Association between Perceived Ethnic Discrimination and Receipt of COVID-19 Vaccine in Pregnancy or Postpartum

Although the COVID-19 vaccination has been shown to be safe and effective during pregnancy, pregnant and postpartum populations continue to experience higher rates of vaccine hesitancy than the general population. The experience of discrimination is associated with vaccine hesitancy, but this association has not yet been examined within a pregnant population, which is a particularly vulnerable group for adverse COVID-19 outcomes.

Pregnant individuals receiving prenatal care at a Midwestern academic institution were approached between June 2021 and March 2022 to complete a web-based discrimination questionnaire. The validated survey- the Brief Perceived Ethnic Discrimination Questionnaire - Community Version (BPEDQ-CV) - measures perceived interpersonal racial and ethnic discrimination through four domains, with questions rated on a five-point Likert scale ranging from "never" to "very often". All four domains were summarized in a lifetime discrimination score ranging from 1 to 5. The primary outcome was receipt of COVID-19 vaccination in pregnancy or within the first 180 days postpartum. A multivariate logistic regression model was used to examine the association between "lifetime discrimination score" and COVID-19 vaccination.

Of the 274 pregnant individuals who met inclusion criteria for this analysis, 211 (77.0%) received the COVID-19 vaccine and 63 (23.0%) declined. For each domain of BPEDQ-CV, and for the combined score of lifetime discrimination, a higher score was associated with a higher rate of declining the COVID-19 vaccine. After adjusting for potential cofounders, each unit increase in lifetime exposure to perceived discrimination was associated with 1.25 higher odds of not receiving the COVID-19 vaccine during pregnancy or within in the first 180 days postpartum (aOR 1.25, 95% CI 1.01 - 1.55).

We found that higher lifetime exposure to perceived discrimination was associated with higher risk of declining COVID-19 vaccination during pregnancy and within six months postpartum.