Acceptance of COVID-19 Vaccine and Associated Factors Among Pregnant Women in Saudi Arabia

COVID-19 Vaccine Uptake and Factors Associated Among Pregnant Women in Mogadishu, Somalia

Background

Pregnant women exhibit COVID-19 vaccine hesitancy due to concerns regarding potential risks to their babies, doubts about vaccine efficacy, and limited access to information. Therefore, this study aims to estimate COVID-19 vaccine uptake and factors associated with pregnant women in Mogadishu, Somalia.

Methods

A cross-sectional study was conducted on pregnant women using a questionnaire covering socio-demographic information, pregnancy-related characteristics, perceptions about the COVID-19 vaccine, and vaccination status. Univariable and multivariable logistic regression analyses were utilized to identify factors associated with the outcome variable.

Results

Among the 400 pregnant women who participated in this study, 26.8% had received a COVID-19 vaccine dose, with only 14.9% receiving it during pregnancy. Reasons for not receiving the vaccine included a lack of information about the vaccine (47.4%), concerns about its adverse effects on personal health (33.8%), misconceptions regarding impacts on fertility or menstrual cycles (14.3%), belief in the vaccine's inefficacy (3.4%), and fears about adverse effects on their fetus. In multivariable logistic regression, pregnant women with a history of chronic diseases (AOR=3.27, 95% CI=1.992-6.145), those who perceived themselves at risk of contracting COVID-19 (AOR=3.81, 95% CI=2.11-5.10), those who believed that the vaccine was accessible to them (AOR=4.34, 95% CI=2.915-6.165), and those who discussed the COVID-19 vaccine with their healthcare provider (AOR=3.91, 95% CI=2.123-7.878) were more likely to receive the COVID-19 vaccine compared to their counterparts.

Conclusion

Pregnant women in Mogadishu, Somalia, face challenges with sub-optimal covid-19 vaccine uptake. Implementations should improve awareness of COVID-19 risks and facilitate discussions between healthcare providers and pregnant women. In addition, efforts to provide reliable information about the vaccine, alleviate concerns about its adverse effects, and dispel misconceptions about fertility, menstrual cycles, efficacy, and foetal impact are crucial.

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

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

Factors Influencing COVID-19 Vaccine Hesitancy in Pregnant and Breastfeeding/Puerperium Women: A Cross-Sectional Study

Vaccination among pregnant and breastfeeding women is critical for protecting this vulnerable population and their children. COVID-19 vaccination is recommended both during pregnancy and breastfeeding; however, we still do not fully understand the determinants that influence hesitancy towards COVID-19 vaccination. This study aimed to identify the determinants of vaccine hesitancy in pregnant and breastfeeding, puerperium women. A multicenter, cross-sectional study, involving 435 pregnant and breastfeeding women, was conducted. Vaccination hesitancy was evaluated by administering the Vaccination Attitudes (VAX) Scale and the Zung Anxiety Self-Assessment Scale (SAS) was adopted to measure anxiety levels. Overall, 14% of the participants reported that they did not receive the COVID-19 vaccine, and 78.3% received their first dose during pregnancy or while breastfeeding. The descriptive statistics for the VAX scale showed a total mean score of 3.35 (±1.6), and 75% of participants reported an anxiety index equal to or lower than the threshold. Vaccine hesitancy increased as "adverse events after vaccination" increased (p < 0.01), while SAS levels positively correlated with the participants' mean age (p < 0.05). Investigating the factors influencing vaccine hesitancy enables the development of targeted health policies and SARS-CoV-2 vaccination programs.

COVID-19 vaccine acceptance and associated factors among pregnant and lactating women attending maternity care clinics in refugee camps in Jordan

BACKGROUND

Despite the advantages of vaccination in preventing maternal and fetal problems, there were many concerns in the medical community regarding vaccine safety for pregnant women, and this has put obstetricians in a challenging situation when it comes to advising their pregnant patients on whether to obtain the vaccine.

AIM

This study was performed to define the level of acceptance of COVID-19 vaccination and assess the impact of COVID-19 attitudes and knowledge on vaccine acceptance between pregnant and lactating Syrian women who are seeking prenatal care services at the clinics in Azraq refugee camp in Jordan.

