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

The effect of alcohol, tobacco, and other drug use on vaccine acceptance, uptake, and adherence: a systematic review

BACKGROUND

Vaccine hesitancy is increasingly recognized as a health challenge affecting populations worldwide. Given the biological vulnerabilities and structural barriers people who use substances and/or have behavioral addictions face, this systematic review aims to evaluate whether this subpopulation is less prone to adhere to vaccination recommendations.

METHODS

Electronic searches of published original research were conducted in PubMed, EMBASE, Scopus, and PsycINFO from database inception to December 2022. Our strategy encompassed retrievals regardless of languages and date of publication. Animal studies, abstracts without a full manuscript, and studies which were considered to have lower robustness of scientific evidence were excluded. Outcomes measured were vaccine acceptance, uptake, and adherence. Results were interpreted through a narrative synthesis.

RESULTS

The search yielded 103 retrievals encompassing data collected on 5 576 374 persons who were predominantly residents of Europe (n = 39) and North America (n = 27). Tobacco use, the substance for which many studies were found (n = 91), was significantly associated with poorer vaccine acceptance, uptake and adherence for influenza, COVID-19, human papillomavirus (HPV), and maternal and childhood vaccines. Peri-natal and parental substance use was identified as a risk factor for suboptimal vaccine-related outcomes concerning maternal COVID-19 and childhood vaccines. Finally, people identified as 'using', 'abusing', or 'misusing' drugs or substances may be at decreased odds of all outcomes in various vaccines.

CONCLUSIONS

Collectively, the studies identified several groups with statistically significant greater vaccine hesitancy and decreased engagement among whom targeted measures could be beneficial. Timely evidence, especially on behavioral addictions and substances besides tobacco, is lacking, and warrants urgent attention.

Risk factors related to the SARS-CoV-2 vaccine additional doses hesitancy among pregnant and non-pregnant people of reproductive age and partners: A Brazilian cross-sectional study

OBJECTIVE

The aim of this study was to assess the predictors of acceptance and hesitancy of additional doses of any SARS-CoV-2 (COVID-19) vaccine among pregnant or recently pregnant and non-pregnant people of reproductive age and partners in Brazil.

METHODS

We conducted an online cross-sectional study from June 2022 to April 2023 and invited women and partners between 18 and 49 years old to participate. We employed a snowball strategy to reach all potential eligible participants. Our primary outcome was the acceptance rate of the COVID-19 booster vaccine. We estimated the frequency and percentage for the three groups and compared categorical variables using the Chi-square test. Moreover, bivariate, backward stepwise regression, and subgroup analyses were performed to evaluate risk factors and predictors of COVID-19 vaccine booster hesitancy. We reported the effect size as OR with a 95% CI.

RESULTS

We included 1487 participants, and among them, 334 (22.5%) were pregnant or recently pregnant people, 905 (60.8%) were non-pregnant people, and 247 (16.6%) were male partners. Pregnant and recently pregnant people showed greater hesitancy for the COVID-19 vaccine booster than non-pregnant people (28% vs 15%, P < 0.001) and male partners (28% vs 16%, P < 0.001). Non-pregnant women accepted the COVID-19 vaccine more often than pregnant or recently pregnant people (OR 1.75; 95% CI: 1.13-2.70). The associated factors to the reduced COVID-19 vaccine booster acceptance were family income between US$ 566-945.00 (54%), evangelic religion (65%), concern about vaccine safety (80%) and perceived common vaccine importance (93%).

CONCLUSION

Pregnant people were more hesitant than non-pregnant people to accept the COVID-19 booster vaccine. Family income, religious beliefs, vaccine safety concerns, and perceived common vaccine importance were significant barriers to accepting COVID-19 booster vaccines. The impact of these factors was more evident among pregnant or recently pregnant people, emphasizing the harmful effect of misinformation among this vulnerable population.

Individual and familial factors associated with mRNA COVID-19 vaccine uptake in pregnancy: A large-scale registry-based linkage study

The association between maternal COVID-19 vaccination in pregnancy and factors such as high risk for severe COVID-19, pre-existing asthma, prior adverse reproductive history, or paternal COVID-19 vaccination during pregnancy, remains unclear. The aim of this study is two-fold: (i) to describe uptake of COVID-19 vaccine during pregnancy by maternal risk for severe COVID-19 and asthma, and (ii) to comprehensively examine individual and familial factors associated with vaccine uptake during pregnancy in Norway. Based on nation-wide registry-linkage data in Norway, we included 101,659 deliveries with gestational length ≥12 weeks, in 2021-2022. Our outcome measure was uptake of at least one dose of mRNA COVID-19 vaccine during pregnancy, using a narrow (first ever dose) and broad (any dose) definition. We fit univariate and multivariate modified Poisson regression models, clustered by county of residency and adjusted for calendar time, to estimate risk ratios (RR) with 95 % Confidence Intervals (CIs). Gestational uptake of any COVID-19 vaccine dose increased from <1 % before mid Aug-2021, to 38.8 % in the rest of 2021, and 48.9 % in 2022. Only 28.8 % and 33.9 % pregnant individuals with high risk for severe COVID-19 or asthma, respectively, received at least one COVID-19 vaccine dose. Paternal COVID-19 vaccination was strongly associated with greater vaccine uptake by pregnant individuals (adjusted RR: 7.2, 95 % CI: 6.8-7.5). Maternal SARS-CoV-2 infection pre-pregnancy (adjusted RR: 0.31, 95 % CI: 0.26, 0.37), familial and individual migrant status were associated with a considerable decreased likelihood of vaccine uptake in pregnancy. History of miscarriage or pregnancy with congenital anomaly were not associated with vaccine uptake. Despite rising COVID-19 vaccine rates in pregnancy, uptake remained low for high-risk individuals. Paternal vaccination, pre-pregnancy infection, migration status, and maternal citizenship were strongly associated with prenatal vaccine uptake. This knowledge can inform tailoring of future vaccination campaigns.

Pregnant individuals perspectives towards receiving COVID-19 vaccination during their pregnancy: an in-depth qualitative study

Introduction

Pregnant individuals have an increased risk of severe illness from coronavirus disease 2019 (COVID-19) infection. Vaccination is an effective strategy to prevent severe illness and complications for pregnant individuals. Pregnant individuals are often excluded from research and remain hesitant to receive vaccination against COVID-19. It is pivotal to study factors related to vaccine uptake and hesitancy among pregnant individuals. We studied barriers and facilitators for pregnant individuals choice and motivation regarding vaccination against COVID-19 during pregnancy to aid future pregnant individuals in their decision to vaccinate against various infectious agents.

Methods

In this qualitative study, pregnant individuals were interviewed between October 2021 and January 2022 using a semi-structured approach. A topic list was used to explore their feelings, perceptions and ideas regarding vaccination against COVID-19 during pregnancy. Interviews were transcribed verbatim and thematic analyses was performed using MAX QDA.

Results

After nine interviews, saturation was reached. Three main themes were identified that influenced pregnant individuals choice and motivation regarding vaccination: health consequences, ambiguity of information and societal motivation. Health consequences mainly concerned the effect for their offspring, and the unknown long-term effects of COVID-19 vaccination. The advice from the Dutch institute for Public Health and Environment changed from not vaccinating pregnant individuals after release of the developed vaccine, to routinely vaccinating all pregnant individuals after research data were available from the United States of America (USA). This change of policy fuelled doubt and confusion for vaccination. Arguments in favor of vaccination from the social perspective were specific behaviour rules and restrictions due to the pandemic. E.g. without vaccination people were unable to travel abroad and having to take a COVID-19 test every time entering a public place.

