage of the population, especially those belonging to vulnerable groups such as pregnant women.
Collapse
Affiliation(s)
- Ioanna Tsiaousi
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Alexandros Psarris
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Panagiotis Antsaklis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Michael Sindos
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens "Alexandra", National and Kapodistrian University of Athens, Athens, GRC
| | - Pelopidas Koutroumanis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens "Alexandra" National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitris Zacharakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens "Alexandra", National and Kapodistrian University of Athens, Athens, GRC, Athens, GRC
| | - George Daskalakis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Athens, GRC
| |
Collapse
|
5
|
Tschann MS, Ronquillo TN, Sternberg LM, Wong ZJ, Soon R, Kaneshiro BE. COVID-19 Vaccine Hesitancy in the Perinatal Period: A Survey Among Residents of Hawaii. AJPM FOCUS 2024; 3:100179. [PMID: 38317785 PMCID: PMC10839259 DOI: 10.1016/j.focus.2023.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
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.
Collapse
Affiliation(s)
- Mary S. Tschann
- Division of Family Planning, Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Taylor N. Ronquillo
- Division of Family Planning, Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | | | - Zarina J. Wong
- Division of Family Planning, Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Reni Soon
- Division of Family Planning, Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Bliss E.K. Kaneshiro
- Division of Family Planning, Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| |
Collapse
|
6
|
Zayoud D, Haddad C, Khachman D, Ajrouche R, Lahoud N. Estimating COVID-19 vaccine acceptance in pregnant and lactating women: a cross-sectional study in Lebanon. Arch Public Health 2024; 82:38. [PMID: 38500217 PMCID: PMC10949662 DOI: 10.1186/s13690-024-01267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic highlights vaccination's critical role in reducing morbidity and mortality, depending on public attitude. This study aims to identify the estimates of COVID-19 vaccine acceptance in pregnant and lactating women, as well as associated potential factors. METHODS A cross-sectional study was conducted between August and September 2021, through an online survey and with a paper survey distributed in gynecology and pediatric clinics. Pregnant and breastfeeding women aged 18 years and above were recruited. The attitude scale was created specifically for evaluating attitudes towards the COVID-19 vaccine. RESULTS In total, 207 women participated, with 132 breastfeeding, 74 pregnant and 1 experiencing both conditions. Of these, one hundred and twenty women (58%) considered themselves at risk for COVID-19 infection. In addition, 51.7% (n = 107) of women expressed the intent to receive the vaccine once available. A multivariable linear regression was conducted taking the COVID-19 vaccination attitude scale as a dependent variable. The results revealed an R-squared value of 0.558, indicating that approximately 55.8% of the variance in the attitude scale was accounted for by the included predictors. The results showed that preventive measures (ß=2.25, 95% Confidence Interval (CI) [1.02; 3.48], p < 0.001), preference for vaccines made in Europe and America (ß=1.23; 95% CI [0.69-1.77], p < 0.001), protect yourself for getting sick (ß=4.22, 95% Confidence Interval (CI) [2.83; 5.61], p < 0.001) and belief in the importance of vaccination for themselves and their baby (ß=3.49; 95% CI [2.01; 4.98], p < 0.001) were associated with a positive attitude towards vaccination. Conversely, experiencing a previous bad reaction to a vaccine (ß= -1.35; 95% CI [0.85-1.85], p < 0.001) and concerns regarding COVID-19 vaccine safety (ß= -4.09; 95% CI [-5.98; -2.21], p < 0.001) were associated with a negative attitude towards vaccination. CONCLUSION Our findings reveal that COVID-19 vaccine acceptability among pregnant and breastfeeding women, amidst the pandemic was insufficient to meet community immunity. The identified reasons for vaccine reluctance, notably concerns about safety for both personal health and the health of their pregnancy or newborns, along with insufficient information about the vaccine, underscore the pressing need to address these factors to improve immunization rates.
Collapse
Affiliation(s)
- Dana Zayoud
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Chadia Haddad
- Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon.
- Faculty of Public Health, Lebanese University, Fanar, Lebanon.
- School of Medicine, Lebanese American University, Byblos, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon.
| | - Dalia Khachman
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Roula Ajrouche
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Department of Health Sciences, University of Sciences and Arts in Lebanon, Beirut, Lebanon
| | - Nathalie Lahoud
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
| |
Collapse
|
7
|
Razai MS, Mansour R, Goldsmith L, Freeman S, Mason-Apps C, Ravindran P, Kooner P, Berendes S, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott P. Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis. J Travel Med 2023; 30:taad138. [PMID: 37934788 PMCID: PMC10755181 DOI: 10.1093/jtm/taad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low. METHODS We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics. RESULTS From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations. CONCLUSIONS Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.
Collapse
Affiliation(s)
- Mohammad S Razai
- Population Health Research Institute, St George’s University of London, London, UK
| | - Rania Mansour
- Population Health Research Institute, St George’s University of London, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George’s University of London, London, UK
| | - Samuel Freeman
- Primary Care Unit, University Hospitals Sussex NHS Foundation Trust, Sussex, UK
| | - Charlotte Mason-Apps
- Population Health Research Institute, St George’s University of London, London, UK
| | - Pahalavi Ravindran
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | | | - Sima Berendes
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joan Morris
- Population Health Research Institute, St George’s University of London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sally Hargreaves
- Population Health Research Institute, St George’s University of London, London, UK
- The Migrant Health Research Unit, Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s University of London, London, UK
| |
Collapse
|
8
|
Askary E, Moradi Alamdarloo S, Keshtvarz Hesam Abadi A. Safety of COVID-19 vaccination in pregnant women and their neonatal outcome: a narrative Review. J Matern Fetal Neonatal Med 2023; 36:2183750. [PMID: 36906793 DOI: 10.1080/14767058.2023.2183750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
BACKGROUND Even through the fact that pregnant women are more and more severely infected with COVID-19 disease, there are still doubts about vaccinating these people due to the lack of sufficient evidence base information. So in this systematic review, we decided to study vaccinated and unvaccinated pregnant women regarding maternal, fetal and neonatal complications and outcomes. THE STRATEGY OF SEARCHING Between 30 December 2019 and 15 October 2021, electronic searches were performed on the databases of PubMed, Scopus, Google Scholar, and Cochrane library by searching in English and free full text. Keywords searched included these: maternal outcome, neonatal outcome, pregnancy, and COVID-19 vaccination. Among 451 articles, finally, seven studies were included to study pregnancy outcomes in vaccinated women compared to unvaccinated for systematic review purposes. RESULTS In this study 30257 vaccinated women in their third trimester compared to 132339 unvaccinated women in terms of age, the root of delivery, neonatal adverse outcomes. There were no significant differences between two groups in terms of: IUFD, and 1 min Apgar score, C/S rate, and NICU admission between the two groups, however, the rate of SGA, IUFD, and also neonatal jaundice, asphyxia, and hypoglycemia was more significant in the unvaccinated group comparing to the vaccinated group as a result. Among them, the chance of preterm labor pain was reported more among vaccinated patients. Emphasizing that, except 7.3% of the case population, everyone in the second and third trimesters had been vaccinated with mRNA COVID-19 vaccines. CONCLUSION COVID-19 vaccination during the second and third trimesters appears to be the right choice due to the immediate impact of COVID-19 antibodies on the developing fetus and formation of neonatal prophylaxis, as well as the absence of adverse outcomes for both the fetus and mothers.
