OB/GYNs make effort to offer COVID-19 vaccination to postpartum inpatients
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Most obstetric patients at a single institution were offered COVID-19 vaccination, and although vaccine uptake was low, researchers said the rate of vaccination at discharge was 50% higher than at admission.
Notably, inpatient vaccination may also improve health disparities.
“Availability of COVID-19 vaccination during obstetric hospitalization for delivery can increase vaccination opportunities, especially for patients who have disproportionately worse outcomes from COVID-19,” Marta J. Perez, MD, assistant professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis, told Healio.
Perez and colleagues conducted a retrospective cohort study, published in Obstetrics & Gynecology, which assessed all obstetric patients at a single institution who delivered between June 1 and July 6 — within the first 36 days after the Pfizer-BioNTech COVID-19 vaccine became available. Of the 329 deliveries, 75 (22.8%) patients were vaccinated before admission and five (1.5%) were not eligible for vaccination because they had active COVID-19. Of the remaining 249 patients, 221 (88.8%) were offered vaccination. The hospital provided vaccine counseling by obstetricians to increase vaccination rates among patients.
Of the eligible patients, 52 (23.5%) were offered vaccination and accepted, and 43 received the vaccine.
“Six of the nine patients who desired vaccination but did not receive it were discharged over the weekend, when vaccination was not available. There was no explanation in the medical record for the other three patients,” Perez and colleagues wrote.
The researchers compared characteristics of patients who were vaccinated before admission with characteristics of those vaccinated during their hospital stay. Patients vaccinated before admission (n = 75; average age, 32 years) were more likely to be white (80%), nulliparous (47%) and have commercial health insurance (80%) compared with patients vaccinated at the hospital (n = 43; average age, 30 years), who were more likely to be Black (58%), have public insurance (61%), have hypertensive disorder of pregnancy (54%) and reside in areas with a higher Area Deprivation Index (P < .001).
“Importantly, inpatient vaccination may improve the health equity of obstetric patients,” Perez and colleagues wrote. “Patients vaccinated during admission were more likely to be from groups with higher health disparities in both COVID-19 acquisition and vaccination access, in addition to having higher rates of comorbidities that increase risk of severe disease.”
According to the researchers, the proportion of vaccinated patients at discharge was 50% higher than at admission, suggesting that the resources provided by hospitals such as vaccine availability and vaccine counseling with an obstetrician can influence vaccination numbers.
“This study should encourage clinicians to work with hospital pharmacies to make COVID-19 vaccinations available to obstetric inpatients,” Perez told Healio. “These findings add to prior literature showing that vaccine availability and counseling obstetric care teams in the obstetric care environment can strengthen vaccination rates in pregnant populations.”
The CDC encourages pregnant and breastfeeding women to get vaccinated against COVID-19, and data show that the vaccines are safe.
Perspective
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Mariam Naqvi, MD
This was a great study done by the group at Washington University in St. Louis and can serve as a model for labor floors across the country. We have a unique opportunity as OB/GYNs to have a window into a patient’s preventive care.
Unfortunately, COVID-19 vaccination rates in pregnant people are just too low. That being said, many of these same patients would be more than willing to be vaccinated once they are not pregnant anymore. To be able to offer the vaccine during the postpartum hospitalization saves an additional trip back to the doctor’s office. This is huge for mothers who are already so busy and exhausted when home with a newborn. Most importantly, it is protecting new mothers from severe COVID-19.
Another interesting point about this study is that the authors found that Black patients and patients with medical problems such as high blood pressure were more likely to be vaccinated as inpatients than as outpatients. Though it is unclear why this is, inpatient vaccination may be an important way to reduce the racial disparities in care that plague this country, especially for mothers.
Though vaccine uptake in this study was still relatively low — less than one-fourth of women accepted — this reinforces the need for future research to better understand what the barriers to vaccine acceptance are, and what needs to be done to overcome those barriers.
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