Conclusion

Pregnant individuals need clear, unambiguous information concerning health consequences, short- and long-term, particularly for their offspring, in the decision-making process regarding COVID-19 vaccination. Additionally, the societal perspective needs to be addressed. Besides the aforementioned themes, general counselling should focus on misperceptions of vaccine safety and the role of misinformation which are also important in the non-pregnant population. This study underlines the importance of including pregnant individuals in research programs to obtain specific information targeted to their needs.

Factors Influencing the Intention of Chinese Adults to Recommend COVID-19 Vaccination for Specific or Non-Specific Groups

The widespread availability of vaccines has profound implications for sustainable public health. Positive recommendation on vaccination is one of the most effective ways to increase the willingness to vaccinate against COVID-19. This study aims to investigate the factors influencing the intentions to recommend COVID-19 vaccination for specific groups (IRCVSG) and the intentions to recommend COVID-19 vaccination for non-specific groups (IRCVNSG) in China and explore the mediating role of vaccine hesitancy and perception of vaccination information. This study conducted a cross-sectional anonymous online survey of adults (N = 903) in 28 provincial-level administrative regions in China in May 2022. The prevalence of IRCVSG and IRCVNSG was 60.5% and 93.0%, respectively. Health information literacy has a significant direct and indirect impact on IRCVSG through safety hesitancy and the perceived adequacy and usefulness of vaccination information. The relationship between health information literacy and IRCVNSG is entirely mediated via hesitation about the effectiveness and perceived usefulness of vaccination information. Special attention should be paid to the safety hesitation of COVID-19 vaccination for specific groups. This study tests these effects from both theoretical and practical perspectives, helping to address barriers to promoting the vaccination of specific groups for COVID-19 in clinical practice, improving health and sustainability.

Disparities in perinatal COVID-19 infection and vaccination

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

COVID-19 vaccination in pregnancy: A quantitative and qualitative analysis of the effect of strong public health messaging in an Australian cohort

BACKGROUND

SARS-CoV-2 infection in pregnancy predisposes women and their offspring to adverse health outcomes, while internationally reported rates of vaccination uptake remain low. Our study objective was to quantify the uptake of COVID-19 vaccination in pregnant women, and to assess their attitudes toward vaccination in pregnancy with both quantitative and qualitative analyses.

MATERIALS AND METHODS

This is a prospective, cross-sectional survey at Australia's largest quaternary level maternity centre. A total of 351 pregnant women, at 6-42 weeks gestation receiving antenatal care at our hospital, completed an online voluntary, anonymous, 17 question survey. This was conducted during a five-week period in November to December 2021. The main outcome measures were demographic data, prior SARS-CoV-2 infection and COVID-19 vaccination status, knowledge and attitudes surrounding COVID-19 disease and vaccination in pregnancy.

RESULTS

High rates of COVID-19 vaccination were observed in this pregnant population. Of the 351 respondents, 82% had received at least one dose of the COVID 19-vaccination. This increased compared to estimates of 15% in June 2021 which were obtained from the hospital's electronic health record.

CONCLUSIONS

Our survey demonstrates that a strong public health campaign with clear messaging regarding the beneficial effects of COVID-19 vaccination in pregnancy can lead to high vaccination uptake rates.

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

Introduction

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

Methods

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

Results

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

Conclusions

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

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

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

Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2020

OBJECTIVES

Estimates of vaccination coverage during pregnancy and identification of disparities in vaccination coverage can inform vaccination campaigns and programs. We reported the prevalence of being offered or told to get the influenza vaccine by a health care provider (hereinafter, provider); influenza vaccination coverage during the 12 months before delivery; and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination coverage during pregnancy among women with a recent live birth in the United States.

METHODS

We analyzed 2020 data from the Pregnancy Risk Assessment Monitoring System from 42 US jurisdictions (n = 41 673). We estimated the overall prevalence of being offered or told to get the influenza vaccine by a provider and influenza vaccination coverage during the 12 months before delivery. We estimated Tdap vaccination coverage during pregnancy from 21 jurisdictions with available data (n = 22 020) by jurisdiction and select characteristics.

RESULTS

In 2020, 84.9% of women reported being offered or told to get the influenza vaccine, and 60.9% received it, ranging from 35.0% in Puerto Rico to 79.7% in Massachusetts. Influenza vaccination coverage was lower among women who were not offered or told to get the influenza vaccine (21.4%) than among women who were offered or told to get the vaccine (68.1%). Overall, 72.7% of women received the Tdap vaccine, ranging from 52.8% in Mississippi to 86.7% in New Hampshire. Influenza and Tdap vaccination coverage varied by all characteristics examined.

CONCLUSIONS

These results can inform vaccination programs and strategies to address disparities in vaccination coverage during pregnancy and may inform vaccination efforts for other infectious diseases among pregnant women.

Impact of SARS-CoV-2 Positivity on Delivery Outcomes for Pregnant Women between 2020 and 2021: A Single-Center Population-Based Analysis

Despite the existing body of evidence, there is still limited knowledge about the impact of SARS-CoV-2 positivity on delivery outcomes. We aimed to assess the impact of SARS-CoV-2 infection in women who gave birth at the University Hospital "Federico II" of Naples, Italy, between 2020 and 2021. We conducted a retrospective single-center population-based observational study to assess the differences in the caesarean section and preterm labor rates and the length of stay between women who tested positive for SARS-CoV-2 and those who tested negative at the time of labor. We further stratified the analyses considering the time period, dividing them into three-month intervals, and changes in SARS-CoV-2 as the most prevalent variant. The study included 5236 women with 353 positive cases. After vaccination availability, only 4% had undergone a complete vaccination cycle. The Obstetric Comorbidity Index was higher than 0 in 41% of the sample. When compared with negative women, positive ones had 80% increased odds of caesarean section, and it was confirmed by adjusting for the SARS-CoV-2 variant. No significant differences were found in preterm birth risks. The length of stay was 11% higher in positive cases but was not significant after adjusting for the SARS-CoV-2 variant. When considering only positive women in the seventh study period (July-September 2021), they had a 61% decrease in the odds of receiving a caesarean section compared to the fourth (October-December 2020). Guidelines should be implemented to improve the safety and efficiency of the delivery process, considering the transition of SARS-CoV-2 from pandemic to endemic. Furthermore, these guidelines should aim to improve the management of airborne infections in pregnant women.

Association between acceptance of routine pregnancy vaccinations and COVID-19 vaccine uptake in pregnant patients

OBJECTIVE

COVID-19 vaccination is a key approach to reduce morbidity and mortality in pregnant patients and their newborns. Anti-vaccine sentiment has recently increased with unclear impact on pregnant patients. We examined the association between acceptance of tetanus-diphtheria-acellular pertussis (Tdap) and influenza vaccines, considered to be routine pregnancy vaccines, and COVID-19 vaccine acceptance. Secondarily, we identified other predictors of COVID-19 vaccine uptake and described pregnancy outcomes in patients who were and were not vaccinated during pregnancy.

METHODS

A retrospective cohort study of all patients who delivered at a single site from December 2020 - March 2022. Demographic, pregnancy, neonatal, and vaccination data were abstracted from the electronic medical record, which imports vaccine history from the California Immunization Registry. The relationship between influenza and Tdap vaccine acceptance, other baseline characteristics, and COVID-19 vaccine uptake was assessed using univariable and multivariable regression analysis.

RESULTS

Of the 7857 patients who delivered during the study period, 4410 (56.1%) accepted the COVID-19 vaccine. Of those who received the COVID-19 vaccine, 3363 (97.6%) and 3049 (88.5%) received influenza and Tdap vaccines, respectively. Patients were more likely to receive the COVID-19 vaccine if they had advanced maternal age, obesity, Asian race, and private insurance. After adjustment for baseline differences, COVID vaccine acceptance was associated with receipt of Tdap (aOR 2.10, 95% CI 1.90-2.33) and influenza vaccines (aOR 2.83, 95% CI 2.55-3.14). There were no differences in preterm birth, low birthweight, and NICU admission between patients who received and did not receive the COVID-19 vaccine.