Collapse
Affiliation(s)
- Elham Askary
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shaghayegh Moradi Alamdarloo
- Department of Obstetrics and Gynecology, School of Medicine, Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | |
Collapse
|
9
|
Mamuk R, Akgün M, Turan Miral M, Göksu Ş. An investigation of the relationship between the general vaccination attitudes of pregnant women and their attitudes toward the COVID-19 vaccine. Women Health 2023; 63:787-796. [PMID: 37867344 DOI: 10.1080/03630242.2023.2272199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
This study aimed to investigate the relationship between the attitudes of pregnant women toward general vaccines based on the Health Belief Model and their attitudes toward the COVID-19 vaccine. The study, which was designed as a descriptive, cross-sectional, and correlational study, was conducted with 348 pregnant women in three public hospitals in Northern Cyprus between June 24 and November 28, 2022. Data were collected using the "Participant Information Form," "Public Attitude Toward Vaccination Scale-Health Belief Model" (PAVS-HBM), and "Attitudes Toward the COVID-19 Vaccine" (ATV-COVID-19). The COVID-19 vaccination rate among pregnant women was quite high. Pregnant women have a high perception of sensitivity, importance, benefit, and health responsibility for routine vaccines and vaccination programs based on the HBM, and a low perception of barriers to vaccination. These results showed that pregnant women have a determined and positive attitude toward the acceptance of vaccines in general. On the other hand, the attitude of pregnant women toward the COVID-19 vaccine was moderately negative. Despite the reservations about the COVID-19 vaccine, a determined and positive attitude toward vaccines in general has increased acceptance of the COVID-19 vaccine.
Collapse
Affiliation(s)
- Rojjin Mamuk
- Nursing Department, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North Cyprus
| | - Meryem Akgün
- Nursing Department, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North Cyprus
| | - Mukaddes Turan Miral
- Nursing Department, Faculty of Health Sciences, Istanbul Kültür University, Istanbul, Türkiye
| | - Şerife Göksu
- Department of Obstetrics and Gynecology, Gazimağusa State Hospital, Famagusta, North Cyprus
| |
Collapse
|
10
|
Triunfo S, Iannuzzi V, Podda M, Pedrina D, Gemelli S, Marconi AM. Reducing vaccine hesitancy in pregnancy by the health literacy model inclusive of modern communication tools. Arch Gynecol Obstet 2023; 308:1391-1393. [PMID: 37552285 DOI: 10.1007/s00404-023-07138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/01/2023] [Indexed: 08/09/2023]
Abstract
Albeit the vaccination is one of the most successful and cost-effective public health interventions, reluctance or refusal to vaccinate represents one of the ten threats to global health by the World Health Organization. Additional efforts to promote vaccination are required for at higher risk categories, such as pregnant women. Our approach supports the role of a clear and transparent communication by using efficient interventions and educational strategies to increase both willingness and confidence for preventable diseases in neonates and infants by vaccinations in pregnancy.
Collapse
Affiliation(s)
- Stefania Triunfo
- Department of Obstetrics and Gynecology, ASST Santi Paolo Carlo, University of Milan, Milan, Italy.
| | - Veronica Iannuzzi
- Department of Obstetrics and Gynecology, ASST Santi Paolo Carlo, University of Milan, Milan, Italy
| | - Martina Podda
- Department of Obstetrics and Gynecology, ASST Santi Paolo Carlo, University of Milan, Milan, Italy
| | - Deborah Pedrina
- Department of Obstetrics and Gynecology, ASST Santi Paolo Carlo, University of Milan, Milan, Italy
| | - Simona Gemelli
- Department of Obstetrics and Gynecology, ASST Santi Paolo Carlo, University of Milan, Milan, Italy
| | - Anna Maria Marconi
- Department of Obstetrics and Gynecology, ASST Santi Paolo Carlo, University of Milan, Milan, Italy
| |
Collapse
|
11
|
Rottenstreich M, Rotem R, Wiener-Well Y, Grisaru-Granovsky S, Sela HY. Covid-19 third vaccination during pregnancy: maternal and neonatal outcomes-a retrospective study. Arch Gynecol Obstet 2023; 308:1197-1205. [PMID: 36155854 PMCID: PMC9513010 DOI: 10.1007/s00404-022-06786-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/04/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the impact of Covid-19 (Pfizer-BioNTech BNT162b2) third booster dose vaccination during pregnancy on maternal and neonatal outcomes. METHODS This is a multicenter, retrospective computerized database study. Parturients who delivered in Israel between August and December 2021 with full records of Covid-19 disease and vaccination status were included. Those who received third booster during pregnancy were compared to those who received two doses of vaccine during pregnancy and to unvaccinated parturients. Various adverse maternal and neonatal outcomes were evaluated. Parturients who were previously positive with Covid-19 PCR swabs during pregnancy or before pregnancy were excluded. Univariate analysis was followed by multivariate analysis. RESULTS A total of 2583 women were included in the analysis; 626 received the third booster dose of the BNT162b2 Covid-19 vaccine, 1094 received two doses of the vaccine, and 863 unvaccinated women. Maternal and neonatal outcomes were comparable between the study groups. An adjusted multivariable logistic regression analysis demonstrated that receiving the third booster was not associated with an increase in neither composite adverse maternal or neonatal outcome (aOR 0.9; 95% CI [0.65-1.22], p = 0.47; aOR 0.7; 95% CI [0.53-1.035], p= 0.09, respectively) when compared to those who received two doses of the vaccine. However, administration of the third booster dose during pregnancy was associated with a reduced composite adverse neonatal outcome when compared to unvaccinated women (aOR 0.6; 95% CI [0.42-0.86], p = 0.01). CONCLUSION Receiving the third booster dose of the BNT162b2 Covid-19 vaccine during pregnancy is not associated with an increased risk of any adverse maternal outcomes and may be beneficial for the neonates.
Collapse
Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 12 Bayit Street, 91031, Jerusalem, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 12 Bayit Street, 91031, Jerusalem, Israel.
| | - Yonit Wiener-Well
- Infectious Disease Unit, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 12 Bayit Street, 91031, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 12 Bayit Street, 91031, Jerusalem, Israel
| |
Collapse
|
12
|
Gianfredi V, Stefanizzi P, Berti A, D’Amico M, De Lorenzo V, Lorenzo AD, Moscara L, Castaldi S. A Systematic Review of Population-Based Studies Assessing Knowledge, Attitudes, Acceptance, and Hesitancy of Pregnant and Breastfeeding Women towards the COVID-19 Vaccine. Vaccines (Basel) 2023; 11:1289. [PMID: 37631857 PMCID: PMC10459271 DOI: 10.3390/vaccines11081289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
The anti-SARS-CoV-2 vaccination is recommended for pregnant women due to the high risk of complications. However, pregnancy has been associated with vaccine hesitancy. Our review aims at summarizing the existing literature about anti-SARS-CoV-2 vaccine hesitancy in pregnant and lactating women. The research was conducted on PubMed/MEDLINE, ExcerptaMedica Database (EMBASE), and Scopus, according to PRISMA guidelines. Articles regarding the COVID-19 vaccine's acceptance and/or refusal by pregnant and lactating women were selected. Only observational, population-based studies were included. The Joanna Briggs Institute quality assessment tools were employed. A total of 496 articles were retrieved, and after the selection process, 21 papers were included in the current analysis. All the included studies were cross-sectional, mostly from Europe and North America. The sample sizes ranged between 72 and 25,111 subjects. All of them included pregnant subjects, except one that focused on breastfeeding women only. Vaccine hesitancy rates ranged from 26% to 57% among different studies. Fear of adverse events and lack of knowledge were shown to be the main drivers of hesitancy. Approximately half of the studies (11/21) were classified as low quality, the remaining (9/21) were classified as moderate, and only one study was classified as high quality. Primigravidae were also shown to be more likely to accept anti-SARS-CoV-2 vaccination. Our findings confirm significant anti-SARS-CoV-2 vaccine hesitancy among pregnant women. Information gaps should be addressed to contain concerns related to adverse events.
