Perceptions and acceptance of COVID-19 vaccine among pregnant and lactating women in Singapore: A cross-sectional study

  1. Pooja A Jayagobi
  2. Chengsi Ong
  3. Yeo Kee Thai
  4. Caleb CW Lim
  5. Seet Meei Jiun
  6. Kwek Lee Koon
  7. Ku Chee Wai
  8. Jerry KY Chan
  9. Manisha Mathur
  10. Chua Mei Chien

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Abstract

Introduction

Vaccination is critical in controlling the coronavirus disease 19 (COVID-19) pandemic. However, vaccine perception and acceptance among pregnant and lactating women is unknown in Singapore. We aimed to determine the acceptance of COVID-19 vaccination among these two groups of women in Singapore, and factors associated with vaccine acceptance.

Methods

We conducted an anonymous, online survey on the perception and acceptance of the COVID-19 vaccine in pregnant and lactating women at a tertiary hospital in Singapore from 1 st March to 31 st May 2021. Information on demographics and knowledge were collected, and these factors were assessed for their relationship with vaccine acceptance.

Results

A total of 201 pregnant and 207 lactating women participated. Vaccine acceptance rates in pregnant and lactating women were 30.3% and 16.9% respectively. Pregnant women who were unsure or unwilling to take the vaccine cited concerns about safety of the vaccine during pregnancy (92.9%), while lactating women were concerned about potential long-term negative effects on the breastfeeding child (75.6%). Other factors significantly associated with vaccine acceptance included a lower monthly household income or education level, appropriate knowledge regarding vaccine mechanism and higher perceived maternal risk of COVID-19. Most pregnant (70.0%) and lactating women (83.7%) were willing to take the vaccine only when more safety data during pregnancy and breastfeeding were available.

Conclusions

COVID-19 vaccine acceptance was low among pregnant and lactating women in Singapore. Addressing safety concerns when more data is available and education on mechanism of vaccine action will likely improve acceptance among these women.

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  1. ScreenIT

    SciScore for 10.1101/2021.06.29.21259741: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethics approval was obtained from the Singhealth Institutional Review Board (CIRB Ref No.: 2020/2648) with a waiver for informed consent.
    Consent: Ethics approval was obtained from the Singhealth Institutional Review Board (CIRB Ref No.: 2020/2648) with a waiver for informed consent.
    Sex as a biological variablePregnant and lactating women over 21 years of age, attending outpatient clinics or admitted to the hospital were invited to participate in an anonymous, online survey from 1st March to 31st May 2021.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All data was analyzed using SPSS version 19.0 (IBM Corp, Armonk, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    A limitation of our study is the cross-sectional nature and the short study period of 3 months. Since conducting our survey, government recommendations regarding vaccination in these groups of women have evolved, with an emphasis that it is safe and recommended. As such, perceptions of pregnant and lactating women may have also changed. However, we believe that our results are still valid in informing educational strategies in women who are unsure or unwilling to take the vaccine despite changes in recommendations. In addition, we measured vaccine acceptance via participant report, and not actual vaccination rates. Reported intent may not translate into actual behavior on vaccination,(28) and whether addressing safety concerns would be adequate in increasing vaccine uptake remains to be determined. To our knowledge, this is the first survey on COVID-19 vaccine perceptions in pregnant and lactating women in Singapore. Our study is timely in informing education programs and vaccination efforts in these groups to design a targeted action plan. Based on our results, an educational brochure is currently being prepared to better inform pregnant women about COVID-19 vaccination. We also propose the use of other platforms such as mass media and social media to help raise awareness and knowledge to aid improve the acceptance of the COVID-19 vaccine. With the expansion of the local vaccination program to pregnant and lactating women, it is important for educational messages to be indiv...

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.06.29.21259741v1 on medRxiv