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Survey Identifies Factors Linked to COVID-19 Vaccine Uptake, Hesitancy During Pregnancy

Key findings

  • This survey of pregnant and postpartum individuals in the outpatient setting characterized their perceptions and attitudes toward COVID-19 vaccination during Summer 2021 and evaluated factors associated with vaccine uptake and vaccine hesitancy
  • Of the 473 respondents, only 49% had received at least one dose of a COVID-19 vaccine or were scheduled to receive one, and there were racial/ethnic disparities in vaccination rates
  • Unvaccinated respondents were more likely to feel the vaccine was rushed, less likely to trust vaccine developers, and more worried about vaccine side effects and the effects of the vaccine on their fetus, among other differences from the vaccinated group
  • 58% of respondents said their provider recommended the COVID-19 vaccine for them while they were pregnant, and that group was 5.82 times more likely than others to have received the vaccine (P<0.005)
  • These findings add to the growing evidence that COVID-19 vaccination rates are suboptimal in pregnant individuals and suggest topics for patient education and counseling

The American College of Obstetrics and Gynecology, the Society for Maternal–Fetal Medicine, and the CDC recommend COVID-19 vaccination during pregnancy. Although pregnant women weren't included in the initial COVID-19 vaccine trials, post-approval studies suggest COVID-19 vaccination is safe during pregnancy and the postpartum period and reduces maternal infections, morbidity, and mortality.

Molly Siegel, MD, a clinical fellow in the Department of Obstetrics and Gynecology at Massachusetts General Hospital, Ilona T. Goldfarb, MD, MPH, a maternal–fetal medicine specialist in the Department, and colleagues surveyed pregnant and postpartum outpatients about their perceptions and attitudes toward COVID-19 vaccination during the second year of the COVID-19 pandemic. In the American Journal of Perinatology, they report factors associated with vaccination uptake and hesitancy and comment on implications for patient education and counseling.


The researchers offered a paper-based, anonymous survey to pregnant and postpartum individuals, ages 18 and older, who received prenatal care at Massachusetts General Hospital, Brigham and Women's Hospital, and three affiliated community health centers between June and August 2021. The survey was available in English and Spanish.

473 respondents were included in the final analyses. 453 were pregnant, 19 were postpartum, and one did not report their pregnancy status. 233 individuals (49%) had received or were scheduled to receive at least one dose of a COVID-19 vaccine.

Characteristics by Vaccine Status

Demographic factors associated with a significantly greater likelihood of COVID-19 vaccination were:

  • Age (mean age 33 in the vaccinated group vs. 31 in the unvaccinated group)
  • Non-Hispanic/non-Latinx ethnicity
  • White race (vs. Black/African American)
  • Working remotely (vs. working in person or not working)
  • Typical receipt of influenza vaccinations

58% of respondents said a clinician recommended the COVID-19 vaccine while pregnant, and that group was substantially more likely than others to have received the vaccine (OR, 5.82; P<0.005).

Attitudes Toward Infection

Vaccinated respondents were significantly more likely than those unvaccinated to:

  • Express fear of becoming infected with SARS-CoV-2 during pregnancy (OR, 2.45)
  • Believe they were at risk of getting very sick if infected (OR, 1.90)
  • Say they knew someone who had been hospitalized with COVID-19 (OR, 1.52)
  • Say they knew someone who had died of COVID-19 (OR, 1.52)

They were significantly less likely than the unvaccinated group:

  • To believe they had COVID-19 during pregnancy (OR, 0.52)
  • To have had a confirmed diagnosis of COVID-19 during pregnancy (OR, 0.27)

Factors Associated With Vaccine Hesitancy

Vaccinated respondents were significantly less likely than unvaccinated participants to agree that:

  • The vaccine was rushed (OR, 0.16)
  • They were worried about the side effects of the vaccine for themselves (OR, 0.18) or their baby (OR, 0.17)
  • They were worried the vaccine would cause them to contract COVID-19 (OR, 0.21)
  • They were worried about toxins in the vaccine (OR, 0.22)

They were significantly more likely than the unvaccinated group to agree that:

  • They believed the vaccine would protect them (OR, 10.75) or their baby (OR, 6.36) from becoming infected
  • They trust vaccine developers (OR, 6.52)
  • They believed people of their race and ethnicity were included in vaccine trials (OR, 2.65)

Barriers to Vaccination

Unvaccinated individuals were significantly less likely than the vaccinated group to agree it would be easy to travel to receive a vaccine (OR, 0.19), it would be easy to miss time with family to receive a vaccine (OR, 0.27), it would be easy to miss work to receive a vaccine (OR, 0.30), and it is easy to schedule a COVID-19 vaccine (OR, 0.56).

Counseling Patients

These results pinpoint myths, misconceptions, and logistical barriers to address during patient counseling. Post-approval studies have not shown more severe side effects of COVID-19 vaccines in pregnant individuals or detrimental effects on pregnancies or fetal and neonatal outcomes.

Conversely, rates of COVID-19–related hospitalization, ICU admission, and death are higher for pregnant individuals than their nonpregnant peers. In addition, COVID-19 increases the risk of adverse pregnancy outcomes such as preeclampsia, preterm birth, and Cesarean delivery.

of pregnant/postpartum individuals had received at least one dose of a COVID-19 vaccine or were scheduled to receive one

of pregnant/postpartum individuals said their provider recommended the COVID-19 vaccine for them while they were pregnant

greater odds of receiving a COVID-19 vaccine during pregnancy if it was recommended by a healthcare professional

Learn more about Maternal-Fetal Medicine at Mass General

Refer a patient to the Maternal-Fetal Medicine Program at Mass General

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