COVID-19 vaccine acceptance and coverage among pregnant persons in the United States

Abstract

Pregnant persons are at higher risk of severe COVID-19. Although vaccination is recommended, COVID-19 vaccination rates are lower among pregnant persons compared to the non-pregnant population. We aimed to evaluate acceptance of any dose of COVID-19 vaccine during pregnancy. A national online cross-sectional survey of US adults who were pregnant between December 2020 and July 2021 was used to measure COVID-19 vaccine behaviors, attitudes, and beliefs. Post-stratification weighting was used to ensure representativeness to the US population. Marginal log-binomial models were used to estimate adjusted prevalence ratios (aPR) of COVID-19 vaccine acceptance, accounting for sociodemographic factors. Of 5,660 who responded to survey advertisements, 2,213 met eligibility criteria and completed the survey; 55.4% of respondents received or planned to receive COVID-19 vaccine prior to or during pregnancy, 27.0% planned to vaccinate after pregnancy, 8.8% were unsure and 8.7% had no plans to vaccinate. Individuals were more likely to receive or plan to receive COVID-19 vaccine if they had group prenatal care (aPR 1.57; 95% CI 1.40, 1.75), were employed in a workplace with a policy recommending vaccination (aPR 1.15; 95% CI 1.06, 1.26), and believed COVID-19 vaccines are safe (aPR 2.86; 95% CI 2.49, 3.29). Pregnant persons who were recommended COVID-19 vaccination by their healthcare provider less commonly reported concerns about vaccine safety (35.5% vs 55.9%) and were more likely to accept COVID-19 vaccines (aPR 1.52; 95% CI 1.31, 1.76). COVID-19 vaccine acceptance during pregnancy is not universal and public health intervention will be needed to continue to increase vaccine coverage.

Keywords: COVID-19; Maternal vaccination; Pregnancy; Vaccine acceptance.

Fig. 1

Attitudes toward COVID-19 vaccines expressed by pregnant persons, by COVID-19 vaccine acceptance – United States, May to July 2021.

Fig. 2

Attitudes toward general vaccines expressed by pregnant persons, by COVID-19 vaccine acceptance* – United States, May to July 2021. *COVID-19 vaccine acceptance was defined as those who had received the vaccine prior to or during pregnancy or planned to receive the vaccine during pregnancy; COVID-19 vaccine delay was defined as those who planned to receive COVID-19 vaccine, but after pregnancy; COVID-19 vaccine hesitancy was defined as those who were uncertain whether they would receive a COVID-19 vaccine; COVID-19 vaccine refusal was defined as those who had no plans to receive COVID-19 vaccine.

Fig. 3

Factors associated with COVID-19 vaccine acceptance* among US pregnant persons – May to July 2021. Abbreviations: CI, confidence interval; HCW, healthcare worker; OR, odds ratio; PNC, prenatal care. *Vaccine acceptance was defined as having received the vaccine prior to or during pregnancy or planning to receive the vaccine during pregnancy. NOTE: Prevalence ratios are adjusted for maternal age, race, region, birth overseas, urban/rural, educational attainment, employment status, insurance status.