Understanding COVID-19 vaccination decisions during pregnancy and while breastfeeding in a Canadian province

ABSTRACT

Background

Vaccination in pregnancy is important for preventing illness for mothers and babies; however, vaccine uptake in pregnant individuals is lower than non-pregnant females of fertile age. Given the devastating effects of COVID-19 and the increased morbidity and mortality risk for pregnant individuals, it is important to understand the determinants of vaccine hesitancy in pregnancy. The focus of our study was to explore COVID-19 vaccination among pregnant and breastfeeding individuals and its association with their reasons (psychological factors) for vaccination using the 5C scale and other factors.

Methods

An online survey investigating prior vaccinations, level of trust in healthcare providers, demographic information, and the 5C scale was used for, pregnant and breastfeeding individuals in a Canadian province.

Results

Prior vaccinations, higher levels of trust in medical professionals, education, confidence, and collective responsibility predicted increased vaccine uptake pregnant and breastfeeding individuals.

Conclusions

There are specific psychological and socio-demographic determinants that affect COVID-19 vaccine uptake in pregnant populations. Implications of these findings include targeting these determinants when informing and developing intervention and educational programs for both pregnant and breastfeeding individuals, as well as healthcare professionals who are making vaccine recommendations to patients. Study limitations include a small sample and lack of ethnic and socioeconomic diversity.

KEYWORDS:

• 5C model
• COVID-19
• pregnancy
• vaccination
• vaccine decision

Abbreviations

WHO	=	World Health Organization
VIP	=	Vaccination in Pregnancy
WEIRD	=	Western, Educated, Industrialized, Rich, and Democratic
NICU	=	Neonatal Intensive Care Unit

Acknowledgments

The authors would like to acknowledge the Protecting Every Mom & Baby Alberta Parent Partner Research Advisory Committee (PEMBA PPRAC) for their contributions to the conceptualization of the survey, input into the survey design and assistance with distributing the survey to parents in Alberta.

Declaration of interest

E Castillo received an honorarium for speaking at educational events from Sanofi June 2021, Sanofi September 2021, and Pfizer in June 2022. She has spoken at educational events sponsored by Moderna in October 2022 and Pfizer in December 2022 without receiving any compensation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors have substantially contributed to this article and have been involved in writing and revising it. Conceptualization EC and MB; methodology EC; analysis GB and GG; resources EC; data curation MB; writing – original draft preparation MB, KL and EC; writing – review and editing EC, GG, MB, MS, KL and GB; visualization KL, MB, and GB; supervision EC; project administration MB; funding acquisition EC. All authors have read and agreed to the published version of the manuscript.

Data availability statement

Data from this study is available upon request.

Previous Presentations

Preliminary results from this study were presented in a poster at the Infectious Diseases Society for Obstetrics and Gynecology (IDSOG) 2022 Annual Meeting in Boston, MA on August 4–6, 2022, and as an oral presentation at the Canadian Immunization Conference (CIC) 2023 in Ottawa, Ontario on 25 April 2023

Additional information

Funding

Funding for this study was provided by the Public Health Agency of Canada (PHAC) [2122-HQ-000436]. The views expressed herein do not necessarily represent the views of PHAC