"This choice does not just affect me." Attitudes of pregnant women toward COVID-19 vaccines: a mixed-methods study

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

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

COVID-19 Vaccination Acceptance During Pregnancy in Europe

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.

Determinants of Non-Acceptance of the COVID-19 Vaccine During Pregnancy in Pregnant and Postpartum Women: A Descriptive Cross-Sectional Study

Objective

The rate of COVID-19 vaccination hesitation among Iranian pregnant women is around 50%. The objective of the present study was to determine the reasons for the refusal of COVID-19 vaccination among pregnant and postpartum women.

Materials and methods

This descriptive cross-sectional study was performed on 304 pregnant and postpartum women in the comprehensive health centers of Yazd, Iran, between October 2022 and April 2023. Researchers collected the data of unvaccinated women through phone calls using a validated questionnaire. Data was collected using a questionnaire consisting of baseline characteristics and reasons for refusing vaccination. Descriptive statistics were used to analyze the data using SPSS version 22.

Results

The mean age of the pregnant and postpartum women participating in this study was 28.31 ± 6.47 years. The most common reasons for refusing the COVID-19 vaccine included fear of harming the fetus (32.2%), fear of side effects in the mother (25.7%), disbelief in COVID-19 disease and vaccine (13.8%), lack of information about the vaccine (12.8%), and negative opinions of the media and society (12.8%). Less common reasons included husband's disagreement (8.2%), history of COVID-19 infection (6.9%), gynecologists' disagreement (6.3%), history of infertility (5.9%), and underlying disease (3.3%). Astonishingly, among participants who did not inject a booster dose of the vaccine, 76% reported they didn't receive any training and recommendation on booster dose injection from health providers.

Conclusion

Findings highlight that the most common reasons for refusing the COVID-19 vaccine were fear of harming the fetus and fear of side effects in the mother.

COVID-19 vaccination in pregnancy: ambiguity in decision-making

Throughout the COVID-19 pandemic, pregnant women/people were identified as an at-risk group of severe COVID-19 disease. Consequently, vaccine uptake among this group became a public health priority. However, the relationship between pregnancy and vaccination decision-making is complex, and the heightened uncertainty and anxiety produced through the pandemic further exacerbated this immunization decision. This study explores COVID-19 vaccination decision-making during pregnancy in Aotearoa New Zealand by using an online story completion survey tool. Ninety-five responses were received and analysed using thematic analysis where ambiguity was a core facet within and across stories. Three ambiguities were identified, including who makes the decision (agential), what the risks are (risk) and how immunity to this threat can be best achieved (immunity). We discuss the implications of this ambiguity and how the strong desire to protect the baby persisted across accounts. The recognition of the rather persistent ambiguity in vaccination decision-making helps conceptualize influencing factors taken into account in a more nuanced manner for further research, public health campaigns and health professionals. Future public health campaigns can consider redistributing responsibility for vaccination decision-making in pregnancy, traverse an either/or perspective of 'natural' and 'artificial' immunity-boosting and consider how risk is perceived through anecdotes and viral immediacy.

Factors related to COVID-19 vaccination intention and uptake among childbearing women

OBJECTIVE

Pregnant women are a vulnerable population for coronavirus disease 2019 (COVID-19) due to their risk for severe symptoms and adverse perinatal outcomes. Our objective was to identify contributors to COVID-19 vaccine intention in pregnancy and subsequent uptake, informed by the Theory of Planned Behavior, the Health Belief Model, and paradigms implicating social determinants of health (SDoH).

METHOD

Total of 1,899 pregnant women across the United States completed questionnaires in December 2020 (T1) and April 2021 (T2). A structural equation model (SEM) was built from hypothesized contributors to vaccine intention (T1) and uptake (T2), including perceived threat of COVID-19, attitudes toward infection mitigation behaviors, and social determinants of health SDoH (i.e., socioeconomic status [SES], minoritized identity), controlling for maternal health, age, and county-level political orientation.

RESULTS

In the SEM, SDoH variables, perceived threat and behavioral attitudes predicted vaccine intention. SDoH were directly associated with vaccine uptake and indirectly associated via vaccine intention (SES direct effect b = .17, total effect b = .38; identifying as Black/African American direct effect b = -.05, total effect b = -.09) The SEM demonstrated good fit and explained 38% of the variance in vaccine intention and 26% in vaccine uptake.