METHOD

A quantitative, cross-sectional study utilizing a non-probability convenience sample. A validated and reliable self-administered questionnaire consisting of four sections was used.

RESULTS

A total of 412 pregnant/lactating women was recruited The acceptance rate of the COVID-19 vaccine among participants was 86.5%. There was a significant positive moderate association between respondents' attitudes and knowledge around the COVID-19 vaccine and their acceptance of the vaccine (r = .468, p < .001, r = .357, p < .001), respectively.

CONCLUSION

To effectively mitigate the COVID-19 pandemic and achieve collective protection, decision-makers must intensify the efforts in promoting the importance of maternal vaccination, especially in vulnerable communities that suffer the most from pandemic outcomes.

Awareness and Safety of COVID-19 Vaccination in Pregnancy

Background

COVID-19 vaccines are safe in pregnancy, as they do not contain a live attenuated virus. Mass vaccination is a key to control the pandemic. Neonates have been shown to be susceptible to severe illness, so maternal vaccination is important to provide neonatal vaccination.

Methods

The present study was conducted for a period of one year from November 21, 2021 to October 2O, 2022 at the Department of Obstetrics and Gynecology A.S.J.S.A.T.D.S. medical college, Fatehpur. It was a hospital-based cross-sectional study. This study aimed to investigate the efficacy, safety, attitude, side effect and maternal neonatal outcome of COVID-19 vaccination among pregnant women.

Results

Out of 3320 pregnant women delivered, only 1170 (35.24%) received at least one dose of COVID-19 vaccine. 69.23% were unaware of the type of COVID-19 vaccine. 66.15% were vaccinated for both the doses before pregnancy. 12.30% of women had taken only the first dose of COVID vaccine before pregnancy. Majority had fever with chills after the first dose. Fatigue was most common side effect after second dose, and no one had any rash or allergic reaction. 56.15% delivered vaginally, 37.69% had LSCS for different obstetric indications, and 6.15% had instrumental delivery. During the antenatal period, 38.46% developed anemia, 11.54% had preterm labor, 2.05% had gestational diabetes, 2.30% developed preeclampsia, and 3.85% developed hypothyroidism. 3.07% prolonged labor in intrapartum period, and 6.92% women developed PPH. 50.77% newborns were between 2.5 and 2.9 kg, and majority 71.54% newborns had an APGAR score of 7 or more at 5 minutes. 14.62% newborns had meconium aspiration syndrome, 3.84% had respiratory distress syndrome, and 20.34% needed NICU admission more than 24 hours.

Conclusion

Available data do not support increased risk of adverse outcome following COVID-19 vaccination. We recommend vaccination during pregnancy as benefit outweigh the potential risk.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13224-023-01918-w.

An investigation of the relationship between the general vaccination attitudes of pregnant women and their attitudes toward the COVID-19 vaccine

This study aimed to investigate the relationship between the attitudes of pregnant women toward general vaccines based on the Health Belief Model and their attitudes toward the COVID-19 vaccine. The study, which was designed as a descriptive, cross-sectional, and correlational study, was conducted with 348 pregnant women in three public hospitals in Northern Cyprus between June 24 and November 28, 2022. Data were collected using the "Participant Information Form," "Public Attitude Toward Vaccination Scale-Health Belief Model" (PAVS-HBM), and "Attitudes Toward the COVID-19 Vaccine" (ATV-COVID-19). The COVID-19 vaccination rate among pregnant women was quite high. Pregnant women have a high perception of sensitivity, importance, benefit, and health responsibility for routine vaccines and vaccination programs based on the HBM, and a low perception of barriers to vaccination. These results showed that pregnant women have a determined and positive attitude toward the acceptance of vaccines in general. On the other hand, the attitude of pregnant women toward the COVID-19 vaccine was moderately negative. Despite the reservations about the COVID-19 vaccine, a determined and positive attitude toward vaccines in general has increased acceptance of the COVID-19 vaccine.

Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world

Despite widespread availability of vaccines against SARS-CoV-2 virus, the cause of Coronavirus Disease 2019 (COVID-19), its uptake in many Arab countries is relatively low. This literature review aimed to scope evidence on COVID-19 vaccine hesitancy (VH) in the Arab world. A total of 134 articles reporting prevalence of COVID-19 VH and associated factors, conducted in any of the 22 Arab League countries, were reviewed. COVID-19 VH prevalence ranged from 5.4% to 83.0%. Female gender, young age, low education level and lack of previous influenza vaccine uptake were most commonly reported to be associated with COVID-19 VH. The most-reported personal concerns contributing toward VH were related to the rapid development, safety and side effects of vaccine, as well as an overall lack of trust in government policies toward pandemic control and widespread conspiracy theories. Tailored interventions to enable the distribution of trusted information and enhance public acceptance of immunization are warranted.

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.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Sociodemographic and clinical predictors for COVID-19 preventive measures compliance among pregnant women in Saudi Arabia: a multicenter study

OBJECTIVE

To assess the levels of adherence among pregnant women to the basic COVID-19 preventive measures, and to analyze the effect of risk perception and sociodemographic and clinical factors on adherence.

METHOD

A multicenter, cross-sectional study was conducted at the obstetrics clinics of 50 primary care centers selected using a multistage sampling method. An online-administered, structured questionnaire was used to collect self-reported levels of adherence to four basic preventive measures against COVID-19, along with perceived COVID-19 severity, infectiousness, and harmfulness to the baby, besides sociodemographic and clinical data including obstetrical and other medical history.

RESULTS

A total of 2460 pregnant women were included with a mean (SD) age of 30.21 (6.11) years. Levels of self-reported compliance were highest for hand hygiene (95.7%), followed by social distancing (92.3%), masking (90.0%), and avoidance of contact with a COVID-19 infected person (70.3%). Perceived COVID-19 severity and infectiousness, and harmfulness to the baby were observed in 89.2%, 70.7%, and 85.0% of the participants, respectively, and were variably associated with compliance to preventive measures. Analysis of sociodemographic factors highlighted the significance of education and economic status in determining adherence to preventive measures, which represents a potential inequity in the risk of COVID-19 infection.

CONCLUSION

This study highlights the importance of patients' education to enable functional perception of COVID-19 that promotes self-efficacy, besides investigating the specific social determinants of health to tackle inequalities in terms of prevention efficiency and the subsequent health outcomes.

COVID-19 vaccine acceptance and predictors among pregnant women in Ethiopia: Systematic Review and Meta-Analysis

Objectives

Despite safe and effective multiple vaccines, the COVID-19 pandemic continued to cause morbidity, mortality, and healthcare burden. Pregnant women are among the high-risk population for COVID-19 infection and bad outcomes. Vaccination is one of the most critical public health interventions to halt the devastating impact of a pandemic. However, hesitancy, unwillingness, and refusal to take the COVID-19 vaccines are global health challenges to vaccination roll-out, especially in Africa, including Ethiopia. Country-specific evidence is essential to take appropriate context-specific actions. Some single studies with inconsistent findings are available in Ethiopia. Therefore, this meta-analysis aims to determine pooled COVID-19 vaccine acceptance among pregnant women in Ethiopia.

Study design

Systematic review and meta-analysis study design was used to synthesize evidence and overall COVID-19 vaccine acceptance and predictors among pregnant women.

Methods

A search of literature from PubMed, Scopus, Web of Science, EMBASE, Cochrane Library, and Google Scholar was conducted until January 30, 2023. All studies that met eligibility criteria were screened, and eight primary studies with 4419 total subjects were included in the meta-analysis. Two authors (DT and MK) independently extracted all the required data using a standardized form. We analyzed the data using STATA version 17 software. Heterogeneity was checked using Chocrane (Q-test) and I² tests. Finally, the overall COVID-19 vaccine acceptance and predictors were computed using a random-effect model.