Collapse
Affiliation(s)
- Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 36, 20133 Milan, Italy; (V.G.); (A.B.); (M.D.); (V.D.L.); (S.C.)
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza G. Cesare 11, 70121 Bari, Italy; (A.D.L.); (L.M.)
| | - Alessandro Berti
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 36, 20133 Milan, Italy; (V.G.); (A.B.); (M.D.); (V.D.L.); (S.C.)
| | - Marilena D’Amico
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 36, 20133 Milan, Italy; (V.G.); (A.B.); (M.D.); (V.D.L.); (S.C.)
| | - Viola De Lorenzo
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 36, 20133 Milan, Italy; (V.G.); (A.B.); (M.D.); (V.D.L.); (S.C.)
| | - Antonio Di Lorenzo
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza G. Cesare 11, 70121 Bari, Italy; (A.D.L.); (L.M.)
| | - Lorenza Moscara
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza G. Cesare 11, 70121 Bari, Italy; (A.D.L.); (L.M.)
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 36, 20133 Milan, Italy; (V.G.); (A.B.); (M.D.); (V.D.L.); (S.C.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy
| |
Collapse
|
13
|
Ramonfaur D, Hinojosa-González DE, Rodríguez RG, Melchor AL, Rodríguez-Ramírez A, Rodríguez-Gómez GP, Cantú-Santos M, Fernández-Gómez A. Determinants of COVID-19 vaccine hesitancy among pregnant persons. J Am Pharm Assoc (2003) 2023; 63:1191-1196. [PMID: 37149143 PMCID: PMC10158039 DOI: 10.1016/j.japh.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Vaccines reduce the risk of contracting and developing complications from coronavirus disease 2019 (COVID-19). Pregnant people are at increased risk of disease-related complications but have a higher prevalence of vaccine hesitancy (VH) than their nonpregnant counterparts. OBJECTIVE This study aimed to describe risk factors and COVID-19- and vaccine-related perspectives that lead to VH among pregnant people in Mexico to target strategies to increase vaccine acceptance in this population. METHODS A cross-sectional survey-based study to evaluate risk factors and COVID-19- and vaccine-related perspectives associated with VH among pregnant people was conducted. Respondents were pregnant people of all ages attending a regular follow-up visit or admitted to labor and delivery in a third-level maternity hospital in Mexico. VH was defined as not having received a COVID-19 vaccine and either declining or being undecided to accept a vaccine during their pregnancy. We used bivariate and multivariable logistic regression models to estimate assess the relationship among demographic factors, COVID-19- and vaccine-related perspectives, and VH. RESULTS A total of 1475 respondents completed the questionnaire; 216 (18%) were under the age of 18 years, and 860 (58%) had received at least one dose of a COVID-19 vaccine. In this sample, 264 (18%) were classified as vaccine hesitant. Key factors associated with VH were adolescence, having family as a primary source of information, first pregnancy, and history of vaccines in previous pregnancies. COVID-19 perspectives were also strongly associated with VH. CONCLUSIONS Among pregnant people in Mexico, VH is associated with demographic factors, vaccination history, sources of information, and perceived risks to the fetus. This information is relevant to policy makers and health care professionals to identify those more likely to be hesitant and to inform strategies to increase vaccine uptake among pregnant people.
Collapse
|
14
|
Ma MZ, Ye S. Coronavirus-Related Searches on the Internet Predict COVID-19 Vaccination Rates in the Real World: A Behavioral Immune System Perspective. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2023; 14:572-587. [PMID: 37220501 PMCID: PMC10195687 DOI: 10.1177/19485506221106012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
According to the smoke detector and functional flexibility principles of human behavioral immune system (BIS), the exposure to COVID-19 cues could motivate vaccine uptake. Using the tool of Google Trends, we tested that coronavirus-related searches-which assessed natural exposure to COVID-19 cues-would positively predict actual vaccination rates. As expected, coronavirus-related searches positively and significantly predicted vaccination rates in the United States (Study 1a) and across the globe (Study 2a) after accounting for a range of covariates. The stationary time series analyses with covariates and autocorrelation structure of the dependent variable confirmed that more coronavirus-related searches compared with last week indicated increases in vaccination rates compared with last week in the United States (Study 1b) and across the globe (Study 2b). With real-time web search data, psychological scientists could test their research questions in real-life settings and at a large scale to expand the ecological validity and generalizability of the findings.
Collapse
Affiliation(s)
- Mac Zewei Ma
- City University of Hong Kong, Kowloon, Hong Kong
| | - Shengquan Ye
- City University of Hong Kong, Kowloon, Hong Kong
| |
Collapse
|
15
|
Pourrazavi S, Fathifar Z, Sharma M, Allahverdipour H. COVID-19 vaccine hesitancy: A Systematic review of cognitive determinants. Health Promot Perspect 2023; 13:21-35. [PMID: 37309435 PMCID: PMC10257562 DOI: 10.34172/hpp.2023.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Although mass vaccination is considered one of the most effective public health strategies during the pandemic, in the COVID-19 era, many people considered vaccines unnecessary and, or doubted the effectiveness of the COVID-19 vaccine. This review aimed to tabulate cognitive causes of COVID-19 vaccination hesitancy, which may help public health policymakers overcome the barriers to mass vaccinations in future pandemics. Methods: For this systematic review, studies pertaining to COVID-19 vaccine hesitancy published up to June 2022 were retrieved from six online databases (Cochrane Library, Google Scholar Medline through PubMed, Scopus, and Web of Science). Inclusion criteria were the studies conducted on people who had a delay in accepting or refusing COVID-19 vaccines, reported the impact of cognitive determinants on vaccine hesitancy, and were written in English in the timeframe of 2020-2022. Results: This systematic review initially reviewed 1171 records. From these 91 articles met the inclusion criteria. The vaccination hesitation rate was 29.72% on average. This systematic review identified several cognitive determinants influencing vaccination hesitancy. Lack of confidence and complacency were the most frequent factors that predicted vaccine hesitancy. Conclusion: The identified prevailing cognitive determinants for COVID-19 vaccine hesitancy indicated that using initiative and effective communication strategies would be a determinant factor in building people's trust in vaccines during the pandemic and mass vaccinations.
