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COVID-19 Vaccine Hesitancy in Pregnancy: A Cross-Sectional Study
Received: 06 Nov 2021 | Accepted: 07 Mar 2022 | Available online: 10 Mar 2022Ayşegül ERCANa, Ebru ŞENOLb, Aysun FIRATa
aClinic of Gynecology and Obstetrics, İstanbul Training and Research Hospital, İstanbul, Türkiye
bDepartment of Social Pediatrics, İstanbul University Institute of Health Sciences and Institute of Child Health, İstanbul, Türkiye
JCOG. 2022;32(1):7-12
DOI: 10.5336/jcog.2021-86957
Article Language: EN
Copyright Ⓒ 2024 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (
http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: As approval of one of many coronavirus disease-2019 (COVID-19) vaccines' use for pregnancy is getting closer, vaccine hesitancy may take place in pregnant individuals for this new vaccine. Our study aimed to evaluate vaccine acceptance and factors affecting vaccine acceptance in case of an approved COVID-19 vaccine for pregnant individuals. Material and Methods: Our study was designed as one group, cross-sectional, prospective study. Sample consisted of pregnant individuals who didn't have any chronic illnesses and didn't contract COVID-19 in the last 6 months. In-person style survey was used to collect data about demographics, knowledge about COVID19 disease and it's effects on pregnant individuals, vaccine acceptance and reasons for acceptance or refusal. Results were analyzed with descriptive statistics, chi-square test and Shapiro-Wilk test of normality using Number Cruncher Statistical System. Results: Among 250 participants, 183 (73.2%) reported they wouldn't accept COVID-19 vaccination if there was a safe and effective vaccine approved for use in pregnancy. Main reasons of refusal were the belief that vaccine hadn't been studied on humans enough or that it might have adverse effectes on baby and/or pregnant individual. Only factor associated with vaccine acceptance was found to be knowing someone who had severe COVID-19 disease (p=0.022). Conclusion: Our study shows that vaccine hesitancy rates may be high among pregnant individuals when a COVID-19 vaccine is approved for use in pregnancy. The main reason for vaccine hesitancy is safety concerns.
REFERENCES:- World Health Organization [Internet]. [Cited: October 30, 2021]. Coronavirus (COVID-19) Dashboard. Available from: [Link]
- Vermillion MS, Klein SL. Pregnancy and infection: using disease pathogenesis to inform vaccine strategy. NPJ Vaccines. 2018;3:6. [Crossref] [PubMed] [PMC]
- Joseph NT, Rasmussen SA, Jamieson DJ. The effects of COVID-19 on pregnancy and implications for reproductive medicine. Fertil Steril. 2021;115(4):824-30. [Crossref] [PubMed] [PMC]
- Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1641-7. [Crossref] [PubMed] [PMC]
- Vivanti AJ, Vauloup-Fellous C, Prevot S, Zupan V, Suffee C, Do Cao J, et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020;11(1):3572. [Crossref] [PubMed] [PMC]
- Woodworth KR, Olsen EO, Neelam V, Lewis EL, Galang RR, Oduyebo T, et al; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team; COVID-19 Pregnancy and Infant Linked Outcomes Team (PILOT). Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy - SET-NET, 16 Jurisdictions, March 29-October 14, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1635-40. [Crossref] [PubMed] [PMC]
- Centers for Disease Control and Prevention [Internet]. [Cited: October 30, 2021]. COVID-19: medical conditions. Available from: [Link]
- Omer SB. Maternal immunization. N Engl J Med. 2017;376(13):1256-67. [Crossref] [PubMed]
- World Health Organization Global Advisory Committee on Vaccine Safety. Safety of immunization during pregnancy, a review of the evidence. 2014.
