Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August–December 2020

  1. Ashley N. Battarbee
  2. Melissa S. Stockwell
  3. Michael Varner
  4. Gabriella Newes-Adeyi
  5. Michael Daugherty
  6. Cynthia Gyamfi-Bannerman
  7. Alan T. Tita
  8. Kelly Vorwaller
  9. Celibell Vargas
  10. Akila Subramaniam
  11. Lawrence Reichle
  12. Romeo R. Galang
  13. Emily Powers
  14. Miriam Lucca-Susana
  15. Mickey Parks
  16. Tiffany J. Chen
  17. Hilda Razzaghi
  18. Fatimah S. Dawood

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Abstract

Objective The aim of the study was to evaluate pregnant women's attitudes toward COVID-19 illness and vaccination and identify factors associated with vaccine acceptability.

Study Design This was a cross-sectional survey among pregnant women enrolled in a prospective COVID-19 cohort study in Salt Lake City, UT, Birmingham, AL, and New York, NY, from August 9 to December 10, 2020. Women were eligible if they were 18 to 50 years old and <28 weeks of gestation. Upon enrollment, women completed surveys regarding concerns about COVID-19 illness and likelihood of getting COVID-19 vaccine if one were available during pregnancy. Vaccine acceptability was defined as a response of “very likely” or “somewhat likely” on a 4-point Likert scale. Factors associated with vaccine acceptability were assessed with multivariable logistic regression.

Results Of 939 pregnant women eligible for the main cohort study, 915 (97%) consented to participate. Among these 915 women, 39% self-identified as White, 23% Black, 33% Hispanic, and 4% Other. Sixty-two percent received an influenza vaccine last season. Seventy-two percent worried about getting sick with COVID-19. If they were to get sick, 92% worried about harm to their pregnancy and 80% about harm to themselves. Only 41% reported they would get a vaccine. Of women who were unlikely to get vaccinated, the most frequently cited concern was vaccine safety for their pregnancy (82%). Non-Hispanic Black and Hispanic women had lower odds of accepting a vaccine compared with non-Hispanic White women (adjusted odds ratios [aOR] 0.4, 95% CI 0.2–0.6 for both). Receipt of influenza vaccine during the previous season was associated with higher odds of vaccine acceptability (aOR 2.1, 95% CI 1.5–3.0).

Conclusion Although most pregnant women worried about COVID-19 illness, <50% were willing to get vaccinated during pregnancy. Racial and ethnic disparities in plans to accept COVID-19 vaccine highlight the need to prioritize strategies to address perceived barriers among groups at high risk for COVID-19.

Key Points

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  1. Version published to 10.1055/s-0041-1735878
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    SciScore for 10.1101/2021.03.26.21254402: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Centralized Institutional Review Board approval was obtained (IRB-AAAT1906), and informed consent was obtained from all participants.
    Consent: Centralized Institutional Review Board approval was obtained (IRB-AAAT1906), and informed consent was obtained from all participants.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableWe performed a cross-sectional study of pregnant women enrolled August 9– December 10, 2020, in the Epidemiology of Severe Acute Respiratory Syndrome in Pregnancy and Infancy (ESPI) Community Cohort, an ongoing prospective longitudinal cohort study conducted at three centers in the United States (Birmingham

    Table 2: Resources

    Experimental Models: Organisms/Strains
    SentencesResources
    Race and ethnicity were characterized as Black if women identified as Non-Hispanic Black or African American, White if women identified as Non-Hispanic White, and Hispanic if women identified as Hispanic or Latino regardless of race.
    Non-Hispanic White
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Several limitations should be considered when interpreting study findings. While the study was designed to maximize diversity and generalizability, only women who had access to prenatal care and who consented to participate in the prospective cohort were included. Thus, our results may not be generalizable to all pregnant women. We also did not enroll a non-pregnant group, and thus we cannot comment about how these findings may differ from a non-pregnant population in the same communities. Given that this study was conducted before a COVID-19 vaccine was available in the United States, we could not assess factors associated with actual vaccine receipt and our findings are based on hypothetical acceptability of a COVID-19 vaccine. In addition, as with all surveys, our findings may be subject to social desirability bias in which participants are more likely to respond in a manner that they perceive to be socially acceptable. Vaccine acceptance as well as perceived motivators and barriers to acceptance may evolve among pregnant women as additional data about COVID-19 vaccine safety and efficacy become available. Additional studies will be needed to monitor trends in vaccine acceptance among pregnant women over time. Widespread vaccination is the most promising strategy to end the current global pandemic, while hand-washing, social distancing, mask wearing and other key non-pharmaceutical interventions will remain important mainstays of COVID-19 prevention. The results of this st...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2021.03.26.21254402 on medRxiv