CONCLUSIONS

COVID-19 vaccination for pregnant women is influenced by SDoH and perceptual factors. Particular attention should focus on persons with lower SES and Black/African American women who reported lower vaccination intention and uptake. Potential routes to increase vaccination in perinatal populations include reducing accessibility barriers and providing information about vaccine safety and efficacy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Social Determinants of Health, Prenatal Maternal Stress, and Earlier Birth During the COVID-19 Pandemic

During the COVID-19 pandemic, pregnant women, especially those from socioeconomically disadvantaged and marginalized groups, experienced unprecedented stress. Prenatal stress and social determinants of health (SDoH) such as lower education and lack of a relationship partner are known to contribute to earlier birth. However, whether SDoH and stress independently contribute or whether the harmful impact of SDoH is mediated by stress is unknown. Moreover, the contributions of these factors has not been investigated in the context of a communal health crisis such as the COVID-19 pandemic. To examine these processes, we used a longitudinal cohort of 2,473 women pregnant during the COVID-19 pandemic who reported a live birth. We compared structural equation models predicting gestational age at birth from SDoH (race/ethnicity, education, financial security, health insurance, relationship status, and lifetime abuse) and from prenatal maternal stress related and unrelated to the COVID-19 pandemic. Results indicate that the association of SDoH with earlier birth was partially mediated by prenatal stress. These findings help uncover mechanisms explaining health disparities in the U.S. and highlight the need to address both SDoH and the stress that these factors produce in under-resourced and marginalized communities.

Influence of the COVID-19 pandemic and social media on the behaviour of pregnant and lactating women towards vaccination: a scoping review

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.

COVID-19 vaccine reluctance and possible driving factors: A comparative assessment among pregnant and non-pregnant women

The coronavirus disease of 2019 (COVID-19) constitutes a serious threat to pregnant women. One of the key strategies for preventing and managing the COVID-19 epidemic is vaccination. Herd immunity is significantly hampered by COVID-19 vaccine reluctance, which poses a potential threat to population health. Therefore, the present work intends to ascertain the incidence and severity of COVID-19 vaccine hesitancy among Pakistani pregnant women, the determinants driving their decision, and a comparative assessment with non-pregnant participants. This cross-sectional survey was carried out from November 2021 to February 2022. The validated vaccination attitude examination (VAX) scale about vaccination reluctance was undertaken by participants, who were also required to indicate whether they would be inclined to acquire the COVID-19 vaccine along with the reasons for reluctance. In comparison to the non-pregnant category with 353 participants, the group of 372 pregnant participants who responded to the questionnaire had a much greater proportion of hesitant respondents. Likewise, contrasted to 31% of non-pregnant participants, about 40% of them attributed their willingness to get vaccinated against coronavirus to social media. They also demonstrated a considerably stronger mean score on all subcategories of the VAX measure. The adjusted odd ratio findings showed that the independent factors for vaccine reluctance appeared to be trusting rumors on social media (adj OR: 2.58), not being afraid of covid-19 (adj OR: 2.01), not believing in COVID-19 existence (adj OR: 2.53), and not believing in vaccines (adj OR: 4.25). Uncertainty about the COVID-19 vaccine is very prevalent among expectant mothers. The investigation accentuates the pressing need to administer COVID-19 vaccination to the general public, including expectant mothers who might be anxious about the vaccine.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSION

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

Determinants of coronavirus disease 2019 vaccine acceptance, hesitancy, and barriers among healthcare workers in Ismailia, Egypt: a mixed methods study

BACKGROUND

Coronavirus disease 2019 vaccine acceptance among healthcare workers (HCWs) plays a fundamental role in combating the COVID-19 pandemic. Vaccination acceptance depends on perceptions of competence and motives of the providers, producers, health professionals, and policymakers. This study aimed to identify the frequency and determinants of COVID-19 vaccine uptake acceptance, hesitancy, and barriers among HCWs.

METHODS

A total of 500 HCWs from 3 different hospital affiliations in Ismailia Governorate, Egypt, were included in this mixed methods study. The study was conducted between March and April 2021 through two phases. Phase 1 included a cross-sectional study using a self-administered questionnaire with inquiries about different determinants of vaccine acceptance, hesitancy, and barriers, which was completed either electronically in a Google form or a hard printed copy. Phase 2 included four focus group discussions to explore the determinants in depth.

RESULTS

The mean age of participants was 33.9 ± 7.9 years, 70% were females, 51.2% were nurses, and 28.6% were physicians. Of the 500 HCWs, only 27.8% accepted taking the vaccine immediately, 49.2% refused, and 23% were hesitant. Vaccine safety was the highest associated factor with vaccine acceptance (odds ratio (OR) = 6.3, 95% confidence interval (CI) 3.132-12.619), followed by previous uptake of influenza vaccine (OR = 3.3, 95% CI 2.048-5.217) and vaccine effectiveness (OR = 2.6, 95% CI 1.282-5.262). The main barriers to vaccine acceptance were mistrust in governmental policies during the pandemic or in the healthcare facility they work in. Hesitancy was common among females and nurses and was attributed to three prominent factors, including safety concerns, negative stories, and personal knowledge.

