COVID-19 vaccination completion is lower in pregnant women (11.1%) compared with nonpregnant females aged 18 to 49 years reported by the Centers for Disease Control and Prevention (CDC) for the same period (24.9%), according to a Morbidity and Mortality Report from the CDC.
As of May 8, 2021, 16.3% of pregnant women identified in CDC’s Vaccine Safety Datalink (VSD) had received ≥1 dose of a COVID-19 vaccine during pregnancy in the United States. Vaccination was lowest among Hispanic (11.9%) and non-Hispanic Black women (6.0%) and women aged 18 to 24 years (5.5%) and highest among non-Hispanic Asian women (24.7%) and women aged 35 to 49 years (22.7%).
In this analysis, receipt of COVID-19 vaccination during pregnancy was lowest among Black and Hispanic women and women aged 18 to 24 years; a larger proportion of pregnant Hispanic women were aged 18 to 24 years compared with pregnant White and Asian women.
These findings indicate the need for improved outreach to and engagement with pregnant women, especially those from racial and ethnic minority groups who might be at higher risk for severe health outcomes because of COVID-19. In addition, providing accurate and timely information about COVID-19 vaccination to healthcare providers, pregnant women, and women of reproductive age can improve vaccine confidence and coverage by ensuring optimal shared clinical decision-making.
Similar increasing trends in COVID-19 vaccination coverage have been observed among the general U.S. population as seen among pregnant women. Even though COVID-19 vaccination coverage has been increasing, Black and Hispanic women still have the lowest vaccination coverage among all racial and ethnic groups. Further, similar results have been reported for receipt of other vaccinations during pregnancy, including influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines, in which the lowest vaccination coverage was noted among pregnant Black and Hispanic women. These findings highlight racial and ethnic disparities in COVID-19 vaccination coverage to date among pregnant women, who are at increased risk for infection and severe COVID-19–associated illness, indicating a need to prioritize vaccine equity by addressing potential barriers and access issues.
Low coverage among pregnant women might be attributable to various factors including limited available safety data on COVID-19 vaccines during pregnancy; need for increased vaccine confidence among health care providers and pregnant women; vaccine prioritization, access, and availability; and cultural and language barriers. Coverage differences by vaccine type might be influenced by the date the vaccines were authorized for use, the shorter interval between receipt of first and second doses of Pfizer-BioNTech COVID-19 vaccine than for Moderna vaccine, and vaccine availability at vaccination sites.
Pregnant women were excluded from preauthorization clinical trials, and only very limited human data on safety and efficacy during pregnancy were available at the time that the vaccines were authorized for use. Survey data before COVID-19 vaccine authorization showed low acceptance of COVID-19 vaccination among pregnant women, and the most frequently reported reasons for lack of intent to get vaccinated during pregnancy were limited safety data in pregnancy and concerns about possibility of harm to the fetus.
Improving outreach to and engagement with healthcare providers and pregnant women, especially those who are younger and from racial and ethnic minority groups, could increase vaccine confidence and thus coverage of COVID-19 vaccination in this population.