Collapse
Affiliation(s)
- Sara Pourrazavi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Fathifar
- Department of Library, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Manoj Sharma
- Department of Social and Behavioral Health, University of Nevada, Las Vegas (UNLV), Las Vegas, NV 89119, USA
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
| | - Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
16
|
Maisonneuve E, Gerbier E, Tauqeer F, Pomar L, Favre G, Winterfeld U, Passier A, Oliver A, Baud D, Nordeng H, Ceulemans M, Panchaud A. Determinants of Vaccination and Willingness to Vaccinate against COVID-19 among Pregnant and Postpartum Women during the Third Wave of the Pandemic: A European Multinational Cross-Sectional Survey. Viruses 2023; 15:1090. [PMID: 37243177 PMCID: PMC10220755 DOI: 10.3390/v15051090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
With COVID-19 vaccination hesitancy at around 50% in the obstetric population, it is critical to identify which women should be addressed and how. Our study aimed to assess COVID-19 vaccination willingness among pregnant and postpartum women in Europe and to investigate associated determinants. This study was a cross-sectional, web-based survey conducted in Belgium, Norway, Switzerland, The Netherlands, and United Kingdom (UK) in June-August 2021. Among 3194 pregnant women, the proportions of women vaccinated or willing to be vaccinated ranged from 80.5% in Belgium to 21.5% in Norway. The associated characteristics were country of residence, chronic illness, history of flu vaccine, trimester of pregnancy, belief that COVID-19 is more severe during pregnancy, and belief that the COVID-19 vaccine is effective and safe during pregnancy. Among 1659 postpartum women, the proportions of women vaccinated or willing to be vaccinated ranged from 86.0% in the UK to 58.6% in Switzerland. The associated determinants were country of residence, chronic illness, history of flu vaccine, breastfeeding, and belief that the COVID-19 vaccine is safe during breastfeeding. Vaccine hesitancy in the obstetric population depends on medical history and especially on the opinion that the vaccine is safe and on the country of residence.
Collapse
Affiliation(s)
- Emeline Maisonneuve
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
| | - Eva Gerbier
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Fatima Tauqeer
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway; (F.T.); (H.N.)
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical pharmacology Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Anneke Passier
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH ’s Hertogenbosch, The Netherlands; (A.P.); (M.C.)
| | - Alison Oliver
- UK Teratology Information Service, Newcastle upon Tyne Hospitals, NHS Foundation Trust and the UK Health Security Agency, Newcastle upon Tynes NE2 4AB, UK;
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway; (F.T.); (H.N.)
| | - Michael Ceulemans
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH ’s Hertogenbosch, The Netherlands; (A.P.); (M.C.)
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- L-C&Y, KU Leuven Child & Youth Institute, 3000 Leuven, Belgium
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| |
Collapse
|
17
|
COVID-19 Vaccination during Pregnancy and Lactation: Attitudes and Uptakes before and after Official Recommendations in Germany. Vaccines (Basel) 2023; 11:vaccines11030627. [PMID: 36992211 DOI: 10.3390/vaccines11030627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Vaccination against COVID-19 is an effective measure to mitigate the pandemic. Pregnant and breastfeeding women were not included in registration studies, so official recommendations to vaccinate this vulnerable group appeared belated. Therefore, our aims were to evaluate vaccination uptake, reasons for and against vaccination, and the changes in these depending on the official national recommendations in Germany. Methods: An anonymous online cross-sectional survey among pregnant and breastfeeding women was conducted prior to and after the publication of the official vaccination recommendation. Results: Data from the convenience sample of 5411 participants (42.9% pregnant; 57% breastfeeding) were analysed. The recommendation was known to 95% of the participants. The information was obtained mainly autonomously (61.6%) and through the media (56.9%). Vaccination uptake increased in pregnant (2.4% before vs. 58.7% after) and breastfeeding women (13.7% vs. 74.7%). As reasons to get vaccinated, pregnant women indicated more fear of the infection than of the side effects of vaccination (52.0% before vs. 66.2% after), intended protection of the baby and oneself (36.0% vs. 62.9%), and limited information about vaccination (53.5% vs. 24.4%). Conclusion: The official national recommendation is widely known and mostly obtained autonomously, thereby showing a high level of awareness and a rise in vaccination uptake. Nonetheless, targeted education campaigns focusing on scientific evidence should be maintained, whereas the engagement of health professionals should be enhanced.
Collapse
|
18
|
Zhang X, Cai Y, Zhu K, Liu Z, Zhou Q, Zhu Y, Zhou C, Zhong Z, Liu Y, Xiao W. Prevalence and risk factors of depression and anxiety among Chinese adults who received SARS-CoV-2 vaccine - A cross-sectional survey. J Affect Disord 2023; 324:53-60. [PMID: 36566938 PMCID: PMC9780025 DOI: 10.1016/j.jad.2022.12.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Direct data reflecting the psychological problems during the nationwide SARS-CoV-2 vaccination campaign are scarce in China. The aim of this study was to assess the prevalence of depression and anxiety and investigate the associated risk factors after vaccination against SARS-CoV-2 among Chinese adults. METHODS We conducted a web-based cross-sectional survey from June to July 2021. A structured questionnaire including the Patient Health Questionnaire-9(PHQ-9) and Generalized Anxiety Disorder-7(GAD-7) was used to investigated depression and anxiety symptoms. After excluding 223 ineligible records, a total of 6984 participants were included in our final analysis. Multivariable logistic regression analysis was used to examined the potential factors associated with depression or anxiety. RESULTS Our data indicated that the overall prevalence of depression and anxiety was assessed at 19.39 % and 9.74 %, respectively. Participants who had vaccinated the second dose were more likely to have depressive symptoms (20.95 % vs.16.40 %) and anxiety symptoms (10.38 % vs. 8.51 %) than who had vaccinated the first dose. Multivariable logistic regression analysis indicated female gender, being healthcare worker, college or above and planning a pregnancy were all independently linked to depression or anxiety. LIMITATIONS The present study was based on an online survey. CONCLUSION The present study confirmed the presence of depression and anxiety among Chinese adults who received SARS-COV-2 vaccine, as well as the potential influencing factors. Additional attention and psychological support should be directed at these high-risk groups during SARS-CoV-2 vaccination campaign.
Collapse
Affiliation(s)
- Xiaobo Zhang
- First People's Hospital of Changde City, 818 Renmin Road, 415000 Changde City, Hunan Province, China
| | - Yang Cai
- First People's Hospital of Changde City, 818 Renmin Road, 415000 Changde City, Hunan Province, China
| | - Kai Zhu
- Jishou University, 120 Renmin South Road, 416000 Jishou City, Hunan Province, China
| | - Zhenghao Liu
- First People's Hospital of Changde City, 818 Renmin Road, 415000 Changde City, Hunan Province, China
| | - Quan Zhou
- First People's Hospital of Changde City, 818 Renmin Road, 415000 Changde City, Hunan Province, China
| | - Yingying Zhu
- Huashan Hospital, Shanghai Medical College, Fudan University, 12 Urumqi Middle Road, 200040 Shanghai, China
| | - Chaojun Zhou
- First People's Hospital of Changde City, 818 Renmin Road, 415000 Changde City, Hunan Province, China
| | - Zhenzhen Zhong
- Jishou University, 120 Renmin South Road, 416000 Jishou City, Hunan Province, China
| | - Yan Liu
- First People's Hospital of Changde City, 818 Renmin Road, 415000 Changde City, Hunan Province, China.
| | - Wei Xiao
- First People's Hospital of Changde City, 818 Renmin Road, 415000 Changde City, Hunan Province, China.