CONCLUSIONS

The vaccine acceptance frequency among HCWs was considered low, as the majority either refused or was hesitant about taking the vaccine. Concerns about vaccine safety and effectiveness were significant determinants of vaccine acceptance. Factors related to trust were the main barriers to vaccine uptake. The health authority should establish a surveillance system for side effects of the COVID-19 vaccine and communicate this information between HCWs to decrease their worries about safety and increase vaccine uptake.

Vaccine regulation should require and enforce the inclusion of pregnant and breastfeeding women in prelicensure clinical trials

Exclusion of pregnant and breastfeeding women from the pivotal randomized controlled trials for COVID-19 vaccines that led to emergency regulatory approval created gaps in data needed for vaccine policy, healthcare provider recommendations, and women's decisions about vaccination. We argue that such knowledge gaps increase potential for vaccine hesitancy and misinformation relating to the health of women and infants, and that these gaps in evidence are avoidable. Over several decades, ethical and scientific guidance, scholarship, and advocacy in favor of pregnant and breastfeeding women's participation in clinical development of vaccines has accumulated. Guidance on how to include pregnant and breastfeeding women in vaccine trials ethically and safely predates the COVID-19 pandemic but has yet to be routinely incorporated in vaccine development. We highlight the important role regulatory authorities could play in requiring that pregnant and breastfeeding women be eligible as volunteer participants in prelicensure vaccine trials for products that are expected to be used in this population. Inclusion of pregnant and breastfeeding populations in clinical trials leading to market approval or emergency use authorization should be undertaken early or concurrently at the time of trials in the general population.

Using Health Behavior Theory to Address COVID-19 Vaccine Hesitancy: A Scoping Review of Communication and Messaging Interventions

Vaccine hesitancy has been among the most vexing challenges during the COVID-19 pandemic, ultimately leading to maladaptive health behaviors such as vaccine delay and refusal. A variety of approaches have been employed to address this problem, including communication and messaging interventions targeting the underlying determinants of vaccine hesitancy. However, there exists no published evidence synthesis examining how such interventions are using health behavior theory to address COVID-19 vaccine hesitancy. The purpose of this study was to conduct a scoping review of health communication and messaging interventions aimed at addressing COVID-19 vaccine hesitancy, and to systematically evaluate the use of health behavior theory in the design of these interventions. The review followed a five-step iterative framework proposed by Levac and colleagues. Comprehensive searches using an exhaustive list of keyword combinations were used across three online databases to identify articles to screen for inclusion. A structured, validated coding scheme was then applied to assess the use of health behavior theory. Additional study data were extracted using a separate structured form. A total of 36 articles published between January 2020 and February 2022 met inclusion criteria and were included in the review. Ten studies (27.7%) did not mention or use health behavior theory at all. Most studies (n = 26) at least mentioned theory or theory-relevant constructs, with 26 different theories and 52 different theoretical constructs represented in the sample. Although theory and theoretical determinants of vaccination behavior were often mentioned, few studies used theory to specify and target causal pathways of behavior change, and only one study targeted misinformation as a determinant of vaccine hesitancy. The findings from this review provide critical insight into the state of theory-based intervention design and point to significant gaps in the literature to prioritize in future research.

COVID-19 in Pregnancy: Knowledge about the Vaccine and the Effect of the Virus. Reliability and Results of the MAMA-19 Questionnaire

BACKGROUND

Fear or mistrust of the vaccine and concern for the well-being of their unborn infants are the main reasons for COVID-19 vaccine hesitancy in pregnant women. The aim of this work was to validate a questionnaire on knowledge about COVID-19 vaccination during pregnancy and to examine the sources of information in a group of new mothers, as well as their effectiveness and intelligibility.

METHODS

A literature review was carried out to develop a questionnaire of forty-five questions, divided into six sections, called MAMA-19. The assessment of agreement and the interrater reliability was carried out using Cronbach's analysis and Cohen's kappa statistic. Data obtained from the questionnaire were analysed using descriptive and univariate statistics.

RESULTS

The total alpha values in the two sections about knowledge of vaccination during pregnancy and about the effects of disease and possible post-COVID-19 consequences for the unvaccinated showed sufficient consistency, at 0.860 and 0.725, respectively. Non-vaccinated women thought that receiving the COVID-19 vaccine during pregnancy can lead to malformations in the newborn (60% vs. 40%, p = 0.002) and to an increased risk of foetal growth restriction (61.9% vs. 38.1%, p < 0.001). The percentage of vaccinated women was significantly higher than non-vaccinated when more than one professional was consulted and consistent information was received from them (74.2% vs. 25.8%, p = 0.008).

CONCLUSION

The MAMA-19 questionnaire shows results in line with the literature and valid in the two main sections. It is quick to use for measuring communication effectiveness by healthcare professionals and institutions in the context of the COVID-19 vaccination campaign in the pregnant population. The results evidence that a physician's recommendation to get vaccinated is the most important factor in maternal decision making, regardless of geographic, social or educational context.

