COVID-19 vaccine acceptance in pregnant women: a systematic review and meta-analysis

Context: Coronavirus Disease 2019 (COVID-19) can result in substantial adverse events in pregnant women, yet many hesitate to get vaccinated.

Objective: Identify racial/ethnic and other individual characteristics associated with COVID-19 vaccine acceptance in the United States during pregnancy.

Study Design and Analysis: Systematic review and meta-analysis of the literature.

Setting/Dataset: Three databases (PubMed, Embase, Web of Science) were searched using keywords relating to immunization, COVID-19, and pregnancy.

Population Studied: Pregnant, lactating and post-partum women in the United States. Articles selected for inclusion met the following inclusion criteria: (1) conducted in the United States, (2) reported on pregnant women, (3) reported on COVID-19 vaccine hesitancy or willingness to vaccinate, and (4) reported on original research.

Outcome measures: Patient self-reported vaccine acceptance, defined as receipt of COVID-19 vaccination, intention to vaccinate, or vaccine hesitancy.

Results: Of 1592 articles, 23 met inclusion criteria and were included in the systematic review. Twenty- two of the studies examined receipt of ≥1 COVID-19 vaccine dose and/or intention to vaccinate, while one examined vaccine hesitancy. Vaccine acceptance rates ranged from 7% to 78.3%. The systematic review revealed that vaccine acceptance was associated with receiving at least a college education, receiving or planning to receive the influenza vaccine, higher income, and at least part-time employment. Meta-analyses of 22 articles demonstrated that compared to Whites, Hispanics (OR, 0.72; 95% CI, 0.58-0.91) and Blacks (OR, 0.44; 95% CI, 0.30-0.63) had less COVID-19 vaccine acceptance, while Asians (OR, 1.78; 95% CI, 1.10-2.88) had greater acceptance. College graduation or more (OR, 3.25; 95% CI, 2.53-4.17), receipt or intention to receive the influenza vaccine (OR, 3.46; 95% CI, 2.22-5.41), and at least part-time employment (OR, 2.12; 95% CI, 1.66-2.72) were significantly associated with vaccine acceptance.

Conclusion: COVID-19 vaccine non-acceptance in pregnant women is associated with Hispanic ethnicity and Black race, while acceptance is associated with Asian race, college education or more, at least parttime employment, and acceptance of the influenza vaccine. Future COVID-19 vaccination campaigns can target identified subgroups of pregnant women who are less likely to accept vaccination.