CONCLUSION

Patients were more likely to accept COVID-19 vaccination if they received Tdap or influenza vaccinations. Older age, obesity, Asian race, and private insurance were independent predictors of vaccine uptake. Disparities in COVID-19 vaccination uptake bear further exploration to guide efforts in equitable and widespread vaccine distribution.

COVID-19 Vaccine Knowledge, Attitude, Acceptance and Hesitancy among Pregnancy and Breastfeeding: Systematic Review of Hospital-Based Studies

The risk of unfavourable outcomes for SARS-CoV-2 infection is significant during pregnancy and breastfeeding. Vaccination is a safe and effective measure to lower this risk. This study aims at reviewing the literature concerning the anti-SARS-CoV-2 vaccine's acceptance/hesitancy among pregnant and breastfeeding women attending hospital facilities. A systematic review of literature was carried out. Hospital-based observational studies related to vaccination acceptance, hesitancy, knowledge and attitude among pregnant and breastfeeding women were included. Determinants of acceptance and hesitancy were investigated in detail. Quality assessment was done via the Johann Briggs Institute quality assessment tools. After literature search, 43 studies were included, 30 of which only focused on pregnant women (total sample 25,862 subjects). Sample size ranged from 109 to 7017 people. Acceptance of the SARS-CoV-2 vaccine ranged from 16% to 78.52%; vaccine hesitancy ranged between 91.4% and 24.5%. Fear of adverse events for either the woman, the child, or both, was the main driver for hesitancy. Other determinants of hesitancy included religious concerns, socioeconomic factors, inadequate information regarding the vaccine and lack of trust towards institutions. SARS-CoV-2 vaccine hesitancy in hospitalized pregnant women appears to be significant, and efforts for a more effective communication to these subjects are required.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Factors associated with COVID-19 vaccination among pregnant women in Rio De Janeiro City, Brazil

COVID-19 vaccination during pregnancy is safe and effective in reducing the risk of complications. However, the uptake is still below targets worldwide. This study aimed to explore the factors associated with COVID-19 vaccination uptake among pregnant women since data on this topic is scarce in low-to-middle-income countries. A retrospective cohort study included linked data on COVID-19 vaccination and pregnant women who delivered a singleton live birth from August 1, 2021, to July 31, 2022, in Rio de Janeiro City, Brazil. Multiple logistic regression was performed to identify factors associated with vaccination during pregnancy, applying a hierarchical model and describing odds ratio with 95% confidence intervals. Of 65,304 pregnant women included in the study, 53.0% (95% CI, 52-53%) received at least one dose of COVID-19 vaccine during pregnancy. Higher uptake was observed among women aged older than 34 (aOR 1.21, 95%CI 1.15-1.28), black (aOR 1.10, 1.04-1.16), or parda/brown skin colour (aOR 1.05, 1.01-1.09), with less than eight years of education (aOR 1.09, 1.02-1.17), living without a partner (aOR 2.24, 2.16-2.34), more than six antenatal care appointments (aOR 1.92, 1.75-2.09), and having a previous child loss (OR 1.06, 1.02-1.11). These results highlight the need for targeted educational campaigns, trustful communication, and accessibility strategies for specific populations to improve vaccination uptake during pregnancy.

COVID-19 Vaccine Acceptance Among Pregnant, Lactating, and Nonpregnant Women of Reproductive Age in Turkey: A Cross-Sectional Analytical Study

OBJECTIVE

This study aims to identify the rates of coronavirus disease 2019 (COVID-19) vaccine acceptance, the reasons for receiving and not receiving the vaccine, and the associated factors among pregnant, lactating, and nonpregnant women of reproductive age.

METHODS

This cross-sectional and analytical study was conducted online in Turkey, at the end of the fourth wave of the COVID-19 pandemic, between February and May 2022. A total of 658 women (230; 35% pregnant) (187; 28.4% lactating) (241; 36.6% nonpregnant) women of reproductive age participated in the study.

RESULTS

Vaccine acceptance rates were found to be 91.7% in nonpregnant women of reproductive age, 77% in lactating women, and 59% in pregnant women (P < 0.05). The highest rate of vaccine hesitancy was observed in pregnant women (31.3%), and vaccine rejection rate was the highest in lactating women (10.2%). Pregnancy (odds ratio [OR] = 3.98; confidence interval [CI] = 1.13-14.10), and the breastfeeding period (OR = 3.84; CI = 1.15-12.78), increased vaccine hesitancy approximately four times.

CONCLUSIONS

Lack of knowledge about and confidence in the COVID-19 vaccine is still one of the barriers to vaccine acceptance today. Health-care providers (HCPs) should provide effective counseling to pregnant, lactating, and nonpregnant reproductive-aged women based on current information and guidelines.

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

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

Attitudes Toward COVID-19 Vaccination Among Pregnant Persons in Urban Hospital-Affiliated Practices: Exploring Themes in Vaccine Hesitancy

OBJECTIVE

To explore beliefs and attitudes toward the COVID-19 vaccine among vaccinated and unvaccinated pregnant persons in order to identify reasons for both vaccine hesitancy and vaccine uptake.

METHODS

From June-August 2021, we conducted a qualitative study consisting of semi-structured interviews with pregnant persons (n = 30). Participants were recruited from university-owned obstetric practices during prenatal and ultrasound appointments. Interviews were audio recorded and transcribed; transcripts were coded and analyzed to identify themes and subthemes.

RESULTS

Of the participants, one-third (n = 10) had received the COVID-19 vaccine, while two-thirds (n = 20) were unvaccinated. Primary themes for unvaccinated participants were concern about the paucity of research on the vaccine in pregnancy and potential impact of the vaccine on both fetal development and maternal health. For vaccinated participants, main themes included potential maternal and fetal protection from COVID-19 and anticipated health complications from contracting COVID-19 as their motivations to get vaccinated. While most participants cited healthcare providers as the most trusted source of vaccine information, a majority reported that the internet was their primary source of vaccine information. Many participants wanted to learn more about the COVID-19 vaccine from their obstetric providers, and notably, most vaccinated participants reported the importance of their obstetrician in their vaccine decision-making process.

CONCLUSIONS

COVID-19 vaccine hesitancy is prevalent among pregnant persons, with concerns for vaccine safety for their fetus, as well as for themselves, being common. Obstetric providers must therefore be prepared to address common concerns with patients during prenatal appointments, taking the time to actively recommend vaccination.

Reduction in preterm birth among COVID-19-vaccinated pregnant individuals in the United States

BACKGROUND

Most studies investigating preterm birth and COVID-19 vaccination have suggested no difference in preterm birth rates between vaccinated and unvaccinated pregnant individuals; however, 1 recent study suggested a protective effect of COVID-19 vaccination on preterm birth rates in Australia.

OBJECTIVE

This study aimed to determine whether a similar association and protective effect of COVID-19 vaccination on preterm birth would be found in our multistate, US cohort.

STUDY DESIGN

A cohort study was conducted using the Vizient Clinical Database, which included data from 192 hospitals in 38 states. Pregnant individuals who delivered between January 2021 and April 2022 were included. Propensity score matching was used to match a "treated" group of pregnant individuals with any COVID-19 vaccination (incomplete or complete vaccination) to a group that had not received any COVID-19 vaccination (the "untreated" group). A complete vaccination series of ≥2 doses of the Moderna or Pfizer vaccines or at least 1 dose of the Johnson & Johnson vaccine was considered. An incomplete series was receipt of 1 dose of the Pfizer or Moderna vaccine. We examined the association between COVID-19 vaccination status and preterm birth at <28, <34, and <37 weeks of gestation. Multivariable logistic regression models were used to adjust for potential confounders, with adjusted odds ratios as the measure of treatment effect.