The COVID-19 Vaccine Opinions of Women Planning a Pregnancy: International Web Blogs Scanning

Background

The unprecedented COVID-19 has infected millions of people and killed hundreds of thousands of people. A strategy to contain the spread of the disease was the development of the COVID-19 vaccine.

Objective

In our study, it was determined the opinions of women who are planning to become pregnant about the COVID-19 vaccine.

Methods

Blogs were used as the data source in the research, which was designed as a descriptive qualitative study. For this purpose, the expressions of 34 women identified between February and March 2021 were evaluated with directed qualitative content analysis.

Results

Psychological changes, cognitive changes, and coping methods were determined as the themes of our results. This study demonstrates the value of using qualitative methods to determine the thoughts of women planning to become pregnant regarding the COVID-19 vaccine.

Conclusion

For women planning pregnancy, continued research into vaccine safety and efficacy is vital, and results should be carefully investigated and handed in the right channels.

What message appeal and messenger are most persuasive for COVID-19 vaccine uptake: Results from a 5-country survey in India, Indonesia, Kenya, Nigeria, and Ukraine

Effective strategies to encourage COVID-19 vaccination should consider how health communication can be tailored to specific contexts. Our study aimed to evaluate the influence of three specific messaging appeals from two kinds of messengers on COVID-19 vaccine acceptance in diverse countries. We surveyed 953 online participants in five countries (India, Indonesia, Kenya, Nigeria, and Ukraine). We assessed participants’ perceptions of three messaging appeals of vaccination—COVID-19 disease health outcomes, social norms related to COVID-19 vaccination, and economic impact of COVID-19—from two messengers, healthcare providers (HCP), and peers. We examined participants’ ad preference and vaccine hesitancy using multivariable multinomial logistic regression. Participants expressed a high level of approval for all the ads. The healthcare outcome–healthcare provider ad was most preferred among participants from India, Indonesia, Nigeria, and Ukraine. Participants in Kenya reported a preference for the health outcome–peer ad. The majority of participants in each country expressed high levels of vaccine hesitancy. However, in a final logistic regression model participant characteristics were not significantly related to vaccine hesitancy. These findings suggest that appeals related to health outcomes, economic benefit, and social norms are all acceptable to diverse general populations, while specific audience segments (i.e., mothers, younger adults, etc.) may have preferences for specific appeals over others. Tailored approaches, or approaches that are developed with the target audience’s concerns and preferences in mind, will be more effective than broad-based or mass appeals.

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

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

Severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Pregnancy in Ontario: A Matched Cohort Analysis

BACKGROUND

Pregnancy represents a physiological state associated with increased vulnerability to severe outcomes from infectious diseases, both for the pregnant person and developing infant. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic may have important health consequences for pregnant individuals, who may also be more reluctant than nonpregnant people to accept vaccination.

METHODS

We sought to estimate the degree to which increased severity of SARS-CoV-2 outcomes can be attributed to pregnancy using a population-based SARS-CoV-2 case file from Ontario, Canada. Because of varying propensity to receive vaccination, and changes in dominant circulating viral strains over time, a time-matched cohort study was performed to evaluate the relative risk of severe illness in pregnant women with SARS-CoV-2 compared to other SARS-CoV-2 infected women of childbearing age (10-49 years old). Risk of severe SARS-CoV-2 outcomes was evaluated in pregnant women and time-matched nonpregnant controls using multivariable conditional logistic regression.

RESULTS

Compared with the rest of the population, nonpregnant women of childbearing age had an elevated risk of infection (standardized morbidity ratio, 1.28), whereas risk of infection was reduced among pregnant women (standardized morbidity ratio, 0.43). After adjustment for confounding, pregnant women had a markedly elevated risk of hospitalization (adjusted odds ratio, 4.96; 95% confidence interval, 3.86-6.37) and intensive care unit admission (adjusted odds ratio, 6.58; 95% confidence interval, 3.29-13.18). The relative increase in hospitalization risk associated with pregnancy was greater in women without comorbidities than in those with comorbidities (P for heterogeneity, .004).

CONCLUSIONS

Given the safety of SARS-CoV-2 vaccines in pregnancy, risk-benefit calculus strongly favors SARS-CoV-2 vaccination in pregnant women.

Covid-19 vaccination in pregnancy

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis

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.

Characteristics and perceptions associated with COVID-19 vaccination hesitancy among pregnant and postpartum individuals: A cross-sectional study

OBJECTIVE

To assess the frequency and associated characteristics of COVID-19 vaccine hesitancy among pregnant and postpartum individuals.

DESIGN

Cross-sectional study.

SETTING

Prenatal care at a single academic tertiary care centre.