| |
Collapse
|
19
|
De Brabandere L, Hendrickx G, Poels K, Daelemans W, Van Damme P, Maertens K. Influence of the COVID-19 pandemic and social media on the behaviour of pregnant and lactating women towards vaccination: a scoping review. BMJ Open 2023; 13:e066367. [PMID: 36764726 PMCID: PMC9922880 DOI: 10.1136/bmjopen-2022-066367] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Pregnant women, foetuses and infants are at risk of infectious disease-related complications. Maternal vaccination is a strategy developed to better protect pregnant women and their offspring against infectious disease-related morbidity and mortality. Vaccines against influenza, pertussis and recently also COVID-19 are widely recommended for pregnant women. Yet, there is still a significant amount of hesitation towards maternal vaccination policies. Furthermore, contradictory messages circulating social media impact vaccine confidence. OBJECTIVES This scoping review aims to reveal how COVID-19 and COVID-19 vaccination impacted vaccine confidence in pregnant and lactating women. Additionally, this review studied the role social media plays in creating opinions towards vaccination in these target groups. ELIGIBILITY CRITERIA Articles published between 23 November 2018 and 18 July 2022 that are linked to the objectives of this review were included. Reviews, articles not focusing on the target group, abstracts, articles describing outcomes of COVID-19 infection/COVID-19 vaccination were excluded. SOURCES OF EVIDENCE The PubMed database was searched to select articles. Search terms used were linked to pregnancy, lactation, vaccination, vaccine hesitancy, COVID-19 and social media. CHARTING METHODS Included articles were abstracted and synthesised by one reviewer. Verification was done by a second reviewer. Disagreements were addressed through discussion between reviewers and other researchers. RESULTS Pregnant and lactating women are generally less likely to accept a COVID-19 vaccine compared with non-pregnant and non-nursing women. The main reason to refuse maternal vaccination is safety concerns. A positive link was detected between COVID-19 vaccine willingness and acceptance of other vaccines during pregnancy. The internet and social media are identified as important information sources for maternal vaccination. DISCUSSION AND CONCLUSION Vaccine hesitancy in pregnant and lactating women remains an important issue, expressing the need for effective interventions to increase vaccine confidence and coverage. The role social media plays in vaccine uptake remains unclear.
Collapse
Affiliation(s)
- Larissa De Brabandere
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Wilrijk, Belgium
| | - Greet Hendrickx
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Wilrijk, Belgium
| | - Karolien Poels
- Department of Communication Studies, University of Antwerp, Antwerpen, Belgium
| | - Walter Daelemans
- Department of Linguistics, Computational Linguistics and Psycholinguistics Research Centre, University of Antwerp, Antwerpen, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Wilrijk, Belgium
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
20
|
Hernandez ND, Pairman S, Fisher AC, Cheng RFJ, Sylvester S. Global Cross-Sectional Study Evaluating the Attitudes towards a COVID-19 Vaccine in Pregnant and Postpartum Women. Vaccines (Basel) 2023; 11:vaccines11020390. [PMID: 36851267 PMCID: PMC9961540 DOI: 10.3390/vaccines11020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Natalie D. Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Sally Pairman
- International Confederation of Midwives, 2514 AE The Hague, The Netherlands
| | | | - Ru-fong J. Cheng
- Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ 08901, USA
| | - Shirley Sylvester
- Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ 08901, USA
- Correspondence: ; Tel.: +41-(76)-5136317
| |
Collapse
|
21
|
Nuampa S, Patil CL, Prasong S, Kuesakul K, Sudphet M. Exploring the Association between Socioeconomic and Psychological Factors and Breastfeeding in the First Year of Life during the COVID-19 Pandemic in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:130. [PMID: 36612453 PMCID: PMC9819422 DOI: 10.3390/ijerph20010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Breastfeeding is essential for the survival, nutrition, and development of infants and young children. As a result of COVID-19’s effects of economic crises and psychological difficulties, breastfeeding outcomes have declined. The purpose of this study was to examine the association between socioeconomic and psychological factors with breastfeeding duration in the first year of life during the COVID-19 pandemic. Cross-sectional online surveys (n = 390) were conducted between August and November 2021. The participants were women aged 15 years and above who had given birth within 6−12 months before data collection and delivered in public hospitals in the top three provinces with the worst COVID-19 outbreaks during the second wave in Thailand. The average breastfeeding duration in this study was 6.20 months (±2.5) with a range of 1−12 months. Of mothers, 44.9% continued to breastfeed until between 6 and 12 months of age. In a multiple regression analysis, family income (Beta = 0.112, t = 1.988, p < 0.05), breastfeeding intention (beta = 0.097, t = 2.142, p < 0.05), intended breastfeeding duration (beta = 0.391, t = 8.355, p < 0.05), intention to receive vaccination (beta =0.129, t = 2.720, p < 0.05), and anxiety (beta = 0.118, t = 2.237, p < 0.05) were associated with breastfeeding duration in the first year of life (F (7, 382) = 20.977, p < 0.05, R2 = 0.278, R2 Adjusted = 0.264). During COVID-19, psychological factors were more strongly associated with breastfeeding duration in the first year of life than socioeconomic factors. Healthcare providers should promote breastfeeding intention, motivate COVID-19 vaccination intention, and support mental health among lactating mothers, particularly in the event of a pandemic.
Collapse
Affiliation(s)
- Sasitara Nuampa
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand
| | - Crystal L. Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Sudhathai Prasong
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand
| | - Kornkanok Kuesakul
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand
| | - Metpapha Sudphet
- Department of Obstetrics and Gynaecology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| |
Collapse
|
22
|
Piekos SN, Price ND, Hood L, Hadlock JJ. The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes. Reprod Toxicol 2022; 114:33-43. [PMID: 36283657 PMCID: PMC9595355 DOI: 10.1016/j.reprotox.2022.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/24/2022] [Accepted: 10/17/2022] [Indexed: 12/22/2022]
Abstract
The rapidly evolving COVID-19 pandemic has resulted in an upsurge of scientific productivity to help address the global health crisis. One area of active research is the impact of COVID-19 on pregnancy. Here, we provide an epidemiological overview about what is known about the effects of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes, and identify gaps in knowledge. Pregnant people are at increased risk for severe COVID-19, and maternal SARS-CoV-2 infection increases the risk of negative maternal-fetal outcomes. Despite this elevated risk, there have been high rates of vaccine hesitancy, heightened by the initial lack of safety and efficacy data for COVID-19 vaccination in pregnancy. In response, retrospective cohort studies were performed to examine the impact of COVID-19 vaccination during pregnancy. Here, we report the vaccine's efficacy during pregnancy and its impact on maternal-fetal outcomes, as well as an overview of initial studies on booster shots in pregnancy. We found that pregnant people are at risk for more severe COVID-19 outcomes, maternal SARS-CoV-2 infection is associated with worse birth outcomes, COVID-19 vaccine hesitancy remains prevalent in the pregnant population, and COVID-19 vaccination and boosters promote better maternal-fetal outcomes. The results should help reduce vaccine hesitancy by alleviating concerns about the safety and efficacy of administering the COVID-19 vaccine during pregnancy. Overall, this review provides an introduction to COVID-19 during pregnancy. It is expected to help consolidate current knowledge, accelerate research of COVID-19 during pregnancy and inform clinical, policy, and research decisions regarding COVID-19 vaccination in pregnant people.