Result

The meta-analysis revealed that a pooled COVID-19 vaccine acceptance among pregnant women in Ethiopia is 42.46% (95%CI: 28.75-56.18). Further subgroup analysis stratified by region of the primary studies showed that the pooled level of COVID-19 Acceptance among pregnant women in the Amhara region is 35.16% (95% CI: 20.49-49.82), South Nation Nationality and People 50.95% (95%C:12.24-89.67) and Oromia region 62.02% (95%CI: 58.27-65.76). Predictors for COVID-19 vaccine acceptance among pregnant women in Ethiopia were awareness/knowledge of pregnant women to COVID-19 vaccine (OR 3.33, 95%CI:2.13-4.14), maternal education (OR 3.09, 95%CI: 1.67-4.51 and chronic disease (OR 2.81, 95%CI: 1.82-3.79. The lowest level of vaccine acceptance was reported in the Amhara region, while the relatively highest was observed in the Oromia region.

Conclusion

The study found a low level of COVID-19 vaccine acceptance among pregnant women in Ethiopia and emphasized the significance of improving awareness and education to increase vaccine uptake. It is crucial to provide interventions that create awareness about the COVID-19 vaccine and promote the importance of vaccination during antenatal care follow-up.

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.

COVID-19 Vaccine Uptake and Hesitancy among Pregnant and Lactating Women in Saudi Arabia

INTRODUCTION

Pregnant and breastfeeding women comprise a high-risk group for the development of severe COVID-19. Therefore, vaccination is highly recommended for perinatal women; however, vaccination levels for this group remain inadequate. This study explores the percentage of COVID-19 vaccination among Saudi pregnant and lactating women, as well as their attitudes toward it.

METHODS

We conducted a cross-sectional questionnaire-based survey on a sample of Saudi pregnant and breastfeeding women. The study included pregnant and lactating women.

RESULTS

The percentage of COVID-19 vaccine uptake was 78.2%. A total of 45 (21.8%) out of 206 women did not receive the vaccine. The overall vaccine hesitancy was 21.8%. Breastfeeding women were 2.86 more likely not to receive the vaccine as compared to pregnant women. Being a mother of over five children increased the vaccine uptake among our participating women (n = 20, 90%; p < 0.01). The majority of the subjects had taken the Pfizer vaccine (81.98%, 132/161). The availability of the COVID-19 vaccine was the most common factor for choosing a particular vaccine. Protection from infection (60.2%, 97/161) was reported as the main driver for vaccine uptake. The most common reason perceived for delaying COVID-19 vaccination was being worried about the side effects (176, 85.44%) on one's own body and the effects on the unborn child (130, 63.1%).

CONCLUSION

We uncovered high levels of hesitancy, primarily induced by concerns about adverse effects and social media-related misinformation. These high levels of vaccine uptake are likely due to the large-scale obligatory vaccination program provided in Saudi Arabia, which was well-structured and far reaching. Our results provide further support for the so-called "protection motivation theory" in boosting vaccine acceptance. Counseling and educating pregnant and breastfeeding women about COVID-19 vaccination is the need of the hour.

Pregnant women's awareness, perception, and acceptability of COVID-19 vaccine attending antenatal clinics in Bharatpur, Nepal

BACKGROUND

Vaccine is the cost-effective and reliable public health intervention to combat the emerging COVID-19 pandemic. The vaccination is considered safe and effective at any stage of pregnancy; however, pregnant women show more vaccine hesitation than the general population. This study aims to assess pregnant women's awareness, perception, and acceptability of COVID-19 vaccine attending antenatal clinics.

METHODS

An institutional-based cross-sectional analytical study design was used to assess the acceptance of the COVID-19 vaccine and associated factors among pregnant women between Feb-1 to March-30-2022 at antenatal clinics of Bharatpur Chitwan using systematic random sampling. A semi-structured interview schedule was used to collect data from 644 respondents. Collected data were analysed using descriptive and inferential statistics like the Pearson chi-square test and logistic regression analysis.

RESULTS

The COVID-19 vaccine acceptance was found to be 22% and ethnicity (AOR = 1.826; 95% CI = 1.215-2.745), education level (AOR = 1.773; 95%CI = 1.025-3,068;), history of COVID-19 infection (AOR = 3.63; 95% CI = 1.323-9.956;), number of child (AOR = 5.021; 95% CI 1.989-12.677;), trimester (week of pregnancy) (AOR = 2.437; 95% CI 1.107-5.366) and level of perception (AOR = 2.152; 95% CI 1.109-4.178) were found to be statistically significant for acceptance of COVID-19 vaccine among pregnant mother.

