Vaccine acceptance in gravid patients in the COVID-19 era

To describe risk factors for declining antepartum vaccination, including the novel COVID-19 vaccine during the COVID-19 pandemic.

Retrospective cohort study including women delivering at a single center in the fall and winter of 2021. Patients without vaccine data were excluded. Baseline characteristics collected from the electronic medical record included maternal age, nulliparity, body mass index, insurance, and self-identified race/ethnicity. Those who accepted the COVID-19 vaccine were compared to those who declined. Separate comparisons were done to assess those who accepted and those who declined influenza and tetanus, diphtheria, pertussis (Tdap) vaccines as well. Statistical analysis was performed using Student's t-test, Fisher's exact test, chi square, and logistic regression. The regression model assessed the impact of patient characteristics on vaccine acceptance and was adjusted for age, nulliparity, body mass index, insurance, and race/ethnicity.

Vaccine data was available for 772 patients. The rate of acceptance was 46.1% for COVID-19 vaccine, 58.0% for influenza vaccine, and 80.8% for Tdap vaccine. Those who accepted the COVID-19 vaccine were older (34.3 ± 3.8 years vs 33.0 ± 4.8 years, p < 0.001) and more frequently nulliparous (8.7% vs 2.9%, p < 0.001) than those declining it. Those accepting Tdap were also older (33.8 ± 4.3 vs 32.7 ± 4.9 years, p = 0.006). Insurance type differed across groups for all three vaccines (p < 0.001). Race differed between acceptance and refusal of the influenza and Tdap vaccines, but not the COVID-19 group. In the adjusted analysis, public insurance remained independently associated with reduced acceptance for COVID-19 (aOR 0.28, 95% CI 0.14-0.55) and influenza (aOR 0.38, 95% CI 0.20-0.73), but not for Tdap. Older age and nulliparity were independently associated with increased acceptance of COVID-19.

Public insurance in pregnancy is associated with a decreased likelihood of vaccine acceptance for the COVID-19 and influenza vaccines. Specific efforts for understanding the motivations for declining vaccination are needed to develop strategies to improve uptake in this population.