- Jaffe E, Lyerly AD, Goldfarb IT. Pregnant women's perceptions of risks and benefits when considering participation in vaccine trials. Vaccine. 2020;38(44):6922-9. [Crossref] [PubMed] [PMC]
- Centers for Disease Control and Prevention [Internet]. [Cited: September 29, 2021]. New CDC data: COVID-19 vaccination safe for pregnant people. Available from: [Link]
- World Health Organization [Internet]. © 2022 WHO [Cited: September 29, 2021]. Coronavirus Disease (COVID-19): Pregnancy and childbirth, 30 August 2021. Available from: [Link]
- American College of Obstetricians and Gynecologists [Internet]. [Cited: September 29, 2021]. COVID-19 vaccination considerations for obstetric-gynecologic care. Last updated 30 July 2021. Available from: [Link]
- Royal College of Obstetricians and Gynecologists. Information sheet and decision aid: Updated 20 August 2021. Cited: September 29, 2021. Available from: [Link]
- Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, et al; CDC v-safe COVID-19 pregnancy registry team. preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. N Engl J Med. 2021;384(24):2273-82. Erratum in: N Engl J Med. 2021;385(16):1536. [Crossref] [PubMed] [PMC]
- Wilson RJ, Paterson P, Jarrett C, Larson HJ. Understanding factors influencing vaccination acceptance during pregnancy globally: a literature review. Vaccine. 2015;33(47):6420-9. [Crossref] [PubMed]
- Wales DP, Khan S, Suresh D, Ata A, Morris B. Factors associated with Tdap vaccination receipt during pregnancy: a cross-sectional study. Public Health. 2020;179:38-44. [Crossref] [PubMed]
- Centers for Disease Control and Prevention [Internet]. [Cited: September 29, 2021]. Maternal vaccination coverage. Available from: [Link]
- Stark LM, Power ML, Turrentine M, Samelson R, Siddiqui MM, Paglia MJ, et al. Influenza vaccination among pregnant women: patient beliefs and medical provider practices. Infect Dis Obstet Gynecol. 2016;2016:3281975. [Crossref] [PubMed] [PMC]
- Maertens K, Braeckman T, Top G, Van Damme P, Leuridan E. Maternal pertussis and influenza immunization coverage and attitude of health care workers towards these recommendations in Flanders, Belgium. Vaccine. 2016;34(47):5785-91. [Crossref] [PubMed]
- Psarris A, Sindos M, Theodora M, Antsaklis P, Pergialiotis V, Loutradis D, et al. Routine immunizations during pregnancy, doctors' compliance and patient hesitancy: A two stage study on vaccination uptake. Eur J Obstet Gynecol Reprod Biol. 2019;243:36-40. [Crossref] [PubMed]
- Vilca LM, Cesari E, Tura AM, Di Stefano A, Vidiri A, Cavaliere AF, et al. Barriers and facilitators regarding influenza and pertussis maternal vaccination uptake: A multi-center survey of pregnant women in Italy. Eur J Obstet Gynecol Reprod Biol. 2020;247:10-5. [Crossref] [PubMed]
- Li WF, Huang SY, Peng HH, Chang YL, Chang SD, Cheng PJ; Taiwan Prenatal Pertussis Immunization Program (PPIP) Collaboration Group. Factors affecting pregnant women's decisions regarding prenatal pertussis vaccination: a decision-making study in the nationwide Prenatal Pertussis Immunization Program in Taiwan. Taiwan J Obstet Gynecol. 2020;59(2):200-6. [Crossref] [PubMed]
- Bettinger JA, Greyson D, Money D. Attitudes and beliefs of pregnant women and new mothers regarding influenza vaccination in British Columbia. J Obstet Gynaecol Can. 2016;38(11):1045-52. [Crossref] [PubMed]
- Centers for Disease Control and Prevention [Internet]. [Cited: September 29, 2021]. COVID-19 vaccination among pregnant people aged 18-49 years overall, by race/ethnicity, and date reported to CDC-Vaccine Safety Datalink, United States. Last update 18 September 2021. Available from: [Link]
- Qiu X, Bailey H, Thorne C. Barriers and facilitators associated with vaccine acceptance and uptake among pregnant women in high income countries: a mini-review. Front Immunol. 2021;12:626717. [Crossref] [PubMed] [PMC]
- Bartolo S, Deliege E, Mancel O, Dufour P, Vanderstichele S, Roumilhac M, et al. Determinants of influenza vaccination uptake in pregnancy: a large single-Centre cohort study. BMC Pregnancy Childbirth. 2019;19(1):510. [Crossref] [PubMed] [PMC]
- Krishnaswamy S, Cheng AC, Wallace EM, Buttery J, Giles ML. Understanding the barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds: a cross-sectional study. Hum Vaccin Immunother. 2018;14(7):1591-8. [Crossref] [PubMed] [PMC]