RESULTS

Matching with replacement was performed for 5749 treated participants. After propensity score matching, there was no difference in maternal demographics of age, race, insurance status, parity, or comorbid conditions. Vaccinated individuals were 26% less likely to deliver at <37 weeks of gestation (adjusted odds ratio, 0.74; 95% confidence interval, 0.73-0.75; P<.001), 37% less likely to deliver at <34 weeks of gestation (adjusted odds ratio, 0.63; 95% confidence interval, 0.61-0.64; P<.001), and 43% less likely to deliver at <28 weeks of gestation (adjusted odds ratio, 0.57; 95% confidence interval, 0.55-0.60; P<0.001) than unvaccinated individuals.

CONCLUSION

Vaccination against COVID-19 may be protective against preterm birth.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

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

How do perceptions of Covid-19 risk impact pregnancy-related health decisions? A convergent parallel mixed-methods study protocol

INTRODUCTION

Pregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic.

OBJECTIVES

Quantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people.Qualitative strand: Understand how pregnant people's perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health.

METHODS AND ANALYSIS

This is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020- December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation.

ETHICS AND DISSEMINATION

This study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics.

TRIAL REGISTRATION

Registration: Clinicaltrials.gov registration number: NCT05663762.

Association between community-level political affiliation and peripartum vaccination

BACKGROUND

Political affiliation has been associated with vaccine uptake, but whether this association holds in pregnancy, when individuals are recommended to receive multiple vaccinations, remains to be studied.

OBJECTIVE

This study aimed to examine the association between community-level political affiliation and vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19 in pregnant and postpartum individuals.

STUDY DESIGN

A survey was conducted about tetanus, diphtheria, and pertussis and influenza vaccinations in early 2021, with a follow-up survey of COVID-19 vaccination among the same individuals at a tertiary care academic medical center in the Midwest. Geocoded residential addresses were linked at the census tract to the Environmental Systems Research Institute 2021 Market Potential Index, which ranks a community in comparison to the US national average. The exposure for this analysis was community-level political affiliation, defined by the Market Potential Index as very conservative, somewhat conservative, centrist, somewhat liberal, and very liberal (reference). The outcomes were self-reported vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19 in the peripartum period. Modified Poisson regression was used and adjusted for age, employment, trimester at assessment, and medical comorbidities.

RESULTS

Of 438 assessed individuals, 37% lived in a community characterized by very liberal political affiliation, 11% as somewhat liberal, 18% as centrist, 12% as somewhat conservative, and 21% as very conservative. Overall, 72% and 58% of individuals reported receiving tetanus, diphtheria, and pertussis and influenza vaccinations, respectively. Of the 279 individuals who responded to the follow-up survey, 53% reported receiving COVID-19 vaccination. Individuals living in a community characterized by very conservative political affiliation were less likely to report vaccinations for tetanus, diphtheria, and pertussis (64% vs 72%; adjusted risk ratio, 0.83; 95% confidence interval, 0.69-0.99); influenza (49% vs 58%; adjusted risk ratio, 0.79; 95% confidence interval, 0.62-1.00); and COVID-19 (35% vs 53%; adjusted risk ratio, 0.65; 95% confidence interval, 0.44-0.96) than those in a community characterized by very liberal political affiliation. Individuals living in a community characterized by centrist political affiliation were less likely to report vaccinations for tetanus, diphtheria, and pertussis (63% vs 72%; adjusted risk ratio, 0.82; 95% confidence interval, 0.68-0.99) and influenza (44% vs 58%; adjusted risk ratio, 0.70; 95% confidence interval, 0.54-0.92) than those in a community characterized by very liberal political affiliation.

CONCLUSION

Compared with pregnant and postpartum individuals living in communities characterized by very liberal political beliefs, those living in communities characterized by very conservative political beliefs were less likely to report vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19, and those in communities characterized by centrist political beliefs were less likely to report vaccinations for tetanus, diphtheria, and pertussis and influenza. Increasing vaccine uptake in the peripartum period may need to consider engaging an individual's broader sociopolitical milieu.

A Systematic Review of Population-Based Studies Assessing Knowledge, Attitudes, Acceptance, and Hesitancy of Pregnant and Breastfeeding Women towards the COVID-19 Vaccine

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.

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

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

Determinants of COVID-19 Vaccination Decision-Making Behaviors among Pregnant Women in Sub-Saharan Africa: A Scoping Review

Despite the availability of the coronavirus disease 2019 (COVID-19) vaccination, uptake among pregnant women in Sub-Saharan Africa has been low. This scoping review aimed to identify and characterize determinants influencing COVID-19 vaccination decision-making behaviors among pregnant women in Sub-Saharan Africa. We searched five online databases for articles on COVID-19 vaccination among pregnant women in Sub-Saharan Africa. We identified studies published in English between March 2020 and April 2023 that assessed vaccine-specific issues, psychosocial constructs, and contextual factors associated with COVID-19 vaccination decision-making behaviors. Of the fourteen studies identified, over half (57.1%) were cross-sectional; three used qualitative research methods; and three involved multi-country participants. Most studies assessed COVID-19 vaccination acceptability and willingness. Overall, 85.7% of the publications examined knowledge, attitudes, or both as critical factors associated with COVID-19 vaccination. The prevalence of COVID-19 vaccine uptake during pregnancy was low in Sub-Saharan Africa (14.4-28%). While most current studies assess COVID-19 vaccination knowledge, research on maternal vaccination in Sub-Saharan Africa would benefit from the inclusion of theory-informed and driven studies that measure additional psychosocial factors and contextual constructs. Future studies should also employ study designs that can determine causal pathways of vaccination determinants and vaccination uptake.

COVID-19 Vaccine Hesitancy Among Pregnant and Lactating Mothers Attending Government Health Care Centers in Karaikal, South India

INTRODUCTION AND AIM

The Government of India has endorsed COVID-19 vaccination for pregnant and lactating mothers. However, the vaccine acceptance rate among this target group is not satisfactory. The study aimed to assess the awareness level, acceptance rate, and hesitancy for COVID-19 vaccination among pregnant and lactating mothers attending government health care centers and to identify the psycho-social factors associated with vaccine hesitancy.

MATERIALS AND METHODS

A government facility-based cross-sectional study was conducted in various government primary and secondary health care centers in Karaikal for a period of six months. After Institutional Ethics Committee (IEC) clearance, a semi-structured questionnaire was used to collect the data from 904 pregnant and lactating mothers. Bivariate and multivariate logistic regression were employed.

RESULTS

Despite a high awareness level (87%), vaccine hesitancy was high (55%) among the study participants. In multivariate analysis, age > 30 years, primi mothers, lactating mothers with < 6 months old children, unawareness, and recent COVID-19 infection were significantly associated with vaccine hesitancy. Fear of side effects for baby and mother following vaccination and family pressure were the prime reasons for vaccine hesitancy.

CONCLUSION

Despite sufficient awareness about the eligibility for COVID-19 vaccination, the acceptance rate was low. There is a dire need to motivate the higher age group, primigravidas, and lactating mothers at the community level to get rid of their fear factors related to vaccination.

Social media and COVID-19 vaccination hesitancy during pregnancy: a mixed methods analysis

OBJECTIVE

To evaluate the reasons for COVID-19 vaccine hesitancy during pregnancy.