POPULATION

Pregnant and postpartum individuals enrolled in prenatal care at a single academic tertiary care centre from 22 March 2021 to 2 April 2021, concurrent with state guidelines recommending COVID-19 vaccination in pregnancy.

METHODS

We used logistic regression to identify characteristics associated with COVID-19 vaccine hesitancy, and adjusted for: age, parity, race, trimester of pregnancy, and chronic comorbidities.

MAIN OUTCOME MEASURES

COVID-19 vaccine hesitancy, defined as uncertainty or refusal of the vaccine, despite the availability of vaccine services, in accordance with the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on vaccine hesitancy.

RESULTS

Of the 485 individuals screened and approached, 456 (94%) enrolled and completed the survey (435/456, 95% pregnant). The frequency of COVID-19 vaccine hesitancy was 46% (95% CI 41%-51%). Sociodemographic characteristics, including non-Hispanic Black race, younger age, lower education, public health insurance receipt, parity >1, and reported substance use, were associated with a higher odds of COVID-19 vaccine hesitancy, but not clinical risk conditions. Individuals who had a family or friend vaccinated for COVID-19, prior or planned vaccination for tetanus, diphtheria and acellular pertussis (Tdap) and/or influenza, and who perceived that vaccination benefited the baby were less likely to express COVID-19 vaccine hesitancy.

CONCLUSIONS

COVID-19 vaccine hesitancy was frequent among pregnant and postpartum individuals. Those who may face barriers to accessing healthcare services were more likely to report vaccine hesitancy. These results can inform interventions to increase COVID-19 vaccine uptake in pregnancy.

TWEETABLE ABSTRACT

COVID-19 vaccination hesitancy is frequent among pregnant and postpartum individuals, and those who face barriers to accessing healthcare services are more likely to report COVID-19 vaccine hesitancy.

Risk Assessment of COVID-19 Vaccination Among Childbearing Women

Background:Recent studies have shown that pregnant women were more likely to experience COVID-19 complications than non-pregnant women, especially during the third trimester. Thus, the objective of the present systematic review is to investigate the literature so as to estimate the safety of COVID-19 vaccination during gestation, regardless of the trimester of pregnancy. Methods:This systematic review was performed based on PRISMA statement and our search included four databases: Medline, PubMed, EMBASE and Google Scholar. Original studies were included. The following search terms were used: coronavirus disease, coronavirus, COVID-19, SARS-CoV-2, vaccine, vaccination, immunity, immunization, pregnancy, gestation, pregnant women, adverse outcomes, impact, safety, risk assessment and all possible combinations between them. Results:The search strategy identified 153 unique items. After the initial screening process, 12 studies underwent full text review and five studies, which met all inclusion criteria, were ultimately included in our systematic review. All four studies claim that COVID-19 vaccination does not have a negative influence on pregnancy and can be beneficial for both the women and their newborns. Conclusion:More clinical trials assessing pregnancy outcome and the value of COVID-19 vaccines in pregnant women are urgently needed. It is vital to determine the most appropriate timing of vaccination across the three trimesters of pregnancy in order to optimize the balance between vaccine efficacy and maternal and foetal safety. Future studies should evaluate the maternal.neonatal transfer of SARS-CoV-2 antibodies as well as long-term infant outcome after administration of the COVID-19 vaccine prenatally.

Uptake of COVID-19 Vaccines among Pregnant Women: A Systematic Review and Meta-Analysis

Mass vaccination against COVID-19 is essential to control the pandemic. COVID-19 vaccines are now recommended during pregnancy to prevent adverse outcomes. With this review, we aimed to evaluate the evidence in the literature regarding the uptake of COVID-19 vaccinations among pregnant women. A comprehensive search was performed in PubMed, Medline, Scopus, ProQuest, Web of Science, CINAHL, and medRxiv from inception to 23 March 2022. We performed a meta-analysis to estimate the overall proportion of pregnant women vaccinated against COVID-19. We found 11 studies including 703,004 pregnant women. The overall proportion of pregnant women vaccinated against COVID-19 was 27.5% (95% CI: 18.8-37.0%). Predictors of COVID-19 vaccination uptake were older age, ethnicity, race, trust in COVID-19 vaccines, and fear of COVID-19 during pregnancy. Mistrust in the government, diagnosis of COVID-19 during pregnancy, and fears about the safety and side effects of COVID-19 vaccines were reasons for declining vaccination. The global COVID-19 vaccination prevalence in pregnant women is low. A large gap exists in the literature on the factors influencing the decision of pregnant women to be vaccinated against COVID-19. Targeted information campaigns are essential to increase vaccine literacy among pregnant women.

