Home Medical profession Low COVID-19 Vaccination Rates Among High-Risk Pregnant Women

Low COVID-19 Vaccination Rates Among High-Risk Pregnant Women


Well into the third year of the coronavirus disease 2019 (COVID-19) pandemic, new vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to be developed. However, many groups and individuals remain hesitant about vaccinating against COVID-19, including pregnant women who are at high risk of severe disease and adverse pregnancy outcomes.

A new Women’s Health Reports The study examines pregnant women’s feelings toward the COVID-19 vaccine based on a survey conducted at a single regional center in New York City.

Study: Cross-sectional survey of the opinions of high-risk pregnant women on vaccination against COVID-19. Image Credit: Andrey_Popov / Shutterstock.com


The COVID-19 pandemic has resulted in widespread and crippling waves of illness around the world. This triggered the implementation of quarantine measures which halted travel, business, education and social interaction.

The resulting disruption of global life has led many pharmaceutical companies to make intensive efforts to develop safe and effective vaccines against SARS-CoV-2. The first type of COVID-19 vaccine to be approved was based on the messenger ribonucleic acid (mRNA) platform. Since then, several billion doses of mRNA vaccines have been administered worldwide.

Pregnant women were not included in clinical trials of mRNA vaccines and were initially reluctant to receive these vaccines for fear of their impact on their health and that of their babies. This fear has been cited, even though COVID-19 during pregnancy is associated with an increased risk of severe illness, mechanical ventilation and death compared to non-pregnant women.

Pregnant women who were at high risk for COVID-19, such as frontline medical staff and other workers, received COVID-19 vaccines early in the pandemic. Observational studies have shown that no harm was done to the mother or the fetus as a result of these vaccinations.

This success has been referenced by many professional societies and public health agencies like the US Centers for Disease Control and Prevention (CDC) to demonstrate that COVID-19 mRNA vaccines are safe in pregnancy.

Despite recommendations from these organizations, including the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal Fetal Medicine (SMFM), and the CDC, social media pressure and a lack of clinical trial data have led to many pregnant women still resist vaccination.

Study results

About 160 women participated in the current study, of whom only about 33% had received the vaccine. Of those who had not yet been vaccinated against COVID-19, most cited lack of information about the vaccine used during pregnancy as a reason for their unvaccinated status and feared adverse effects.

More than 50% of study participants said they felt the vaccine platform was too new for them to trust its safety. About a third did not trust the benevolent intentions of the government in recommending widespread vaccination.

There was a weak positive trend with education level, with those who had completed less than eight years of formal schooling being half as likely to be vaccinated. The differences in the other groups, from those who completed the ninth grade to the baccalaureate, were not significant.

Bayesian hierarchical logistic regression.Bayesian hierarchical logistic regression.

Other factors didn’t seem to play a major role in the decision, including race, type of residence, occupation, marital status, type of insurance, and drug use. The woman’s body habitus, the number of living children or the term of the pregnancy also had no significant difference on the decision to be vaccinated.

A history of influenza or tetanus-diphtheria pertussis (Tdap) vaccination also did not show a correlation with COVID-19 acceptance rates. Interestingly, only one-third of patients who received COVID-19 vaccines had taken the Tdap vaccine, whereas two-thirds of unvaccinated women had received this vaccine, although this difference did not reach statistical significance.

Among study participants with high-risk factors such as hypertension, heart disease, asthma, diabetes mellitus, cancer, chronic kidney disease, and developmental disabilities, only diabetes was associated with a 30% higher probability of vaccination against COVID-19.

Overall, women said they would rather learn about the vaccine from their doctor than from brochures, videos, websites or social media. This response was referenced by half of unvaccinated women versus 60% of vaccinated women. The least popular choice was a short recorded video or a webinar and was selected by 10% or less of both groups.


Vaccination rates for pregnant women remain low. It seems that the lack of reliable data regarding the safety of current COVID-19 vaccines in pregnancy is the main obstacle.

The disconnect between influenza and Tdap vaccination and COVID-19 vaccination status during pregnancy belies assumptions that hesitancy about COVID-19 vaccination reflects a negative view of vaccines in general. The importance of discussing the COVID-19 vaccine with patients during elective antenatal visits is evident given the confidence expressed by women in obtaining information about this vaccine from their physicians.

Perhaps the slightly higher vaccination rate among pregnant women with diabetes is due to their increased frequency of interaction with their health care providers, through which they may have gained a positive opinion of the vaccine through a increased information.

Further research could involve providing more clinic visits and assessing any changes in willingness to vaccinate afterwards.

Opinions on COVID-19 vaccination are dynamic throughout the natural history of the pandemic and future studies may be useful to reassess changing patient opinions.”

Journal reference:

  • DesJardin, M., Raff, E., Baranco, N., et al. (2022). Cross-sectional survey of the opinions of high-risk pregnant women on vaccination against COVID-19. Women’s Health Reports. doi: 10.1089/whr.2022.0006.