Association between acceptance of routine pregnancy vaccinations and COVID-19 vaccine uptake

Abstract

COVID-19 vaccination is a key approach to reduce morbidity and mortality in pregnant patients and their newborns. Anti-vaccine sentiment has recently increased, with unclear impact on pregnant patients. We examined the association between acceptance of Tdap and influenza (flu) vaccines, considered to be routine pregnancy vaccines, and COVID-19 vaccine acceptance. A retrospective cohort study of all patients who delivered at a single site from December 2020 - March 2022. Demographic, pregnancy, neonatal, and vaccination data were abstracted from the electronic medical record, which imports vaccine history from the California Immunization Registry. COVID-19 vaccine acceptance was defined by receiving at least 1 vaccine dose. The relationship between flu and Tdap vaccine acceptance, baseline characteristics, and COVID-19 vaccine uptake was described by univariable analysis. We identified independent predictors of vaccine uptake with multivariable logistic regression. Of the 8,070 patients, 4,483 (55.5%) accepted the COVID-19 vaccine. Of those who received the COVID-19 vaccine, 3,432 (76.6%) and 3,109 (69.4%) received flu and Tdap vaccines. Patients were more likely to receive the COVID-19 vaccine if they had received the flu vaccine (OR 3.8, 95% CI 3.5 - 4.2) and if they had received the Tdap vaccine (OR 2.9, 95% CI 2.7 - 3.2). Tdap vaccine acceptance, flu vaccine acceptance, advanced maternal age, obesity, Asian race, and private insurance were independent predictors of vaccine uptake after adjusting for potential confounders (Figure). There were no differences in preterm birth, low birthweight and NICU admission between patients who received and did not receive the COVID-19 vaccine (Table). Patients were more likely to accept COVID-19 vaccination if they received Tdap or flu vaccinations. Older age and obesity, known risk factors for severe COVID-19 infections, were independent predictors of vaccine uptake. Disparities in COVID-19 vaccination uptake bear further exploration to guide efforts in equitable and widespread vaccine distribution.View Large Image Figure ViewerDownload Hi-res image Download (PPT)