COVID-19 Vaccines Confer Protection in Hospitalized Pregnant and Postpartum Women with Severe COVID-19: A Retrospective Cohort Study

The coronavirus disease 2019 (COVID-19) pandemic has had deleterious effects among the obstetric population. Pregnant and postpartum women constitute a high-risk group for severe COVID-19. Vaccination reduces the risk of infection, but it is not known whether women who become infected despite vaccination have a milder course of disease than those who had not been vaccinated. This retrospective cohort study evaluated whether vaccination reduces the severity of COVID-19 infection, as measured by severe maternal morbidity and mortality among hospitalized pregnant and postpartum individuals. A total of 2284 pregnant and postpartum women hospitalized with severe COVID-19 were included. Those who did and who did not receive COVID-19 vaccination were compared. The rates of intensive care unit admission, intubation, and mortality were significantly lower among subjects in the vaccinated group (p < 0.001, p < 0.001 and p < 0.001, respectively). The numbers of patients who needed to be vaccinated to avoid one case of intensive care unit admission, intubation, or death due to COVID-19 were 7, 7, and 9, respectively. The COVID-19 vaccine offers protective effects against intensive care unit admission, intubation, and death in hospitalized pregnant and postpartum women with severe SARS-CoV-2-induced SARS.

Monitoring and Evaluation of National Vaccination Implementation: A Scoping Review of How Frameworks and Indicators Are Used in the Public Health Literature

An effective Monitoring and Evaluation (M&E) framework helps vaccination programme managers determine progress and effectiveness for agreed indicators against clear benchmarks and targets. We aimed to identify the literature on M&E frameworks and indicators used in national vaccination programmes and synthesise approaches and lessons to inform development of future frameworks. We conducted a scoping review using Arksey and O’Malley’s six-stage framework to identify and synthesise sources on monitoring or evaluation of national vaccination implementation that described a framework or indicators. The findings were summarised thematically. We included 43 eligible sources of 4291 screened. Most (95%) were in English and discussed high-income (51%) or middle-income (30%) settings, with 13 in Europe (30%), 10 in Asia-Pacific (23%), nine in Africa (21%), and eight in the Americas (19%), respectively, while three crossed regions. Only five (12%) specified the use of an M&E framework. Most (32/43; 74%) explicitly or implicitly included vaccine coverage indicators, followed by 12 including operational (28%), five including clinical (12%), and two including cost indicators (5%). The use of M&E frameworks was seldom explicit or clearly defined in our sources, with indicators rarely fully defined or benchmarked against targets. Sources focused on ways to improve vaccination programmes without explicitly considering ways to improve assessment. Literature on M&E framework and indicator use in national vaccination programmes is limited and focused on routine childhood vaccination. Therefore, documentation of more experiences and lessons is needed to better inform vaccination M&E beyond childhood.

Intention to Receive COVID-19 Vaccine during Pregnancy: A Systematic Review and Meta-analysis

OBJECTIVE

This meta-analysis aimed to assess the level of intent to receive coronavirus disease 2019 (COVID-19) vaccination and demographical factors influencing vaccine uptake among pregnant individuals.

STUDY DESIGN

PubMed, Scopus, and archive/pre-print servers were searched up to May 22nd, 2021. Cross sectional surveys reporting the percentage of the pregnant individuals intending to get a COVID-19 vaccine were considered eligible for meta-analysis. This review was registered with PROSPERO (CRD42021254484). The primary outcome was to estimate the prevalence of COVID-19 vaccination intent among pregnant population. The secondary outcome was to evaluate the factors influencing the intention for vaccination.

RESULTS

Twelve studies sourcing data of 16,926 individuals who were identified as pregnant were eligible. The estimated intention for the receipt of COVID-19 vaccine among women who were pregnant was 47% (95% CI: 38-57%), with the lowest prevalence in Africa 19% (95% CI: 17-21%) and the highest in Oceania 48.0% (95% CI: 44.0-51.0%). Uptake of other vaccines (influenza and/or TdaP) during pregnancy was associated with higher rate of intent to receive the COVID-19 vaccine (OR = 3.03; 95% CI: 1.37-6.73; p = 0.006).

CONCLUSION

The intent to receive COVID-19 vaccine is relatively low among women who are pregnant and substantially varies based on the country of residence. In our meta-analysis, intent of women who were pregnant to receive the COVID-19 vaccine was significantly associated with the history of receiving influenza or TdaP vaccine during pregnancy. Given that in every country only a minority of gravidae have received the COVID-19 vaccine, despite known risks of maternal morbidity and mortality with no evidence of risks of vaccination, it highlights the importance of revised approaches at shared decision making and focused public health messaging by national and international advisories.

KEY POINTS

· The estimated global intention for COVID-19 vaccination among pregnant women was 47%.. · The lowest intention was in Africa and the highest in Oceania.. · These findings highlight the importance of public health messaging by by different agencies..