DESIGN

We used regular expressions to identify publicly available social media posts from pregnant people expressing at least one reason for their decision not to accept COVID-19 vaccine.

SETTING

Two social media platforms - WhatToExpect and Twitter.

SAMPLE

A total of 945 pregnant people in WhatToExpect (1017 posts) and 345 pregnant people in Twitter (435 tweets).

METHODS

Two annotators manually coded posts according to the Scientific Advisory Group for Emergencies (SAGE) working group's 3Cs vaccine hesitancy model (confidence, complacency and convenience barriers). Within each 3Cs we created subthemes that emerged from the data.

MAIN OUTCOME MEASURES

Subthemes were derived according to the people's posting own words.

RESULTS

Safety concerns were most common and largely linked to the perceived speed at which the vaccine was created and the lack of data about its safety in pregnancy. This led to a preference to wait until after the baby was born or to take other precautions instead. Complacency surrounded a belief that they are young and healthy or already had COVID-19. Misinformation led to false safety and efficacy allegations, or even conspiracy theories, and fed into creating confidence and complacency barriers. Convenience barriers (such as availability) were uncommon.

CONCLUSION

The information in this study can be used to highlight the questions, fears and hesitations pregnant people have about the COVID-19 vaccine. Highlighting these hesitations can help public health campaigns and improve communication between healthcare professionals and patients.

The risk of miscarriage following COVID-19 vaccination: a systematic review and meta-analysis

STUDY QUESTION

What is the risk of miscarriage among pregnant women who received any of the COVID-19 vaccines?

SUMMARY ANSWER

There is no evidence that COVID-19 vaccines are associated with an increased risk of miscarriage.

WHAT IS KNOWN ALREADY

In response to the COVID-19 pandemic, the mass roll-out of vaccines helped to boost herd immunity and reduced hospital admissions, morbidity, and mortality. Still, many were concerned about the safety of vaccines for pregnancy, which may have limited their uptake among pregnant women and those planning a pregnancy.

STUDY DESIGN, SIZE, DURATION

For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception until June 2022 using a combination of keywords and MeSH terms.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We included observational and interventional studies that enrolled pregnant women and evaluated any of the available COVID-19 vaccines compared to placebo or no vaccination. We primarily reported on miscarriage in addition to ongoing pregnancy and/or live birth.

MAIN RESULTS AND THE ROLE OF CHANCE

We included data from 21 studies (5 randomized trials and 16 observational studies) reporting on 149 685 women. The pooled rate of miscarriage among women who received a COVID-19 vaccine was 9% (n = 14 749/123 185, 95% CI 0.05-0.14). Compared to those who received a placebo or no vaccination, women who received a COVID-19 vaccine did not have a higher risk of miscarriage (risk ratio (RR) 1.07, 95% CI 0.89-1.28, I2 35.8%) and had comparable rates for ongoing pregnancy or live birth (RR 1.00, 95% CI 0.97-1.03, I2 10.72%).

LIMITATIONS, REASONS FOR CAUTION

Our analysis was limited to observational evidence with varied reporting, high heterogeneity and risk of bias across included studies, which may limit the generalizability and confidence in our findings.

WIDER IMPLICATIONS OF THE FINDINGS

COVID-19 vaccines are not associated with an increase in the risk of miscarriage or reduced rates of ongoing pregnancy or live birth among women of reproductive age. The current evidence remains limited and larger population studies are needed to further evaluate the effectiveness and safety of COVID-19 vaccination in pregnancy.

STUDY FUNDING/COMPETING INTEREST(S)

No direct funding was provided to support this work. M.P.R. was funded by the Medical Research Council Centre for Reproductive Health Grant No: MR/N022556/1. B.H.A.W. hold a personal development award from the National Institute of Health Research in the UK. All authors declare no conflict of interest.

REGISTRATION NUMBER

CRD42021289098.

The impact of COVID-19 on select considerations in patients of reproductive age: Brief talking points for pharmacists

The coronavirus disease 2019 (COVID-19) pandemic has elicited many health concerns, including the impact of the infection and vaccine on reproductive health. Although robust evidence demonstrates the safety of all available COVID-19 vaccines, misinformation and disinformation related to the vaccine continue to circulate. As accessible and essential health care workers, it is crucial that pharmacists are informed of the evidence related to effects of the COVID-19 infection and vaccinations on reproductive health care. Menstrual cycle changes have been noted owing to COVID-19 infection, pandemic stress, and COVID-19 vaccination. COVID-19 infection and vaccination have not been shown to influence female fertility, pregnancy rates, and lactation. The use of exogenous estrogen may further contribute to an increased risk of thromboembolism with COVID-19 infection, and differences in the risk of cerebral venous sinus thrombosis appear to exist between the types of vaccines. The benefits of COVID-19 vaccination outweigh any risks. Shared decision-making is necessary when discussing vaccination with patients. Pharmacists play a vital role in dispelling misinformation and disinformation related to the impact of COVID-19 illness and vaccination on reproductive health care.

Understanding Factors Impacting Coronavirus Disease 2019 Vaccine Hesitancy in a Rural Surgical Clinic

Objective: Evaluate patient hesitancy about the coronavirus disease 2019 (COVID-19) vaccine. Patients and Methods: English and Spanish pre-and post-video surveys were completed by patients at rural surgery clinics. The surveys consisted of 25 or 21 five-point Likert statements, respectively. Paired difference t-tests and independent sample t-tests were performed. Results: Ninety-four patients completed the surveys: 137 females (73%) and 51 (27%) males; 113 patients were Hispanic (64%); 63 patients were white (36%). The pre-video survey showed that the top two factors influencing patients were: preference for wearing masks over vaccination (n = 185; x¯ = 3.55) and not trusting the effectiveness of the vaccine (n = 186; x¯ = 3.01). Patients agreed that the video made them want to talk to their family about getting vaccinated (n = 176; x¯ = 3.14) and made them appreciate that they can get really sick from COVID-19 (n = 177; x¯ = 3.14). After watching the video, women of childbearing age (WCBA; n = 65; x¯ = 3.20) agreed more that the video made them want to get the COVID-19 vaccine than non-WCBA (n = 59; x¯ = 2.37; p = 0.0123). Women of childbearing age (n = 66; x¯ = 3.32) also agreed more that the video made them appreciate that they can get really sick from the COVID virus than non-WCBA (n = 60; x¯ = 2.58; p = 0.0254). Post-video statements showed that patients agreed that the video was easy to understand, they liked the video, and the video was helpful. Conclusions: There is room to better inform patients in a rural setting, especially WCBA, about COVID-19 illness and vaccination through video testimonies. Surgeons are uniquely positioned to offer effective recommendations, to increase vaccination rates, and address vaccine hesitancy.

COVID-19 Vaccination and Breastfeeding Mothers in Kahta District, Turkey

We aimed to determine the attitudes and behaviors of breastfeeding mothers regarding the vaccine by examining their knowledge of the COVID-19 virus vaccine and their hesitations about it. The research is a cross-sectional and descriptive study conducted in the Kahta district of Adıyaman, a southeastern province in Turkey, between January and May 2022. The study population consisted of 405 mothers who applied to the Kahta State Hospital Pediatrics outpatient clinic. A questionnaire form was used as a data collection tool, and a consent form was obtained from the participants. The vaccination rate (89%) of those who graduated from high school and above was significantly higher than that of those who graduated from secondary school or below (77.7%). As the economic situation worsened, the vaccination rate decreased. The vaccination rate (85.7%) of mothers whose breastfed child was 0-6 months old was found to be significantly higher than that of those with 7-24-month-olds (76.4%) (p:0.02). The rate of being vaccinated (73.3%) of those who had a new type of COVID-19 virus infection was significantly lower than the rate of being vaccinated (86.3%) of those who did not have a COVID-19 virus infection. The vaccination rate of those who received information from their family doctor and the internet was higher than that of those who received information from radio/TV and people around. The rate of mothers thinking babies should stop breastfeeding who graduated from secondary school or below was higher (53.2%) than the rate of mothers who graduated from high school or above (30.2%) to be vaccinated against the COVID-19 virus. To eliminate the hesitancy about vaccination in mothers, it is necessary to inform and educate the whole society correctly, starting with families with low education and economic levels.

