In a recent paper published in Jama Network Open, researchers designed a survey to investigate whether maternal beliefs were associated with coronavirus disease 2019 (COVID-19) vaccine-hesitancy during pregnancy, to devise strategies to address related issues.
COVID-19 vaccines have demonstrated high efficacy in reducing obstetric complications throughout the pregnancy among women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yet, COVID-19 vaccine acceptance in pregnancy remains low.
In the United States of America (USA), as of January 2022, only 24.4% of pregnant women received at least one vaccine dose during pregnancy, and barely 42.6% of pregnant women received a complete two-dose primary regimen of the COVID-19 vaccine.
About the study
In the present prospective study, researchers surveyed unvaccinated pregnant women at a healthcare center in the Medical College of Wisconsin, USA, between June and August 2021. For the study purposes, having received a COVID-19 vaccination meant a respondent had received at least one dose of the vaccine during pregnancy.
The COVID-19 Vaccine Attitudes in Pregnancy survey was adapted from a previously validated survey but modified based on clinical experience and existing literature. Nevertheless, it was easy to read and took less than 10 minutes to complete.
It comprised sociodemographic questions covering four broad domains -
i) perception towards immunization,
ii) general outlook towards SARS-CoV-2 infection,
iii) concerns regarding COVID-19 vaccine safety, and
iv) social and informational attitudes toward the COVID-19 vaccine
The team used three survey response formats, including dichotomous responses (yes or no), a five-point Likert scale (e.g., strongly disagree, not sure, strongly agree), and a similar 10-point scale.The primary outcome of the survey was to measure the strength of intention to receive the COVID-19 vaccine during pregnancy.
Furthermore, the team used factor analysis to determine the optimal number of grouping survey items under a pooled comprehensive paradigm. When initial grouping linked conceptually similar areas of questioning, survey items loaded on the identified factors. Factor analysis confirmed that the five-factor solution provided the best fit for the data with a p-value of 0.703 and factor loadings greater than 0.3.
The team validated the survey and found that it had a moderate internal consistency with a Cronbach alpha coefficient (α) of 0.50 to 0.77.
The participants self-reported their race in the survey. Consequently, of the total 295 unvaccinated pregnant participants who filled the survey, 9.5% declared themselves Hispanic, 15.9% as non-Hispanic Black, and 74.2% as non-Hispanic White. The mean age of the survey participants was 30.8 years, and 56.6% received the COVID-19 vaccine during pregnancy.
The respondents who eventually got vaccinated self-identified as educated with higher household income, non-Hispanic White, and married. Compared to unvaccinated respondents, they had a favorable attitude towards vaccination (in general). They preferred to receive their annual influenza vaccine and accepted vaccination for their children.
The majority of unvaccinated survey respondents raised concerns over the long-term effects of COVID-19 vaccine and research to support vaccination in pregnancy. The vaccinated and unvaccinated pregnant groups had different views about vaccine efficacy. Accordingly, 34.1% of vaccinated respondents and 13.3% of unvaccinated respondents believed vaccines offered protection against SARS-CoV-2 infection.
Interestingly, 80.2% of vaccinated vs. 42.2% of unvaccinated respondents believed that the COVID-19 vaccine conferred protection to family members of the SARS-CoV-2-infected individuals. Likewise, 61.7% of vaccinated vs. 32.8% of unvaccinated respondents believed that vaccine passed on immunity to the infant.
The maternal belief that the vaccine will confer immunity to the infant markedly increased the odds for vaccination in a multivariate regression model, with an adjusted odds ratio (aOR) of 3.82, 95% CI. Conversely, concerns about the long-term effects of the vaccine continued to be an important factor against vaccination among pregnant women, with aOR =0.28, 95% CI.
Based on the survey responses, the study identified two primary concerns related to COVID-19 vaccines among pregnant people. This subset of the population appeared highly concerned primarily with the long-term effects of COVID-19 vaccines and the ability of these vaccines to pass immunity to the infant.
Therefore, based on these findings, the authors recommended targeting interventions to address vaccine hesitancy in pregnant women. For instance, they supported running public health campaigns in the US, at both local and national levels, that could make growing scientific data showing anti-SARS-CoV-2 antibody transfer via placenta and breastmilk following COVID-19 vaccination to pregnant women and their doctors.
Moreover, the researchers emphasized continuing research in the area to ascertain and publish concrete evidence of the long-term effects of COVID-19 vaccines for pregnant women and their infants.