Author ORCID Identifier

https://orcid.org/0000-0002-5810-0835

Date of Award

Spring 5-10-2024

Degree Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

Department

Public Health

First Advisor

Harry Heiman

Second Advisor

Sarah McCool

Third Advisor

Sascha Ellington

Fourth Advisor

Lee Warner

Abstract

Background: In January 2020, the United States (US) declared a public health emergency due to COVID-19. The first COVID-19 vaccine was issued an emergency use authorization by the Food and Drug Administration in December 2020. At this time, only select populations (e.g., high-risk, essential workers) were eligible for the vaccine. By April 2021, vaccine eligibility was expanded to include all individuals ≥16 years old. Pregnant persons could elect to be vaccinated if they were eligible for the vaccine; however, guidance recommending vaccination during pregnancy was officially released in July 2021. Staying up to date with COVID-19 vaccinations during pregnancy can help prevent severe illness and complications. This study examined COVID-19 vaccine-related experiences and behaviors among individuals who had a live birth in 2021.

Methods: Data from 25 US jurisdictions implementing the Pregnancy Risk Assessment Monitoring System COVID-19 Vaccine Supplement were analyzed. Examined data included individuals with a live birth occurring January-December 2021. This study examined COVID-19 vaccination during pregnancy, barriers to vaccination among unvaccinated, and healthcare provider (HCP) COVID-19-related practices during prenatal care (talking about the vaccine, recommending vaccination, offering the vaccine, or providing referral for vaccination). Indicators were examined overall, and by select respondent demographic, health-related, and geographic characteristics. SAS statistical software was used to calculate weighted prevalence estimates and 95% Confidence Intervals (CI), using nonoverlapping CI’s to assess significant differences across groups within each of the examined characteristics. Chi-squared tests were used to compare distributions (p<0.05, statistically significant).

Results: Among 20,056 respondents with a live birth in 2021, 28.1% reported getting a COVID-19 vaccine during pregnancy ranging from 16.9% in Wyoming to 52.0% in the District of Columbia. COVID-19 vaccination was lowest among those with births between January-April 2021 (10.1%) and highest for those September-December 2021 (45.2%). Compared to their counterparts, COVID-19 vaccination was lowest among individuals that were non-Hispanic, Black respondents (16.1%); aged <20 (10.7%) and 20-24 (15.6%), had high school education (15.1%) or less (15.9%); those with incomes ≤100% the Federal Poverty Level; had depression during pregnancy (23.1%); those with ≤8 prenatal care visits; and those who had a home birth (5.1%). Among those unvaccinated, the most reported barriers to vaccination were related to safety-related concerns (75.0%), followed by concerns over vaccine efficacy and perceived risk (37.4%), vaccine access (16.3%), and HCP-related barriers (7.0%). Other reasons were reported by 41.7%, including preferring to use other preventive measures (31.6%); having an allergy or health condition preventing vaccination (2.0%); getting vaccinated before pregnancy (1.9%); or other, not specified (10.7%). Overall, 73.8% reported having an HCP talk with them about the COVID-19 vaccine, 58.3% were recommended the vaccine, 38.3% were offered the vaccine, and 27.3% were referred somewhere else for vaccination. Most of the vaccinated respondents reported having a HCP talk with them about the vaccine (94.0%) or recommend vaccination (87.7%) during prenatal care.

Conclusion: COVID-19 vaccination during pregnancy was suboptimal among individuals with a live birth in 2021, with safety-related concerns being the most commonly reported barrier to vaccination. Study findings show that HCPs could play an important role in supporting vaccine uptake for newly developed or recommended vaccinations during pregnancy. Continued messaging highlighting the safety and benefits of staying up to date with recommended vaccinations before, during and after pregnancy may be warranted.

DOI

https://doi.org/10.57709/36979030

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