COVID-19 Vaccination during Pregnancy and Lactation: Attitudes and Uptakes before and after Official Recommendations in Germany

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.

Prevalence and predictive determinants of adherence to vaccination against COVID-19 among mothers who gave birth in the last two years in Morocco

Background and aim

Vaccination against COVID-19 was one of the most important resolute to stop the spread of the pandemic; however, its acceptance was controversial especially by pregnant and lactating women. This study aims to assess the prevalence of vaccination among participants as well as to explore the determinants of reluctance or adherence to vaccination among this population, and to investigate the intention towards vaccination among the unvaccinated.

Method

This is a cross-sectional study conducted among mothers (n = 458) residing in the prefecture of Skhirat-Temara in Morocco, and who have children aged between one month to 2 years, the survey was conducted on the basis of a semi-structured questionnaire.

Result

The prevalence of vaccination among the participants was 61.8%, although they were all vaccinated after their delivery. Among the unvaccinated, 64% wanted to be vaccinated either because they believed the vaccines were useful or because they wanted to get the vaccine pass, while 36% absolutely refused to be vaccinated due to lack of sufficient information on the efficacy and safety of new vaccines against COVID-19. The age of the last child (p < 0.001) and no gestational diabetes during pregnancy (p = 0.016) were found to be positive predictors of vaccination adherence; however, the average or the high monthly income (p = 0.003) and the lack of medical coverage (p = 0.046) were predictive factors limiting adherence to vaccination.

Conclusion

The results of this study suggest that public health decision-makers need to increase awareness of the benefits of vaccination and to address the economic and social factors limiting access to COVID-19 vaccination.

Impact of the COVID-19 Pandemic on Influenza Vaccination and Associated Factors among Pregnant Women: A Cross-Sectional Study in Korea

Pregnant women are vulnerable to developing influenza complications. Influenza vaccination during pregnancy is crucial to avoid infection. The COVID-19 pandemic might exacerbate fear and anxiety in pregnant women. The purpose of this study was to evaluate the effect of the COVID-19 pandemic on influenza vaccination and determine the factors associated with influenza vaccine acceptance among pregnant women in Korea. We conducted a cross-sectional study using an online survey in Korea. A survey questionnaire was distributed among pregnant or postpartum women within 1 year after delivery. Multivariate logistic regression analysis was performed to identify the factors associated with influenza vaccination among pregnant women. A total of 351 women were included in this study. Of them, 51.0% and 20.2% were vaccinated against influenza and COVID-19 during pregnancy, respectively. The majority of participants who had a history of influenza vaccination reported that the COVID-19 pandemic did not affect (52.3%, n = 171) or increased the importance (38.5%, n = 126) of their acceptance of the influenza vaccine. Factors associated with influenza vaccine acceptance were knowledge of influenza vaccine (OR 1.21; 95% CI 1.09, 1.35), trust in healthcare providers (OR 2.57; 95% CI 1.43, 4.65), and COVID-19 vaccination during pregnancy (OR 6.11, 95% CI 2.86, 13.01). Participants were more likely to accept the influenza vaccine when they received a COVID-19 vaccine during pregnancy, but the rate of influenza vaccination was not affected by the COVID-19 pandemic. This study showed that the COVID-19 pandemic did not influence influenza vaccine uptake in the majority of pregnant women in Korea. The results emphasize the necessity of appropriate education for pregnant women to enhance awareness of vaccination.

Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study

Introduction

The coronavirus disease 2019 (COVID-19) caused a global pandemic that resulted in devastating health, economic and social disruption. Pregnant mothers are susceptible to COVID-19 complications due to physiological and immunity changes in pregnancy. We aimed to assess the maternal vaccine acceptance of the COVID-19 vaccine.

Methods

A multi-center study across four teaching hospitals in the Klang Valley, Malaysia was conducted between September 2021 and May 2022. A survey was conducted using a self-administered electronic questionnaire. The survey instruments included; (1) maternal perception and attitude toward COVID-19 vaccination, (2) COVID-19 pregnancy-related anxiety, and 3) generalized anxiety disorder.

Results

The response rate was 96.6%, with a final number for analysis of 1,272. The majority of our women were Malays (89.5%), with a mean age (standard deviation, SD) of 32.2 (4.6). The maternal vaccine acceptance in our study was 77.1%. Household income (p < 0.001), employment status (p = 0.011), and health sector worker (p = 0.001) were independent predictors of maternal willingness to be vaccinated. COVID-19 infection to self or among social contact and greater COVID-19 pregnancy-related anxiety were associated with increased odds of accepting the SARS-CoV-2 vaccine. Women who rely on the internet and social media as a source of vaccine information were more likely to be receptive to vaccination (adjusted odd ratio, AOR 1.63; 95% CI 1.14-2.33). Strong correlations were observed between maternal vaccine acceptance and the positive perception of (1) vaccine information (p < 0.001), (2) protective effects of vaccine (p < 0.001), and (3) getting vaccinated as a societal responsibility (p < 0.001).

Discussion

The high maternal vaccine acceptance rate among urban pregnant women in Malaysia is most likely related to their high socio-economic status. Responsible use of the internet and social media, alongside appropriate counseling by health professionals, is essential in reducing vaccine hesitancy among pregnant women.

Pregnancy Care during the COVID-19 Pandemic in Germany: A Public Health Lens

The COVID-19 pandemic has led to various challenges in German health care, including pregnancy care. This paper aims to provide an overview of the pandemic-related challenges faced by pregnant women, new mothers, and their families in maternal and newborn care. A literature review was performed by including international literature as well as recommendations of institutions and official stakeholders. These challenges refer to restrictions at all stages of pregnancy, including wearing masks during labour, limitations of a companion of choice during birth, and restrictions of unvaccinated women from attending, e.g., antenatal classes. Compared with the general population, COVID-19 vaccination of pregnant women was recommended later, as pregnant women were initially excluded from clinical trials. Women who gave birth during the COVID-19 pandemic also reported mental health issues. The findings stress the importance of the inclusion of pregnant women in clinical trials. This might also help to overcome vaccine hesitancy among pregnant women and women seeking family planning. Taking the COVID-19 pandemic as an example, one must weigh the changes and restrictions associated with the potential disadvantages for mothers, newborns, and their families in pregnancy care against the measures to control the pandemic.

Dynamic mechanism of eliminating COVID-19 vaccine hesitancy through web search

This research focuses on the research problem of eliminating COVID-19 vaccine hesitancy through web search. A dynamic model of eliminating COVID-19 vaccine hesitancy through web search is constructed based on the Logistic model, the elimination degree is quantified, the elimination function is defined to analyze the dynamic elimination effect, and the model parameter estimation method is proposed. The numerical solution, process parameters, initial value parameters and stationary point parameters of the model are simulated, respectively, and the mechanism of elimination is deeply analyzed to determine the key time period. Based on the real data of web search and COVID-19 vaccination, data modeling is carried out from two aspects: full sample and segmented sample, and the rationality of the model is verified. On this basis, the model is used to carry out dynamic prediction and verified to have certain medium-term prediction ability. Through this research, the methods of eliminating vaccine hesitancy are enriched, and a new practical idea is provided for eliminating vaccine hesitancy. It also provides a method to predict the quantity of COVID-19 vaccination, provides theoretical guidance for dynamically adjusting the public health policy of the COVID-19, and can provide reference for the vaccination of other vaccines.