CONCLUSIONS

In this study, low levels of vaccine acceptance were found. Several influential factors like occupation, history of COVID-19 infection, number of pregnancies, week of gestation, and level of attitude were found to be significant for acceptance of COVID-19 vaccine among pregnant women. Everyone needs vaccine acceptance to get herd immunity and reduce the COVID-19 infection. But Vaccine hesitancy is one of the significant threats to the COVID-19 rollout and successful pandemic mitigation. Therefore, properly disseminating information and removing misperceptions about the COVID-19 vaccine is necessary to raise the acceptance.

COVID-19 Vaccination and Related Determinants of Hesitancy among Pregnant Women: A Systematic Review and Meta-Analysis

Mass vaccination against COVID-19 is necessary to control the pandemic. COVID-19 vaccines are now recommended during pregnancy to prevent the disease. A systematic review of the literature in the electronic databases PubMed and EMBASE was performed and we aimed to investigate the attitude of documents towards COVID-19 vaccination and the prognostic factors of vaccination hesitation. A meta-analysis was also conducted to estimate the overall percentage of pregnant women who were willing to be vaccinated or had been vaccinated against COVID-19. A total of 18 studies were included in the review and meta-analysis. The acceptance rate of vaccination against COVID-19 among pregnant women ranged from 17.6% to 84.5%. The pooled proportion of acceptance of vaccination against COVID-19 in pregnant women was 0.53 (95% CI: 0.44-0.61). Predictors of acceptance of COVID-19 vaccination were older age, White race, occupational status, higher level of education, comorbidities, third trimester of pregnancy, influenza vaccination, knowledge about COVID-19, and confidence that vaccines for COVID-19 are safe and effective. The prevalence of COVID-19 vaccination in pregnant women is low. Targeted information campaigns are needed to increase vaccine education in this population.

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.

A Mixed-Methods Study of COVID-19 Vaccine Acceptance and Its Determinants Among Pregnant Women in Northeast Ethiopia

Background

The World Health Organization recommends that pregnant women should receive a vaccine against COVID-19. However, COVID-19 vaccine hesitance was one of the barriers to delivering the vaccine, and this issue was not well addressed in Ethiopia. Therefore, we aimed to determine the prevalence of COVID-19 vaccination acceptability and the factors that influence it among pregnant women in Northeast Ethiopia.

Methods

A mixed-methods approach comprising both qualitative interviews and a quantitative survey was conducted from January 1-30, 2022. For the quantitative part, a multi-stage sampling technique was used to recruit the study participants (n=702). Data was collected through face-to-face interviews using pretested and structured questionnaires. Bivariate and multivariable logistic regression analyses were employed. The statistical difference was considered at P-0.05, and the strength of association was assessed by the odds ratio and respective 95% confidence intervals. For the qualitative part, 18 participants were selected purposively for in-depth interviews, an interviewer guide was used for data collection and thematic content analysis was performed.

Results

In this study, a total of 702 pregnant women were included with the response rate of 100%. The rate of COVID-19 vaccine acceptance was 22.6% (95% CI: 19.6%, 25.9%). The husbands' educational level (AOR = 1.99, 95% CI: 1.09, 3.64), chronic medical illness (AOR = 2.41, 95% CI: 1.28, 4.54), positive attitude (AOR = 1.59, 95% CI: 1.09, 2.31), and good practice of COVID-19 preventive measures (AOR = 1.59, 95% CI: 1.09, 2.31) were determinant factors of COVID-19 vaccine acceptance. According to the qualitative findings, the most common reasons for COVID-19 vaccine hesitancy were fear of fetal side effects, misconceptions about the vaccine, and religious beliefs.

Conclusion

In this study, the acceptability of the COVID-19 vaccine was low. Therefore, health professionals should disseminate accurate vaccination information and address misinformation to boost vaccine acceptance among pregnant women.

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.