“This choice does not just affect me.” Attitudes of pregnant women toward COVID-19 vaccines: a mixed-methods study

Figures & data

Table 1. Characteristics of participants according to likelihood of COVID-19 vaccine in pregnancy (1–10, 10 = very likely, 1 = very unlikely)*.

	Score <8	Score ≥8
	N = 187	N = 113	p-value
Age			0.006
18–24	5% (10)	1% (1)
25–30	26% (49)	15% (17)
31–35	39% (72)	60% (68)
36–40	26% (49)	19% (22)
41–45	3% (6)	4% (4)
>45	1% (1)	1% (1)
Birthplace			0.37
Ireland	82% (153)	86% (97)
Outside of Ireland	18% (34)	14% (16)
Race			0.46
Asian	3% (6)	3% (3)
Black	3% (5)	1% (1)
White	90% (169)	96% (108)
Other	3% (6)	1% (1)
Prefer not to answer	1% (1)	0% (0)
Education**			0.042
Some secondary school, no leaving certificate	4% (7)	2% (2)
Secondary school, complete	9% (17)	4% (5)
Third level education: certificate or diploma	22% (42)	13% (15)
Third level education: bachelor’s degree	37% (69)	40% (45)
Master’s, professional, or doctorates degree	28% (52)	41% (46)
Household income			0.026
€0–24,999	5% (9)	3% (3)
€25,000–44,999	8% (15)	9% (10)
€45,000–64,999	17% (31)	13% (15)
€65,000–99,999	28% (53)	33% (37)
€100,000 +	30% (57)	41% (46)
Prefer not to answer	12% (22)	2% (2)
Pregnancy care			0.11
Community midwife	16% (30)	16% (18)
Public clinic	46% (86)	34% (38)
Semi-private clinic	13% (24)	13% (15)
Private clinic	25% (47)	37% (42)
Gestational age (weeks)			0.008
<12	9% (16)	3% (3)
12–16	9% (17)	8% (9)
17–20	10% (19)	5% (6)
21–30	48% (90)	41% (46)
31–36	18% (33)	29% (33)
37+	6% (12)	14% (16)
Parity			0.74
≥1 previous pregnancy	66% (124)	68% (77)
First pregnancy	34% (63)	32% (36)
Received or intend to receive pertussis and or Flu vaccine			0.006
No	10% (19)	2% (2)
Yes	90% (168)	98% (111)
Likely receipt of recommended vaccines during pregnancy (1–10 scale) ^§	8 (6–9)	10 (10–10)	<0.001
Likely receipt of COVID-19 vaccine during pregnancy (1–10 scale) ^§	2 (1–4)	10 (9–10)
Likely receipt of COVID-19 vaccine if not pregnant (1–10 scale) ^§	7 (2–10)	10 (10–10)	<0.001

*Women responded to the following question: “If a COVID-19 vaccine was available and was recommended for pregnant women how likely is it that you would receive the vaccine during this pregnancy?”

**Highest level of education completed.

§Results presented as median and interquartile ranges.

Figure 1. (a) Scale responses to the question “If a COVID-19 vaccine was available and was recommended for pregnant women how likely is it that you would receive the vaccine during this pregnancy?” (b) Scale responses to the question “If a COVID-19 vaccine became available and was recommended for everyone, how likely is it that you would receive this vaccine if not pregnant?” (c) Scale responses to the question “In general how likely are you to accept recommended vaccines during pregnancy?”.

Table 2. Themes and illustrative quotations from analysis of free text responses.

Likelihood of COVID-19 vaccine receipt ≥8/10	Likelihood of COVID-19 vaccine receipt <8/10
Vaccine safety concerns and emphasis on research
Inclusion of pregnant women in clinical trials “Clinical Trials on Pregnant women and clinical research on babies born to women who had the vaccine whilst pregnant.” “Further testing for pregnant cohort.” “Medical studies on pregnancy and covid vaccines. I would like a bit of scientific reassurance.” “Amount of pregnant women in the clinical trials.” Demonstrating safety through data “I would want to wait until more testing was done to understand the effect of the vaccine on pregnant women and their unborn children. However, once more was known and it was recommended, I would definitely want to receive the vaccine in the same way as I receive the flu vaccine, to ensure mine and my unborn child’s safety.” “Supporting data proving safety in pregnant women. If shown to be safe, I would absolutely get it, I am very pro vaccine and work in healthcare.” “If it was proven to protect pregnant women without any harmful side effects on their unborn baby, I would take it.” “If it helps protect both my child, partner(transmission) & myself from covid-19 I see no reason not to get it as extensive clinical testing has been done.”	Introduction of a new vaccine “Because it is brand new and not much is known about it in terms of long-term side effects or any harm it may cause my baby.” “I wouldn’t take it as it is a new vaccine, and no one knows the effects of it yet.” “The results of a brand-new vaccine for such a new illness on an unborn baby can’t be known yet.” “It’s so new and thinking of the baby and not just me. Would be very likely to get if not pregnant.” Fear and anxiety “I would be so scared about the effects it could cause to my unborn son.” “My fear of putting my unborn baby at risk.” “It’s so new. Would be afraid of the effect it would have on the baby.” “Well, I feel it takes years of research to get the right vaccine, and I will like to see more sides effects before risking my baby’s life.” “I’ll be afraid for my baby.” “ … this choice does not just affect me. For example, (nonsmoker) I’ve cut alcohol, pate, cheesecake, coffee, soft serve ice cream and google pretty much everything I’ve put into my mouth for the last 6 months to protect my unborn child … given the above are minor low risk sacrifices I feel the C19 vaccine is too high of a risk, given the nature of the ‘unknowns’.” Concern about long- term effects “Insufficient scientific and medical evidence that the vaccine doesn’t harm the unborn baby or have long term implications to mother and child.” “If I wasn’t pregnant, I would get it. But not while I’m pregnant as I would be more worried about unknown long term side effects on my unborn child.” “I’d want to see robust data confirming that it did not result in any defects or have any long-term impact on the infant.”
The role of provider recommendation
“What the professionals say about it. If they say it is safe during pregnancy, I would question it but trust their professional knowledge.” “Public health guidance and advice from my medical team. I would be very happy to get a vaccine if it were recommended during pregnancy.” “The advice received by my consultant and GP. I trust their judgment and that they are placed to advise me on best practices during pregnancy.” “Advice from my midwife/doctors. I trust in what they tell me is important for me and my baby.” “The communicated risks would be a consideration but overall I trust my consultant and if it is being recommended by my consultant I would 100% take it as I trust her.” “What the professionals say about it. If they say it is safe during pregnancy I would question it but trust their professional knowledge.”	“The vaccine has been created in such a short time frame, so would just be a bit unsure about getting it. Will take GP and hospital advice as what is best for me and baby.” “Depending on whether my consultant advises me to get it.” “Obstetrician recommendation based on RCOG recommendation.”

Women responded to the question “What do you think would most affect your choice about receiving or not receiving a COVID-19 vaccine during pregnancy?”