COVID-19 vaccine hesitancy persists in pregnant women despite recommendations

Acceptance rates of COVID-19 vaccines have remained unchanged among unvaccinated pregnant women following national recommendations, with nearly one-third of patients seeing the vaccine as something harmful to their pregnancy, according to a study.

“COVID-19 vaccination is safe in pregnancy and has been recommended to reduce severe maternal and fetal morbidity; however, hesitancy still exists,” said lead author Julia Knypinski, MD, who presented the study at the 2022 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists (ACOG).

Knypinski and colleagues investigated perceptions and acceptance of vaccination among pregnant women recruited during telehealth visits in a prospective, cross-sectional manner. An online survey using a health belief model was completed by participants to understand factors that predict COVID-19 vaccination acceptance in pregnancy.

The researchers then determined the perceptions of barriers to and benefits of vaccinations, as well as susceptibility to and severity of COVID-19 disease during pregnancy.

Vaccine acceptance rate pre- and postrecommendations from the ACOG and Gynecologists and Society for Maternal–Fetal Medicine (SMFM) was the primary outcome. Secondary outcomes were perceptions of barriers to and benefits of vaccination.

A total of 1,291 women were included in the survey from May to November 2021, from whom 238 responses (18.4 percent) were obtained. [ACOG 2022, abstract A127]

Vaccination rates did not significantly differ when ACOG/SMFM recommendations were considered (before: 94.1 percent; after: 89.1 percent; p=0.54). During the postrecommendation period, more patients were fully vaccinated prior to pregnancy following recommendations (46.7 percent vs 18.8 percent; p=0.01).

Although the participants expressed more confidence in the personal (53.5 percent vs 33.y percent; p=0.01) and foetal protective benefits of vaccination (46.5 percent vs 23.5 percent; p=0.01), no change occurred in the perception of vaccine harm to the pregnancy (30.7 percent vs 39.8 percent).

“Counseling regarding vaccine safety prior to and during pregnancy is crucial to improve acceptance rates,” the researchers said.

Predictors of vaccine hesitancy

In another study presented at ACOG 2022, lead author Michelle Sutanto and colleagues found that vaccine-hesitant patients, compared to those who were vaccinated, tended to be younger (28.0 vs 31.0 years; odds ratio [OR], 0.90; p=0.004) and further along in their pregnancy (210 vs 140 days; OR, 1.01). [ACOG 2022, abstract A128]

In addition, vaccine-hesitant participants were more likely to also report hesitancy towards influenza vaccine and Tdap and to believe they did not have enough information to confidently make their decision.

Some of the concerns with COVID-19 vaccines were short- and long-term side effects on the pregnancy, personal long-term side effects, and harmful ingredients in the vaccine.

“Results suggest that public health strategies aimed at increasing COVID-19 vaccine acceptance in pregnant women should focus on younger women, addressing broader hesitancy with vaccines in general and COVID-19 vaccine safety concerns,” Sutanto said.

This cross-sectional study was conducted from August to September 2021 following institutional review board approval. Pregnancy women at an urban South Texas clinic were surveyed to identify predictors of COVID-19 vaccine hesitancy.

The authors used Fisher’s exact test and Mann-Whitney U test to identify variables predicting vaccine hesitancy. They also analysed subcohorts of unvaccinated participants using a multinomial logistic regression model.