Knowledge, Attitudes, Behavior, Acceptance, and Hesitancy in Relation to the COVID-19 Vaccine among Pregnant and Breastfeeding Women: A Systematic Review Protocol

A new coronavirus, SARS-CoV-2, was identified at the end of 2019. It swiftly spread all over the world, affecting more than 600 million people and causing over 6 million deaths worldwide. Different COVID-19 vaccines became available by the end of 2020. Healthcare workers and more vulnerable people (such as the elderly and those with comorbidities) were initially prioritized, followed by the entire population, including pregnant and breastfeeding women. Despite the safety and efficacy of COVID-19 vaccines, a certain level of skepticism was expressed, including among pregnant and breastfeeding women. There were several reasons for this reluctancy, among them, fear of side-effects for both women and fetuses. Nevertheless, acceptance, as well as hesitancy, were time, country and vaccine specific. This review will collect available evidence assessing knowledge, attitudes, behaviour, practice and acceptance/hesitancy of pregnant/breastfeeding women in relation to the COVID-19 vaccination. The PubMed/MEDLINE, Scopus and EMBASE databases will be consulted. A predefined search strategy that combines both free text and MESH terms will be used. The systematic review will adhere to the PRISMA guidelines and the results will be reported in both narrative and summary tables. A meta-analysis will be conducted if data are available.

COVID-19 Vaccine Acceptance During Pregnancy, Women's Views, and Influencing Factors

BACKGROUND

COVID-19 vaccination is advised for pregnant women all over the world; however, vaccine acceptance is variable across the globe.

METHODS

This study was conducted by enrolling 292 antenatal women attending the outpatient department (OPD) in a tertiary care hospital in Delhi, India, between August 1, 2022 and October 31, 2022, with the aim to determine the acceptability of vaccination against COVID-19 disease in pregnancy, women's views regarding the vaccine and to ascertain reasons for acceptance or denial during pregnancy.

RESULT

Of the 292 pregnant women who completed the questionnaire, 39.73% had received both doses of vaccination against COVID-19 disease before pregnancy, and 39.04% had received a single dose. Twenty-one percent of women did not receive any vaccine. Eighty-four percent of the unvaccinated and 35% of the women with a single dose of the vaccine refused further doses during pregnancy. The most common concern was the fear that the vaccine might cause harm to the fetus (35.3%), followed by the fear of vaccine-related reactions (25.4%). Also, 14.6% of women feared that the vaccine might cause them to abort the ongoing pregnancy. Thirteen percent of women stated their intent to receive the vaccine after they were informed regarding its safety and requirement. No difference was found in the acceptability of the vaccine based on the educational status of women or on the monthly income of the families.

CONCLUSION

Adequate communication regarding safety information on COVID-19 vaccines is a must for pregnant women and their families to provide reassurance about the need and safety of the vaccines. It would facilitate making informed decisions and is likely to be helpful in increasing vaccine acceptance.

The COVID-19 Vaccine and Pregnant Minority Women in the US: Implications for Improving Vaccine Confidence and Uptake

The American College of Obstetricians and Gynecologists (AGOG) recommends the FDA-approved Pfizer and Moderna mRNA COVID-19 vaccines and boosters for all eligible pregnant women in the US. However, COVID-19 vaccine confidence and uptake among pregnant minority women have been poor. While the underlying reasons are unclear, they are likely to be associated with myths and misinformation about the vaccines. Direct and indirect factors that deter minority mothers in the US from receiving the mRNA COVID-19 vaccines require further investigation. Here, we examine the historical perspectives on vaccinations during pregnancy. We will examine the following aspects: (1) the influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccinations during pregnancy; (2) the exclusion of pregnant and lactating women from COVID-19 vaccine trials; (3) COVID-19 vaccine safety during pregnancy, obstetric complications associated with symptomatic COVID-19 during pregnancy, COVID-19 vaccine hesitancy among pregnant minority women, and racial disparities experienced by pregnant minority women due to the COVID-19 pandemic as well as their potential impact on pregnancy care; and (4) strategies to improve COVID-19 vaccine confidence and uptake among pregnant minority women in the US. COVID-19 vaccine hesitancy among minority mothers can be mitigated by community engagement efforts that focus on COVID-19 vaccine education, awareness campaigns by trusted entities, and COVID-19-appropriate perinatal counseling aimed to improve COVID-19 vaccine confidence and uptake.

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

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.

SARS-CoV-2 Vaccine Booster Elicits Robust Prolonged Maternal Antibody Responses and Passive Transfer Via The Placenta And Breastmilk

Background

Infection during pregnancy can result in adverse outcomes for both pregnant persons and offspring. Maternal vaccination is an effective mechanism to protect both mother and neonate into post-partum. However, our understanding of passive transfer of antibodies elicited by maternal SARS-CoV-2 mRNA vaccination during pregnancy remains incomplete.

Objective

We aimed to evaluate the antibody responses engendered by maternal SARS-CoV-2 vaccination following initial and booster doses in maternal circulation and breastmilk to better understand passive immunization of the newborn.

Study Design

We collected longitudinal blood samples from 121 pregnant women who received SARS-CoV-2 mRNA vaccines spanning from early gestation to delivery followed by collection of blood samples and breastmilk between delivery and 12 months post-partum. During the study, 70% of the participants also received a booster post-partum. Paired maternal plasma, breastmilk, umbilical cord plasma, and newborn plasma samples were tested via enzyme-linked immunosorbent assays (ELISA) to evaluate SARS-CoV-2 specific IgG antibody levels.

Results

Vaccine-elicited maternal antibodies were detected in both cord blood and newborn blood, albeit at lower levels than maternal circulation, demonstrating transplacental passive immunization. Booster vaccination significantly increased spike specific IgG antibody titers in maternal plasma and breastmilk. Finally, SARS-CoV-2 specific IgG antibodies in newborn blood correlated negatively with days post initial maternal vaccine dose.

Conclusion

Vaccine-induced maternal SARS-CoV-2 antibodies were passively transferred to the offspring in utero via the placenta and after birth via breastfeeding. Maternal booster vaccination, regardless of gestational age at maternal vaccination, significantly increased antibody levels in breastmilk and maternal plasma, indicating the importance of this additional dose to maximize passive protection against SARS-CoV-2 infection for neonates and infants until vaccination eligibility.

"Maternal Vaccination Greatly Depends on Your Trust in the Healthcare System": A Qualitative Study on the Acceptability of Maternal Vaccines among Pregnant Women and Healthcare Workers in Barcelona, Spain

The World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019. Health promotion and education have been seen to improve knowledge and uptake of vaccinations in pregnancy. This qualitative study was conducted based on phenomenology, a methodological approach to understand first-hand experiences, and grounded theory, an inductive approach to analyse data, where theoretical generalisations emerge. Data were collected through semi-structured interviews with pregnant women attending antenatal care services and healthcare workers (HCWs) in Barcelona, Spain. Interviews were audio-recorded, transcribed, and coded, and notes were taken. Inductive thematic analysis was performed, and data were manually coded. Pertussis was reported as the most trusted vaccine among pregnant women due to its long-standing background as a recommended vaccine in pregnancy. The influenza vaccine was regarded as less important since it was perceived to cause mild disease. The COVID-19 vaccine was the least trustworthy for pregnant women due to uncertainties about effectiveness, health effects in the mid- and long-term, the fast development of the vaccine mRNA technology, and the perceptions of limited data on vaccine safety. However, the necessity to be vaccinated was justified by pregnant women due to the exceptional circumstances of the COVID-19 pandemic. The recommendations provided by HCW and the established relationship between the HCW, particularly midwives, and pregnant women were the main factors affecting decision-making. The role of mass media was perceived as key to helping provide reliable messages about the need for vaccines during pregnancy. Overall, vaccines administered during pregnancy were perceived as great tools associated with better health and improved quality of life. Pregnancy was envisioned as a vulnerable period in women's lives that required risk-benefits assessments for decision-making about maternal vaccinations. A holistic approach involving the community and society was considered crucial for health education regarding maternal vaccines in support of the work conducted by HCWs.