Collapse
Affiliation(s)
- Samantha N Piekos
- Institute for Systems Biology, 401 Terry Ave N, Seattle, WA, 98109, USA
| | - Nathan D Price
- Institute for Systems Biology, 401 Terry Ave N, Seattle, WA, 98109, USA; Thorne HealthTech, New York, NY, 10019, USA
| | - Leroy Hood
- Institute for Systems Biology, 401 Terry Ave N, Seattle, WA, 98109, USA
| | - Jennifer J Hadlock
- Institute for Systems Biology, 401 Terry Ave N, Seattle, WA, 98109, USA.
| |
Collapse
|
23
|
Montalti M, Guaraldi F, Di Valerio Z, Ragghianti B, Tedesco D, Mannucci E, Monami M, Gori D. Adherence to and early adverse events of COVID-19 vaccine in a cohort of 600 Italian breastfeeding and pregnant physicians. Hum Vaccin Immunother 2022; 18:2106747. [PMID: 35944074 DOI: 10.1080/21645515.2022.2106747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Pregnant and breastfeeding women (PBW) have been excluded from COVID-19 vaccine registry and the majority of post-marketing trials, despite the recognized increased risk of severe infections and complications. The lack of efficacy and safety data prevented the formulation of specific indications/guidelines for vaccination and could have also contributed to increased vaccine hesitancy (VH) in PBW. The aim of this cross-sectional study is to assess the rate and predictors of VH, and early adverse events (AEFI) following COVID-19 vaccine in PBW with a cross-sectional study. In January 2021, a purposely designed questionnaire was administered to 600 PBW part of a Facebook group of physicians, immunized with two doses of Comirnaty®. Thirty-eight (29%) pregnant women and 13 (2.8%) breastfeeders were hesitant. The only statistically significant negative predictor of COVID-19 VH appeared to be having had the flu shot in 2020/2021 (OR: 0.35; 95% CI: 0.13-0.97; p = .044). Approximately 27% of PBW reported hesitancy toward the 2020/2021 season influenza vaccine. Among the vaccinated subjects, 51.6% of pregnant and 75.2% of breastfeeding women reported at least one symptom after the first, and 82.4% and 81.6%, respectively, after the second dose. Nausea/vomiting, fatigue, headache and arthralgia/myalgia were the most common symptoms; dizziness, shivering, syncope and limb paresthesia were rarely reported. Among infants of breastfeeding mothers, six experienced fever, five rash and four moderate and self-limiting diarrhea. Preliminary data on mRNA COVID-19 vaccine in PBW and in their infants are reassuring since AEFI, although frequent, are typically mild and similar to those occurring in the general population, and in PBW after other vaccines. Larger studies with longer follow-up after vaccination are strongly recommended to develop recommendations in these patients.
Collapse
Affiliation(s)
- Marco Montalti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Federica Guaraldi
- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Zeno Di Valerio
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | - Dario Tedesco
- Regional Authority for Healthcare and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Edoardo Mannucci
- Diabetology Unit, Careggi Hospital, and University of Florence, Florence, Italy
| | - Matteo Monami
- Diabetology Unit, Careggi Hospital, and University of Florence, Florence, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| |
Collapse
|
24
|
Sarantaki A, Kalogeropoulou VE, Taskou C, Nanou C, Lykeridou A. COVID-19 Vaccination and Related Determinants of Hesitancy among Pregnant Women: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10122055. [PMID: 36560464 PMCID: PMC9785275 DOI: 10.3390/vaccines10122055] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Mass vaccination against COVID-19 is necessary to control the pandemic. COVID-19 vaccines are now recommended during pregnancy to prevent the disease. A systematic review of the literature in the electronic databases PubMed and EMBASE was performed and we aimed to investigate the attitude of documents towards COVID-19 vaccination and the prognostic factors of vaccination hesitation. A meta-analysis was also conducted to estimate the overall percentage of pregnant women who were willing to be vaccinated or had been vaccinated against COVID-19. A total of 18 studies were included in the review and meta-analysis. The acceptance rate of vaccination against COVID-19 among pregnant women ranged from 17.6% to 84.5%. The pooled proportion of acceptance of vaccination against COVID-19 in pregnant women was 0.53 (95% CI: 0.44-0.61). Predictors of acceptance of COVID-19 vaccination were older age, White race, occupational status, higher level of education, comorbidities, third trimester of pregnancy, influenza vaccination, knowledge about COVID-19, and confidence that vaccines for COVID-19 are safe and effective. The prevalence of COVID-19 vaccination in pregnant women is low. Targeted information campaigns are needed to increase vaccine education in this population.
Collapse
Affiliation(s)
- Antigoni Sarantaki
- Midwifery Department, University of West Attica, 12243 Athens, Greece
- Correspondence:
| | | | | | - Christina Nanou
- Midwifery Department, University of West Attica, 12243 Athens, Greece
| | | |
Collapse
|
25
|
Alshahrani SM, Alotaibi A, Almajed E, Alotaibi A, Alotaibi K, Albisher S. Pregnant and Breastfeeding Women's Attitudes and Fears Regarding COVID-19 Vaccination: A Nationwide Cross-Sectional Study in Saudi Arabia. Int J Womens Health 2022; 14:1629-1639. [PMID: 36457719 PMCID: PMC9707376 DOI: 10.2147/ijwh.s387169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/17/2022] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Contracting coronavirus disease (COVID-19) during pregnancy has been linked to an increased risk of severe maternal and fetal complications. Mass vaccination is considered a promising solution to successfully combat the COVID-19 pandemic. It includes vaccinating of pregnant and breastfeeding women. The success of a vaccine is determined not only by its efficacy, but also by its acceptability. Therefore, our study aimed to explore the acceptability and reluctance of pregnant and breastfeeding women to receive COVID-19 vaccination in Saudi Arabia. METHODS This cross-sectional study was conducted in Saudi Arabia from March 2022-beginning to June 2022-end. Using an online self-administered questionnaire with a convenience sampling technique, we assessed women for pregnancy, gravidity, parity, high-risk pregnancy, trimester of pregnancy, and current or planned breastfeeding. Furthermore, we assessed patients with preexisting chronic illnesses. The questionnaire comprised sociodemographic data and items drawn from Goncu Ayhan et al, including vaccination history, perception of risk related to the COVID-19 pandemic, impact of the COVID-19 pandemic, and acceptance and attitude toward future COVID-19 vaccination. RESULTS A total of 854 women (615 pregnant and 192 breastfeeding women) were included. Predictors of COVID-19 vaccination acceptance were found in women with a high level of education, those who lived with an elderly family member, and had close contact with a COVID-19-positive person. The reasons for declining vaccination included COVID-19 diagnosis during pregnancy and concerns about side effects of COVID-19 vaccines. A total of 503 (58.9%) women believed that COVID-19 vaccines had the potential to harm their babies. Only 415 (48.6%) agreed they would take the COVID-19 vaccine if it were recommended for pregnant women. CONCLUSION Pregnant and breastfeeding women fear COVID-19 vaccination due to safety concerns for their babies. COVID-19 vaccine acceptance varies among pregnant and breastfeeding women, regardless of whether they receive the COVID-19 vaccine. Our study underlines the importance of public education campaigns to improve the overall quality of information on COVID-19 vaccination, particularly among pregnant and breastfeeding women.