Global prevalence of acceptance of COVID-19 vaccines and associated factors in pregnant women: a systematic review and meta-analysis

INTRODUCTION

Pregnant women have a difficult choice about the COVID- 19 vaccination. We performed a systematic review and meta-analysis to evaluate the acceptance of a coronavirus disease 2019 (COVID-19) vaccine among pregnant women and its determinants.

METHOD

We searched the bibliographic databases (Scopus, Medline, and Web of Science) for the relevant studies from 1 January 2020 to 11 July 2021. We pooled the prevalence of vaccine acceptance among pregnant women using a random-effects model and conducted subgroup analyses to explore its determinants. The result was expressed as a prevalence percentage with 95% CIs.

RESULTS

We found ten studies that were suitable, with 16696 participants from 32 countries. COVID-19 vaccination acceptability in pregnant women was 54 percent globally (95 percent CI, 45 percent, 62 percent), with significant heterogeneity (I2= 99.05 percent, p <0.001). The pooled adjusted OR of COVID-19 vaccine acceptance in pregnant women with age >35 years, high education and income levels, and knowledge scores on COVID-19 infection were 1.17, 1.03, 1.18, and 2.55, respectively.

CONCLUSION

About half of pregnant women accepted the COVID-19 vaccine. A high knowledge score on COVID-19 infection had an effective role to increase this acceptance. To promote vaccine knowledge, appropriate planning should be done by the health policy-makers.

The risk factors and pregnant women's willingness toward the SARS-CoV-2 vaccination in various countries: A systematic review and meta-analysis

Introduction

Pregnant women will benefit from research on immunization during pregnancy because they will have more accurate information on the SARS-CoV-2 vaccine. The purpose of this study was to determine the risk factors and pregnant women's desire to get the SARS-CoV-2 vaccine in various countries.

Methods

A search of PubMed, ProQuest, and EBSCO for related publications published (January and December 2021) on risk factors and pregnant women's desire to get the SARS-CoV-2 vaccine in various countries. The Pooled Odds Ratio (POR) were calculated using fixed and random-effect analysis. The I-squared formula was used to calculate the heterogeneity. Egger's and Begg's tests were used to identify study bias. STATA 16.0 was used for data analysis.

Results

This study revealed good practice has the highest POR (8.99), followed by received influenza vaccine last year (2.72), high perception of SARS-CoV-2 vaccine (2.70), >35 years (2.01), sufficient information about the SARS-COV-2 vaccine (1.94), higher school education (1.84), and third trimester (1.35) with pregnant women's desire toward the SARS-CoV-2 vaccination. The heterogeneity analysis revealed homogenous among risk factors in >35 years, high perception of SARS-CoV-2 vaccine, good practice, and third trimester (I² ≤ 50%). In the articles combined in this study, there was no indication of study bias.

Conclusion

The insights of this study might help the authorities in determining the most effective strategy to deploy SARS-CoV-2 mass immunization campaigns for pregnant women.

Approach of Pregnant Women from Poland and the Ukraine to COVID-19 Vaccination—The Role of Medical Consultation

There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnancy. The aim of this study is to describe the level of vaccination acceptance, to find the factors that most influence the decision to vaccinate, and to describe the scale of changes in vaccination acceptance influenced by medical information on the safety, efficacy, and benefits of vaccination among pregnant women. A total of 300 patients completed the questionnaire, including 150 in Poland and 150 in the Ukraine. The level of vaccination acceptance was assessed before and after medical consultation. There were 53 (35.3%) patients with the intention to get vaccinated in Poland and 25 (16.7%) in the Ukraine. After consultation with a physician, this increased to 109 (72.6%) in Poland and 69 (46%) in the Ukraine. The main factors influencing the acceptance of vaccinations were the fear of harming the foetus (OR-0.119, CI-0.039–0.324 p < 0.001), complications in pregnancy (OR-0.073 CI-0.023–0.197 p < 0.001), and limitations in the vaccination programme (OR-0.026 CI-0.001–0.207 p < 0.001). Medical information about the safety, effectiveness and benefits of vaccinations among pregnant women, provided during a medical visit, may increase the acceptance of vaccinations by 105.6%, as among Polish patients, and by 176%, as among pregnant women from the Ukraine.

Evaluating COVID-19 vaccine hesitancy: A qualitative study from Vietnam

BACKGROUND AND AIMS

Vaccine hesitancy is a major threat to COVID-19 vaccination programs. This study aimed to examine the public attitudes towards COVID-19 vaccines, the variance of these attitudes, and associated determinants within a large COVID-19 outbreak in Vietnam.

METHODS

Two focus group discussions were conducted online with 20 people from different socio-economic and profession backgrounds. Purposive sampling was used to recruit participants. Discussions were recorded and transcribed verbatim. Key themes were extracted using reflexive thematic analysis method.

RESULTS

Four distinct, non-static attitudes including acceptance, conditional acceptance, hesitancy, and anti-vaccination were found. Themes identified as determinants of these attitudes were external factors, internal factors, and risk-benefit self-assessment regarding COVID-19 vaccination.

