Covid-19 Vaccination During Pregnancy in France: a Descriptive Study of Uptake Using the National Healthcare data System

Pregnant women and their fetus are at increased risk of complications when infected by SARS-CoV-2. This study describes COVID-19 vaccine uptake during pregnancy in France (i) according to socio-demographic characteristics, and (ii) over calendar time and pregnancy stages. Using the hospital discharge records of the national healthcare database, we identified women ending pregnancy at hospital between Dec 27, 2020, i.e. beginning of Covid-19 vaccine availability, and Dec 31, 2022. Covid-19 vaccinations and SARS-CoV-2 infections were also available on two specific linked databases. Vaccine coverage was defined as uptake of at least one dose of vaccine during the 2-year study period, or more specifically during one of five phases of pregnancy (first, second and third trimesters, pre-conceptional and post-pregnancy periods). We also defined ineligibility as the six-month period following each Covid-19 infection. We calculated weekly rates of vaccination by pregnancy phase, accounting for ineligibility. About 75% of women received at least one dose of vaccine in 2021-2022 vs. 90% in the general population with a similar age structure. About 26% received at least one dose of vaccine while pregnant. The rate was lower among younger women, deprived women, and those living in the south-east of mainland France or in overseas territories. Weekly vaccination rates according to the phase of pregnancy showed that women mostly received vaccination outside the pregnancy trimesters (after or, to a less extent, before pregnancy). Vaccinations during pregnancy mostly occurred in the second trimester. When only elective terminations were considered, weekly rates of vaccination were almost identical, whatever the pregnancy phase (before, during or after pregnancy). Overall, our results show the positive impact of national recommendations on uptake dynamics. Vaccine coverage in pregnant women could be improved with targeted campaigns.