Collapse
Affiliation(s)
- Sultan M Alshahrani
- Department of Neurosciences, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Amjad Alotaibi
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ebtesam Almajed
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Aisha Alotaibi
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Kholoud Alotaibi
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sara Albisher
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
26
|
Miraglia del Giudice G, Folcarelli L, Napoli A, Corea F, Angelillo IF. COVID-19 vaccination hesitancy and willingness among pregnant women in Italy. Front Public Health 2022; 10:995382. [PMID: 36262230 PMCID: PMC9575585 DOI: 10.3389/fpubh.2022.995382] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/30/2022] [Indexed: 01/26/2023] Open
Abstract
Background Pregnant women, especially those with comorbidities, compared to those non-pregnant, have higher risk of developing a severe form of COVID-19. However, COVID-19 vaccine uptake is very low among them. Methods An anonymous questionnaire was administered to randomly selected women 18 years of age that were currently pregnant or had just given birth between September 2021 and May 2022 in the geographic area of Naples. Vaccine hesitancy was assessed using the vaccine hesitancy scale (VHS). Results A total of 385 women participated. Women who had not been infected by SARS-CoV-2 and who needed information about vaccination against COVID-19 had a higher perceived risk of being infected with SARS-CoV-2. More than half (54.3%) of the women were very afraid of the potential side effects of the COVID-19 vaccination on the fetus. There was higher concern of the side effects of the vaccine on the fetus among those who did not have a graduate degree, those with high-risk pregnancy, those who had not been infected by SARS-CoV-2, those who were more concerned that they could be infected by SARS-CoV-2, those who did not know that this vaccination was recommended for them, and those trusting mass media/internet/social networks for information. Only 21.3% were vaccinated when pregnant, mostly women with a university degree, those who had been infected by SARS-CoV-2 before pregnancy, those who did not need information, and those who acquired information about the vaccination from gynecologists. Almost three-quarters (71.9%) were willing to receive the vaccination and those more likely were those with a university degree, those who have had at least one relative/cohabitant partner/friend who had been infected by SARS-CoV-2, those who were more concerned that they could be infected by SARS-CoV-2, and those who were not extremely concerned of the side effects of the vaccine on the fetus. A total of 86.4% were highly hesitant. Highly hesitant were respondents who did not get a graduate degree, those less concerned that they could be infected by SARS-CoV-2, and those trusting mass media/internet/social networks for information. Conclusion Public health efforts and education campaigns for pregnant women are needed for changing their perception patterns and for supporting gynecologists in promoting the uptake of this vaccination.
Collapse
|
27
|
Demir R, Kaya Odabaş R. A systematic review to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated. J OBSTET GYNAECOL 2022; 42:2603-2614. [PMID: 36018038 DOI: 10.1080/01443615.2022.2114327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated. In this study, data was obtained by retrospectively scanning the cross-sectional and qualitative studies published in the databases of 'PubMed, Cochrane, EBSCOhost, ULAKBİM and Google Scholar' in Turkish and English languages between 2011-2021. The PRISMA method was used in the preparation of the systematic review. In the studies reviewed, it was determined that the rate of pregnant women who were against the vaccine ranged from 6.2% to 98.6%, and the opinions of pregnant women against vaccination and the reasons for not getting vaccinated are presented under seven themes. The results of the study were considered important in terms of showing that quality and important studies were carried out in the literature on the subject and that the data were presented.IMPACT STATEMENTWhat is already known on this subject? Today, with the global coronavirus pandemic, vaccines and their effects are on the agenda again. Especially in pregnant women, opposition to vaccination and not getting vaccinated have emerged for various reasons.What do the results of this study add? The anti-vaccine thoughts of the pregnant women and the reasons for not getting vaccinated were mostly as follows: insufficient level of knowledge, mistrust of vaccines, perception of low infection risk, misconceptions and beliefs about the safety, content, side effects and efficacy of vaccines, worry and fear about the side effects of vaccines, the thought that the vaccine will harm herself and the baby, causes arising from healthcare professionals, financial, temporal and logistical barriers.What the implications are of these findings for clinical practice and/or further research? Scientific studies that can provide comprehensive and strong evidence about vaccine hesitancy and its causes, methods of increasing social approval in vaccination, and solutions should be proposed in the light of these researches in the fight against vaccine rejection.
Collapse
Affiliation(s)
- Rukiye Demir
- Department of Midwifery, Faculty of Health Sciences, Canakkale Onsekiz Mart University, Canakkale, Turkiye
| | - Resmiye Kaya Odabaş
- Department of Midwifery, Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkiye
| |
Collapse
|
28
|
Abuhammad S. Attitude of pregnant and lactating women toward COVID-19 vaccination in Jordan: a cross-sectional study. J Perinat Med 2022; 50:896-903. [PMID: 35503514 DOI: 10.1515/jpm-2022-0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/27/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study was to survey pregnant and lactating toward COVID-19 vaccination in Jordan and determine the predictors of this attitude. METHODS This study used a 10 min anonymous, online, cross-sectional survey to collect data. The survey was carried out between September and October 2021. Eligible study participants included all pregnant and lactating women in Jordan. The participants were recruited through social media, midwives, and gynecologists. Survey was used to collect data from the participants. RESULTS The mean attitude of pregnant and lactating women toward COVID vaccination was moderate 71 (SD=100.5). Many factors were predicted the attitude of pregnant and lactating women toward COVID-19 vaccination. The factors were source of data regarding COVID-19 (B=-0.140, p=0.009), level of income (B=-0.141, p=0.009), and social status (B=0.130, p=0.034). These results mean lower income, people who frequently hearing news from news channel or ministry of health and married are showed more positive attitude toward COVID-19 vaccination for children. CONCLUSIONS This is a large national study regarding attitude of pregnant and lactating women toward COVID-19 vaccination in Jordan. This study found that more than 50% for the parents were hesitant to allow their children to receive COVID-19 vaccination. There were no differences between pregnant and lactating women toward COVID-19 vaccination.
Collapse
Affiliation(s)
- Sawsan Abuhammad
- Department of Maternal and Child Health, Jordan University Of Science And Technology, Irbid 22110, Jordan
| |
Collapse
|
29
|
Pecks U, Mand N, Kolben T, Rüdiger M, Oppelt P, Zöllkau J, Dempfle A. SARS-CoV-2 Infection During Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:588-594. [PMID: 35794736 PMCID: PMC9749842 DOI: 10.3238/arztebl.m2022.0266] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/09/2022] [Accepted: 06/30/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Using data from the German CRONOS registry, we assessed the risk of a complicated course of COVID-19 in women with a SARS-CoV-2-infection during pregnancy, with particular consideration of gestational age, vaccination status, and pandemic dynamics. METHODS Data acquired in two separate periods (March 2020 to August 2021; January to June 2022) for CRONOS, a prospective, hospital-based observational study (DRKS00021208), were studied with logistic regression models. Odds ratios comparing 32 with 22 weeks of gestation were calculated for relevant COVID-19-specific events occurring within 4 weeks of a positive test result. RESULTS Data from 3481 women were evaluated. The risk of all of the defined COVID-19-specific events was low among women who became ill with COVID-19 during the first trimester and rose with increasing gestational age into the early third trimester. For example, the odds ratio for hospitalization because of a COVID-19 infection, comparing 32 versus 22 weeks of gestation, was 1.4 (95% confidence interval [1.2; 1.7]). This risk was lower in the second period of data acquisition than in the first (OR 0.66; 95% CI [0.50; 0.88]), and it was even lower if the pregnant patient had been vaccinated against COVID-19 (OR 0.27; 95% CI [0.18; 0.41]). CONCLUSION These findings can serve as a basis for counseling about prophylactic or therapeutic measures, such as the administration of monoclonal antibodies. They underscore the efficacy of vaccination for pregnant women even during the omicron phase of the pandemic.