CONCLUSIONS

We found mixed, non-static COVID-19 vaccination attitudes. People's vaccination risk-benefit self-assessment greatly determines the variance of their attitudes over time. Given high public trust in the authorities, the government should take the lead to counter COVID-19 vaccine misinformation. To increase acceptance, vaccine advertising campaigns should focus on providing information about the dangers of COVID-19, the ability to manage side-effects at the vaccination centers, and updated, precise information on both the outbreak and vaccines. Future research is needed to identify the public most common COVID-19 information channels to enable effective community education.

Worldwide beliefs among pregnant women on SARS-CoV-2 vaccine: a systematic review

BACKGROUND

SARS-CoV-2 vaccine has been recommended to pregnant women, but survey studies showed contrasting findings worldwide in relation to the willingness to accept vaccination during pregnancy.

OBJECTIVE

To evaluate the evidence from the literature regarding the acceptance rate of the SARS-CoV-2 vaccine in pregnant and breastfeeding women.

STUDY DESIGN

We performed a systematic review on the main databases (MEDLINE (PubMed), Scopus, ISI Web of Science) searching for all the peer-reviewed survey studies analyzing the eventual acceptance rate of the SARS-CoV-2 vaccine among pregnant and breastfeeding women. To combine data meta-analyses of proportions and pooled proportions with their 95% confidence intervals (CI) were calculated.

RESULTS

15 studies including 25,839 women were included in the analysis. The proportion of women actually willing to be vaccinated during pregnancy is 49.1% (95% CI, 42.3-56.0), and the proportion of breastfeeding women is 61.6% (95% CI, 50.0-75.0).

CONCLUSION

The cumulative SARS-CoV-2 vaccine acceptance rate among pregnant women appears still low. Vaccinal campaign are urgently needed to drive more confidence into the vaccine to help reducing the spread of the infection and the possible consequences during pregnancy.

Worldwide beliefs among pregnant women on SARS-CoV-2 vaccine: a systematic review

BACKGROUND

SARS-CoV-2 vaccine has been recommended to pregnant women, but survey studies showed contrasting findings worldwide in relation to the willingness to accept vaccination during pregnancy.

OBJECTIVE

To evaluate the evidence from the literature regarding the acceptance rate of the SARS-CoV-2 vaccine in pregnant and breastfeeding women.

STUDY DESIGN

We performed a systematic review on the main databases (MEDLINE (PubMed), Scopus, ISI Web of Science) searching for all the peer-reviewed survey studies analyzing the eventual acceptance rate of the SARS-CoV-2 vaccine among pregnant and breastfeeding women. To combine data meta-analyses of proportions and pooled proportions with their 95% confidence intervals (CI) were calculated.

RESULTS

15 studies including 25,839 women were included in the analysis. The proportion of women actually willing to be vaccinated during pregnancy is 49.1% (95% CI, 42.3-56.0), and the proportion of breastfeeding women is 61.6% (95% CI, 50.0-75.0).

CONCLUSION

The cumulative SARS-CoV-2 vaccine acceptance rate among pregnant women appears still low. Vaccinal campaign are urgently needed to drive more confidence into the vaccine to help reducing the spread of the infection and the possible consequences during pregnancy.

The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review

Background and Objectives: Pregnant women are more likely to develop a more severe course of COVID-19 than their non-pregnant peers. There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnant women. The aim of this study is to conduct a systematic review concerning the approach of pregnant women towards vaccination against COVID-19, with particular regard to determinants of vaccination acceptance. Materials and Methods: Articles were reviewed in which the aim was to evaluate—via a survey or questionnaire—the acceptance and decision to undergo vaccination against COVID-19. The articles were subjected to review according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Results: In various studies, the percentage of pregnant women accepting the COVID-19 vaccine was between 29.7% and 77.4%. The strongest factors co-existing with the acceptance of the COVID-19 vaccination in pregnancy were trust in the importance and effectiveness of the vaccine, explicit communication about the safety of COVID-19 vaccines for pregnant women, acceptance of other vaccinations such as those for influenza, belief in the importance of vaccines/mass vaccination in one’s own country, anxiety about COVID-19, trust in public health agencies/health science, as well as compliance to mask guidelines. The remaining factors were older age, higher education, and socioeconomic status. Conclusions: This review allowed us to show that geographic factors (Asian, South American countries) and pandemic factors (different threats and risks from infection) significantly influence the acceptance of vaccines. The most significant factors affecting acceptance are those related to public awareness of the risk of infection, vaccine safety, and the way in which reliable information about the need and safety of vaccines is provided. Professional and reliable patient information by obstetricians and qualified medical personnel would significantly increase the level of confidence in vaccination against COVID-19.