Perceptions, healthcare messaging and its impact on COVID vaccine uptake in pregnancy : A cross-sectional survey

Objective: To gain in-depth insights into factors affecting COVID-19 vaccine acceptance in pregnant women. This demographic has lower rates of COVID vaccination despite being disproportionally negatively affected by COVID. Design: A single centre cross-sectional online survey distributed 13th August 2021 to 21st September 2021 on local networks. Setting: Online Population: Pregnant population in a large District General Hospital in the West Midlands, UK. Main Outcome Measures: i) demographic and baseline data ii) awareness of information sources; iii) opinions on COVID and vaccination, iv) vaccination decisions. Results: 92 total eligible responses were quantitatively and qualitatively analysed. 60.9% (n=56) had declined, or would decline, a COVID-19 vaccination. Those who had a previous negative pregnancy experience were significantly more likely to accept a COVID-19 vaccination (OR 3.9; p<0.05, 95% CI 1.32-11.52). Over half (53.2%) of participants either agreed or strongly agreed that discussion with a healthcare professional was important in decision making on vaccination . GPs were the least supportive of the vaccination (62.5%) compared to midwives (78.8%) and obstetric consultants (81.8%). The most common reason for declining the vaccine were perceived risks to the fetus; this was also frequently reported in the qualitative analysis. Other qualitative themes included; distrust of recommendations, conflict of information and uncertainty. Conclusions: There is a need for consistent health professional messaging around vaccine uptake in pregnancy and the use of appropriate evidence based information, particularly focusing on its safety and impact on fetus. There is a need to nurture a collaborative approach and informed decision making.