COVID-19 vaccine uptake and attitudes among pregnant and postpartum parents

BACKGROUND

Pregnancy poses increased risks from COVID-19, including hospitalization and premature delivery. Yet pregnant individuals are less likely to have received a COVID-19 vaccine.

OBJECTIVE

This study aimed to investigate COVID-19 vaccine uptake and reasons for delay or refusal among perinatal parents.

STUDY DESIGN

A total of 1542 eligible parents who delivered between 2019 and 2021 were surveyed through the Ovia parenting app, which has a nationally representative user base. Adjusted and nationally weighted means were calculated. Multivariate logistic regression and survival models were used to examine uptake.

RESULTS

At least 1 dose of the COVID-19 vaccine was received by 70% of the parents. Those with a bachelor's or graduate degree were significantly more likely to have received a vaccine relative to those with some college or less (adjusted odds ratio for bachelor's degree, 1.854; 95% confidence interval, 1.19-2.90; adjusted odds ratio for graduate degree, 2.833; 95% confidence interval, 1.69-4.75). Parents living in rural areas were significantly less likely to have received a vaccine relative to those living in urban areas (adjusted odds ratio for small city, 0.62; 95% confidence interval, 0.45-0.86; adjusted odds ratio for rural area, 0.56; 95% confidence interval, 0.35-0.89); 56% (281/502) of unvaccinated parents considered that the vaccine "was too new." Among those pregnant in 2021, 44% (258/576) received at least 1 dose, and 34% (195/576) reported that pregnancy had "no impact" on their vaccine decision.

CONCLUSION

There was significant heterogeneity in vaccine uptake and attitudes toward vaccines during pregnancy by sociodemographics and over time. Public health experts need to consider and test more tailored approaches to reduce vaccine hesitancy in this population.

Women's attitude towards COVID-19 vaccination in pregnancy: A survey study in northern Italy

OBJECTIVE

To investigate attitudes and risk perceptions towards the coronavirus disease 2019 (COVID-19) vaccine and reasons for hesitancy among pregnant women.

METHODS

A prospective survey study was conducted at a University Maternity Department. Participants included any pregnant woman aged 18 years or older, able to understand the Italian language, who accessed the antenatal clinic for a prenatal appointment. The survey comprised questions about sociodemographic characteristics, pregnancy vaccination history, and perception of risk related to the immunization for the woman herself and her infant.

RESULTS

A total of 538 women completed the questionnaire, 445 (82.7%) accepted COVID-19 vaccination. Women vaccinated against pertussis were three times more likely to take up the COVID-19 vaccine (odds ratio [OR] 3.19; 95% confidence interval [CI] 1.78-5.72). Having had COVID-19 during pregnancy (OR 0.24; 95% CI 0.11-0.54), and having a high-risk perception towards the immunization for the fetus (OR 0.18; 95% CI 0.09-0.34) were factors associated with vaccine hesitancy. Lack of safety data in pregnancy and the possibility of harm to the fetus were the main concerns.

CONCLUSION

A trusting and supportive relationship with the healthcare professional to address fears, and the transmission of evidence-based information, are pivotal to guide women through an informed choice. Understanding the determinants implicated in women's decision making might guide towards effective public health strategies to boost vaccine acceptance.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

COVID-19 vaccination hesitancy and willingness among pregnant women in Italy

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.

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

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

COVID-19 vaccine acceptance and perceived risk among pregnant and non-pregnant adults in Cameroon, Africa

Background

The public health response to the global COVID-19 pandemic has varied widely by region. In Africa, uptake of effective COVID-19 vaccines has been limited by accessibility and vaccine hesitancy. The aim of this study was to compare perceptions of COVID-19 infection and vaccination between pregnant women and non-pregnant adults in four regions of Cameroon, located in Central Africa.

Methods

A cross-sectional survey study was conducted at urban and suburban hospital facilities in Cameroon. Participants were randomly selected from a convenience sample of adult pregnant and non-pregnant adults in outpatient clinical settings between June 1st and July 14th, 2021. A confidential survey was administered in person by trained research nurses after obtaining written informed consent. Participants were asked about self-reported sociodemographics, medical comorbidities, perceptions of COVID-19 infection, and vaccination. Descriptive statistics were used for survey responses and univariate and multivariable logistic regression models were created to explore factors associated with COVID-19 vaccine acceptability.

Results

Fewer than one-third of participants were interested in receiving the COVID-19 vaccine (31%, 257/835) and rates did not differ by pregnancy status. Overall, 43% of participants doubted vaccine efficacy, and 85% stated that the vaccine available in Africa was less effective than vaccine available in Europe. Factors independently associated with vaccine acceptability included having children (aOR = 1.5; p = 0.04) and higher education (aOR = 1.6 for secondary school vs primary/none; p = 0.03). Perceived risks of vaccination ranged from death (33%) to fetal harm (31%) to genetic changes (1%). Health care professionals were cited as the most trusted source for health information (82%, n = 681).

Conclusion

COVID-19 vaccine hesitancy and misinformation in Cameroon was highly prevalent among pregnant and non-pregnant adults in 2021 while vaccine was available but not recommended for use in pregnancy. Based on study findings, consistent public health messaging from medical professionals about vaccine safety and efficacy and local production of vaccine are likely to improve acceptability.

COVID-19 vaccine hesitancy among pregnant women: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis to estimate the vaccines' acceptance level and to find the factors influencing pregnant women's vaccination decisions, with the goal of assisting in the development of interventions and promoting more research in this area.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, CINAHL and PubMed.

ELIGIBILITY CRITERIA

Studies providing any kind of quantitative assessment of overall COVID-19 vaccination acceptance among pregnant women in any country or region across the globe.

DATA EXTRACTION AND SYNTHESIS

The pooled prevalence of COVID-19 vaccine acceptance among pregnant women was calculated using the random-effects model. Subgroup (sensitivity) analysis was performed to determine the overall COVID-19 vaccine acceptance level to understand the sources of substantial heterogeneity.

RESULTS

Out of the 375 studies identified, 17 studies from four continents assessing 25 147 participants (pregnant women) were included in this study. Among the participants, only 49% (95% CI 42% to 56%, p<0.001) had COVID-19 vaccine acceptance. High-income countries (47%; 95% CI 38% to 55%, p<0.001), participants with fewer than 12 years of education (38%; 95% CI 19% to 58%, p<0.001) and multiparous women (48%; 95% CI 31% to 66%, p<0.001) had lower COVID-19 vaccine acceptance. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (p<0.001). A very weak positive correlation between COVID-19 knowledge and COVID-19 vaccine acceptance was observed (r=0.164; 95% CI -0.946 to 0.972; p=0.8359).

CONCLUSION

Overall, COVID-19 vaccine acceptance among pregnant women was low across the studies and considerably low among some specific subgroups of participants. These research findings have implications for the development of effective interventions that could increase the COVID-19 vaccine acceptance level among pregnant women to attain herd immunity.

PROSPERO REGISTRATION NUMBER

CRD42021277754.