Pregnant women report increased COVID-19 vaccine hesitancy during omicron wave

Key takeaways:

• Survey responses from pregnant women suggest an increase in COVID-19 vaccine hesitancy from 2021 to 2023.
• Trusted sources for COVID-19 information varied based on vaccination status and race and ethnicity.

Pregnant and recently pregnant women reported increased COVID-19 vaccine hesitancy and changes in perceptions of vaccine safety from 2021 to 2023, according to survey results published in JAMA Network Open.

“As of July 29, 2023, Vaccine Safety Datalink surveillance found just 16.2% of pregnant people aged 18 to 49 years had received a COVID-19 booster vaccine, with only 8.3% of Black pregnant people and 9.6% of Latino pregnant people vaccinated during pregnancy,” Joshua T. B. Williams, MD, assistant professor in the department of pediatrics at the University of Colorado School of Medicine and Ambulatory Care Services at Denver Health and Hospitals, and colleagues wrote. “Assessing attitudes toward COVID-19 vaccines among pregnant and recently pregnant people is critical to public health messaging and clinician counseling.”

Williams and colleagues conducted a cross-sectional survey study with pregnant or recently pregnant women aged 18 to 49 years who were members of the Vaccine Safety Datalink. All women were pregnant at some time from December 2020 to August 2021 or January to August 2022. Researchers administered the first survey to 1,500 women from November 2021 to February 2022 (wave 1) and the second survey to 1,456 women from October 2022 to February 2023 (wave 2). The survey asked respondents to report COVID-19 vaccination status and share attitudes toward COVID-19 infection and monovalent COVID-19 vaccines in wave 1 or bivalent omicron booster vaccines in wave 2.

Response rates were 43.5% for wave 1 and 39.5% for wave 2, resulting in 1,227 respondents (mean age, 31.7 years). Overall, 29% of respondents identified as Black, 45.2% identified as Hispanic and 36.3% preferred the Spanish language.

Of all respondents, 76.8% reported receiving one or more COVID-19 vaccination. Spanish-speaking Hispanic respondents had the highest self-reported COVID-19 vaccination rates, with 86.9% in wave 1 and 84.2% in wave 2. Black respondents had the lowest self-reported COVID-19 vaccination rates, with 68% in wave 1 and 69.7% in wave 2.

From wave 1 to wave 2, researchers observed a 34% relative decrease in responses from respondents with one or more vaccinations agreeing that COVID-19 vaccines are safe for pregnant women and a 32% relative decrease in responses agreeing that COVID-19 vaccines are safe for the infant. Researchers observed a 41% relative decrease in responses from ever-vaccinated women agreeing that most pregnant women should receive a COVID-19 vaccine.

White respondents had the greatest decreases in self-perceived COVID-19 vaccine safety, with a decrease of 41% for themselves and 40% for their infants. White respondents also had the greatest decrease of 43% in agreeing that most pregnant women should receive a COVID-19 vaccine. Spanish-speaking Hispanic respondents had the greatest decrease of 42% in the proportion of responses indicating they were not hesitant about receiving a COVID-19 vaccine.

Trusted sources for COVID-19 information varied based on vaccination status and self-reported race and ethnicity. In addition, Black respondents had the highest trust in the CDC with 32.5% and the lowest trust in their physicians with 18.7%. Conversely, Spanish-speaking Hispanic and white respondents had the lowest trust in the CDC (26.1% and 26.6%, respectively) and the highest trust in their physicians (35.1% and 38.2%, respectively).

For unvaccinated respondents, attitudes toward COVID-19 vaccines were largely unfavorable and did not change from wave 1 to wave 2.

“Our data suggest more modest levels of trust in the CDC and physicians with notable differences by race, ethnicity and language preferences,” the researchers wrote. “Future work could study perceived safety of COVID-19 vaccines as a function of message tailoring for diverse groups.”