In a recent study published in Preventive Medicine Reports, researchers evaluated the factors associated with lower coronavirus disease 2019 (COVID-19) vaccination rates among pregnant individuals in the United States (U.S.).
Study: COVID-19 vaccine acceptance and coverage among pregnant persons in the United States. Image Credit: M M Vieira/Shutterstock
Background
Many studies have reported severe reactions to SARS-CoV-2 infection in pregnant individuals, including requirements for mechanical ventilation, admission to intensive care units (ICU), and extracorporeal membrane oxygenation. Pregnancy causes physiological changes that affect the immune system, making the individual vulnerable to infections and possibly increasing morbidity and mortality risks for both mother and fetus.
The U.S. Centre for Disease Control and Prevention (CDC) considers pregnant people and new mothers at high risk, with potential health problems such as postpartum hemorrhage and admission to neonatal ICU for infants born to mothers with COVID-19 infections. Despite the risks, vaccination rates among pregnant individuals are low. A better understanding of the safety concerns about the COVID-19 vaccine is essential to increase public health interventions that can improve vaccine acceptance among expectant and breastfeeding mothers.
About the study
In the present study, the researchers conducted an online national survey between May and July 2021 to understand the attitudes and beliefs about the COVID-19 vaccine that affect the vaccination rates among individuals who are pregnant or breastfeeding. The final participant list consisted of 2,213 individuals between the ages of 18 and 45 who were pregnant or had pregnancies that ended after December 2020, when the COVID-19 vaccines became available in the U.S.
The survey requested information on aspects such as pregnancy history, social support, COVID-19 vaccine and infection experience, sociodemographic factors, prenatal care, risk factors such as substance use, and area of residence. The participants were divided into four groups based on the survey responses about the COVID-19 vaccine — individuals who have been or plan to get vaccinated before or during pregnancy (vaccine acceptance group), those who plan to receive it after the pregnancy (vaccine delay group), individuals who are uncertain about getting the vaccine (vaccine hesitancy group), and those who did not plan on getting vaccinated (vaccine refusal group).
The data were post-stratification weighted by race or ethnicity, maternal age, and region of residence to ensure representativeness of the U.S. population. Additionally, sociodemographic factors were considered by using marginal log-binomial models to estimate adjusted prevalence ratios of vaccine acceptance.
Results
The results of the national survey showed that only 8% of the participants had received one or more doses of the COVID-19 vaccine before their pregnancy, and 47% had taken or were planning to take one or more doses of the vaccine during their pregnancy. Another 27% of the participants planned to delay the vaccine to the end of their pregnancy. The researchers estimated that this left close to half of the pregnant population vulnerable to COVID-19 because they decided to delay or refuse the vaccine.
The authors reported that other surveys had similar results, with the Vaccine Safety Datalink showing a 45% COVID-19 vaccination coverage among pregnant individuals, of which only 23% had received the vaccine during their pregnancy. Furthermore, most U.S. surveys consistently showed a 41 to 44% and 55% vaccine acceptance rate among pregnant, and breastfeeding individuals, respectively, compared to the 76% vaccine acceptance rate seen in the non-pregnant population.
The major factors affecting the acceptance of the COVID-19 vaccine were concerns about the safety of the vaccine and the dearth of information on how safe the vaccine was for pregnant and breastfeeding individuals. Surprisingly, pregnant individuals who planned to delay the COVID-19 vaccine had accepted other recommended vaccines, indicating the lack of clarity about the safety of the COVID-19 vaccine.
Interestingly, participants who had accepted the vaccine and had fewer safety concerns about it had been recommended the vaccine by their health care provider. This highlights the importance of improved patient-provider conversations about the health benefits of the vaccine in increasing vaccine acceptance rates among the pregnant population.
Conclusions
To conclude, the above results suggest that the decision to delay or refuse the COVID-19 vaccine is leaving at least one-third of the pregnant population vulnerable to the disease. The metabolic changes during pregnancy that affect the immune system increase the infection risk for pregnant individuals making their immunization against COVID-19 a priority.
Most vaccine deferrals or refusals are due to the lack of information about the safety of the vaccine, and healthcare provider recommendations have been seen to improve acceptance rates. Public health interventions and increased awareness of vaccine safety could help improve patient confidence and acceptance rates of the COVID-19 vaccine.
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