Collapse
Affiliation(s)
- Ulrich Pecks
- Department of Gynecology and Obstetrics, University Hospital Schleswig–Holstein, Kiel,*Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Schleswig-Holstein Campus Kiel Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Nadine Mand
- Center for Pediatric and Adolescent Medicine, University Hospital Gießen and Marburg GmbH, Philipps University Marburg
| | - Thomas Kolben
- Department of Gynecology and Obstetrics, LMU Medical Center, Munich
| | - Mario Rüdiger
- Neonatology and Pediatric Intensive Care Medicine, Department of Pediatric and Adolescent Medicine, Medical Faculty, Technical University of Dresden,Center for Fetal and Neonatal Health, Technical University of Dresden
| | - Peter Oppelt
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | | | - Astrid Dempfle
- Institute for Medical Informatics and Statistics, University Hospital Schleswig–Holstein, Kiel
| | | |
Collapse
|
30
|
Abstract
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.
Collapse
Affiliation(s)
- Martina L Badell
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA. USA
| | - Carolynn M Dude
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA. USA
| | - Sonja A Rasmussen
- Departments of Pediatrics and Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA. USA
| |
Collapse
|
31
|
Bianchi FP, Stefanizzi P, Di Gioia MC, Brescia N, Lattanzio S, Tafuri S. COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines 2022; 21:1443-1454. [PMID: 35818804 DOI: 10.1080/14760584.2022.2100766] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19. Despite this, low vaccination coverages are reported in this population sub-group. AREAS COVERED The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Forty-six studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar, and Scopus databases between January 1, 2020 and February 6, 2022. The vaccine hesitation rate among pregnant and breastfeeding women was 48.4% (95%CI= 43.4-53.4%). In a sub analysis by study period, it was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events. EXPERT OPINION Available evidence in the literature has shown that fighting vaccine resistance is harsh and too slow as a process, considering the rapidity and unpredictability of a pandemic. Health education should be provided in order to improve the willingness of the community, especially for those with lower levels of education.
Collapse
Affiliation(s)
| | | | | | - Nazario Brescia
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
| | - Sabrina Lattanzio
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
| |
Collapse
|
32
|
Klipstein S, Dionne JA, Feinberg EC, Kawwass JF, Pfeifer SM, Schlegel PN, Racowsky C. Data-Driven Commentary on SARS-CoV-2 Infection, Vaccination, and Fertility. Am J Epidemiol 2022; 191:1343-1346. [PMID: 35766432 PMCID: PMC9278241 DOI: 10.1093/aje/kwac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/01/2022] [Accepted: 04/06/2022] [Indexed: 01/28/2023] Open
Abstract
A recent study by Wesselink et al. (Am J Epidemiol. 2022;191(8):1383-1395) adds to the growing body of research finding that vaccination for coronavirus disease 2019 (COVID-19) is safe for individuals either seeking pregnancy or who are pregnant. The study's authors found no effect of COVID-19 vaccination on fecundity in a population of individuals with no known infertility who were attempting conception. The finding reinforces the messaging of the American Society for Reproductive Medicine COVID-19 Task Force, the aim of which is to provide data-driven recommendations to individuals contemplating pregnancy in the face of the COVID-19 pandemic. As safe and effective COVID-19 vaccines became available, and with an increasing number of studies showing a heightened risk of severe disease during pregnancy, an important role of the Task Force is to encourage vaccination during the preconceptual window and in early pregnancy. The Task Force supports ongoing research to address gaps in knowledge about safe and effective therapies and preventive measures for individuals contemplating pregnancy and during pregnancy. Such research will help optimize care for reproductive-age individuals in the face of current and future health crises.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Catherine Racowsky
- Correspondence to Dr. Catherine Racowsky, Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150 Suresnes, France (e-mail: ; )
| |
Collapse
|
33
|
Lis-Kuberka J, Berghausen-Mazur M, Orczyk-Pawiłowicz M. Attitude and Level of COVID-19 Vaccination among Women in Reproductive Age during the Fourth Pandemic Wave: A Cross-Sectional Study in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6872. [PMID: 35682455 PMCID: PMC9180577 DOI: 10.3390/ijerph19116872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022]
Abstract
COVID-19 vaccination, apart from the sanitary regime, is the most efficient strategy to limit the spread of the SARS-CoV-2 virus and significantly reduce the severity of the disease following infection. A cross-sectional survey was conducted during the fourth wave of the COVID-19 pandemic among pregnant Polish women and women who have already given birth to evaluate the level and attitude to vaccination. Briefly, 1196 women (256 pregnant and 940 mothers) participated in the study; 68.0% of pregnant women and 66.2% of mothers declared that they had received COVID-19 vaccination. The most frequently stated reasons not to get vaccinated were possible adverse effects on the mother, fetus or breastfed child, post-vaccination complications and limited scientific evidence on the safety of the COVID-19 vaccine. The identified predictors of avoiding COVID-19 vaccination are young age, residing in small cities or rural areas, cohabitation, low anxiety level regarding SARS-CoV-2 infection, and little knowledge concerning maternal vaccine-induced immune protection delivered to offspring. Despite the unlimited access to COVID-19 vaccination, the declared level of vaccination is worryingly low. The knowledge concerning the benefits of vaccination to mothers and their offspring is not satisfactory and requires urgent educational action, particularly among young women living outside big cities and single motherhood.
Collapse
Affiliation(s)
- Jolanta Lis-Kuberka
- Department of Biochemistry and Immunochemistry, Division of Chemistry and Immunochemistry, Wroclaw Medical University, M. Skłodowskiej-Curie 48/50, 50-369 Wroclaw, Poland
| | - Marta Berghausen-Mazur
- Department of Nursing and Obstetrics, Wroclaw Medical University, Bartla 5, 51-618 Wroclaw, Poland;
| | - Magdalena Orczyk-Pawiłowicz
- Department of Biochemistry and Immunochemistry, Division of Chemistry and Immunochemistry, Wroclaw Medical University, M. Skłodowskiej-Curie 48/50, 50-369 Wroclaw, Poland
| |
Collapse
|
34
|
Prasad S, Kalafat E, Blakeway H, Townsend R, O'Brien P, Morris E, Draycott T, Thangaratinam S, Le Doare K, Ladhani S, von Dadelszen P, Magee LA, Heath P, Khalil A. Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy. Nat Commun 2022; 13:2414. [PMID: 35538060 PMCID: PMC9090726 DOI: 10.1038/s41467-022-30052-w] [Citation(s) in RCA: 145] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022] Open
Abstract
Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 vaccinated pregnant people, I2 = 73·9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0·85; 95% CI 0·73-0·99, 66,067 vaccinated vs. 424,624 unvaccinated, I2 = 93·9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission (p > 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth.
Collapse
Affiliation(s)
- Smriti Prasad
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - Erkan Kalafat
- Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey
- Department of Obstetrics and Gynaecology, School of Medicine, Koc University, Istanbul, Turkey
| | - Helena Blakeway
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - Rosemary Townsend
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Pat O'Brien
- The Royal College of Obstetricians and Gynaecologists, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Tim Draycott
- The Royal College of Obstetricians and Gynaecologists, London, UK
- North Bristol NHS Trust Department of Women's Health, Westbury-on-Trym, Bristol, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, England, UK
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, England, UK
| | - Peter von Dadelszen
- Institute of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Laura A Magee
- Institute of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Paul Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| |
Collapse
|
35
|
Affiliation(s)
- Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, 1600 Archer Road, Box 100296, Gainesville, Florida, 32610; Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA; Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA.
| | - Denise J Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Woodruff Memorial Research Building, 101 Woodruff Circle, Suite 4208, Atlanta, GA 30322, USA
| |
Collapse
|