COVID-19 vaccination in pregnancy: views and vaccination uptake rates in pregnancy, a mixed methods analysis from the Born In Wales study

  1. M Mhereeg
  2. H Jones
  3. J Kennedy
  4. M Seaborne
  5. M Parker
  6. N Kennedy
  7. S Beeson
  8. L Zuccolo
  9. A Davies
  10. S Brophy

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Abstract

Background

Vaccine hesitancy amongst pregnant women has been found to be a concern during past epidemics.

Objectives

The aims of this study were to 1) estimate COVID-19 vaccination rates among pregnant women in Wales and their association with age, ethnicity, and area of deprivation, using electronic health records (EHR) linkage, and 2) explore pregnant women’s views on receiving the COVID-19 vaccine during pregnancy using data from a survey recruiting via social media (Facebook, Twitter), through midwives, and posters in hospitals (Born in Wales Cohort).

Design

A mixed methods study utilising routinely collected linked data from the Secure Anonymised Information Linkage (SAIL) (Objective 1) and the Born In Wales Birth Cohort participants (Objective 2). SAIL combines data from general practice, hospital admissions, the national community child health dataset, maternal indicators dataset, and COVID-19 vaccination databases.

Setting and participants

Objective 1) All women documented as being pregnant on or after 13 th April 2021, aged 18 years or older, and eligible for COVID-19 vaccination were identified in routine health care. They were linked to the vaccination data up to and including 31 st December 2021. Objective 2) Separately, a cross-section of pregnant women in Wales were invited to complete an online survey via social media advertising. The survey asked what their views were on having the COVID-19 vaccination during pregnancy, and if they had already received, or intended to receive, the COVID-19 vaccination during their pregnancies. They were also asked to give reasons for their decisions.

Outcomes

1 (a). Rate of vaccination uptake per month during pregnancy among women eligible for vaccination. 1 (b). Survival analysis was utilised to examine and compare the length of time to vaccination uptake in pregnancy, and variation in uptake by; age, ethnicity, and deprivation area was examined using hazard ratios (HR) from Cox regression. 2.Expectant mothers’ views of the COVID-19 vaccination during pregnancy.

Results

Population-level data linkage (objective 1)

Within the population cohort, 32.7% (n = 8,203) were vaccinated (at least one dose of the vaccine) during pregnancy, 34.1% (n = 8,572) remained unvaccinated throughout follow-up period, and 33.2% (n = 8,336) received the vaccine postpartum. Younger women (<30 years) were less likely to have the vaccine and those living in areas of high deprivation were also less likely to have the vaccine (HR=0.88, 95% CI 0.82 to 0.95). Asian and other ethnic groups were 1.12 and 1.18 times more likely to have the vaccine in pregnancy compared to women of White ethnicity (HR=1.12, 95% CI 1.00 to 1.25) and (HR=1.18, 95% CI 1.03 to 1.37) respectively.

Survey responses (objective 2)

69% of participants stated that they would be happy to have the vaccine during pregnancy (n = 207). The remainder, 31%, indicated that they would not have the vaccine during pregnancy (n = 94). Reasons for having the vaccine related to protecting self and baby, perceived risk level, and receipt of sufficient evidence and advice. Reasons for vaccine refusal included lack of research about long-term outcomes for the baby, anxiety about vaccines, inconsistent advice/information, and preference to wait until after the pregnancy.

Conclusion

Potentially only 1 in 3 pregnant women would have the COVID-19 vaccine during pregnancy, even though 2 in 3 reported they would have the vaccination, thus it is critical to develop tailored strategies to increase its acceptance rate and to decrease vaccine hesitancy. A targeted approach to vaccinations may be required for groups such as younger people and those living in higher deprivation level areas.

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  1. ScreenIT

    SciScore for 10.1101/2022.05.09.22274769: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The Research Ethics Service approval was also given by the North West-Greater Manchester East Research Ethics Committee for the qualitative research.
    Sex as a biological variableAll women recorded as being pregnant on or after 13th April 2021, aged 18 years or older, and eligible for COVID-19 vaccination were identified.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Final data preparation specific to these analyses such as setting the reference groups was performed in IBM SPSS Statistics 28.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    Descriptive statistics were performed in Microsoft Excel 2016 and Survival/Cox regression analyses were performed in SPSS.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    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:
    Strengths and limitations: The study has several strengths, it utilises primary and secondary health care data for pregnant women in Wales including the maternity and child health data, it gives a national perspective of COVID-19 vaccine hesitancy, making the findings generalisable due to its total population cohort. Our qualitative survey questions allowed a free text response asking participants to provide their opinion on the vaccine and any reasons why they would or would not have it. These responses gave a true insight into the thoughts and feelings of pregnant women in Wales during the pandemic. Findings showing that the reasons for not wanting a vaccine included anxiety about the vaccine, change in advice and information or prefer to delay until after the birth. The mixed methods design used in this study provided rich detailed information firstly about population-level vaccination uptake rates as well as rich qualitative responses from a cross-section of pregnant women in Wales. Using the two methods provides us with more insight into the reasons why 34.1% of pregnant women refused the vaccine completely and may inform vaccine strategies moving forward. Vaccinations protect against severe disease. As the pandemic continues, booster vaccinations are increasingly important to provide protection against severe COVID-19, especially in vulnerable populations such as pregnant women. However, the data shows that 67.3% of pregnant women did not receive the vaccine in pregnanc...

    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.
    • Thank you for including a protocol registration statement.

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

    About SciScore

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  2. Version published to 10.1101/2022.05.09.22274769v1 on medRxiv