Prevalence of Vaccine Hesitancy Among Expectant Mothers in Houston, Texas

Acad Pediatr. 2018 Mar;18(2):154-160. doi: 10.1016/j.acap.2017.08.003. Epub 2017 Aug 4.


Objective: Nonmedical exemptions continue to rise because of increasing proportions of vaccine-hesitant parents. The proportion of expectant parents who are vaccine-hesitant is currently unknown. We assessed the prevalence of vaccine hesitancy among expectant parents receiving care at an obstetrics clinic in Houston, Texas.

Methods: We conducted a cross-sectional survey of expectant parents between 12 and 31 weeks gestation who received care at Texas Children's Pavilion for Women between July 2014 and September 2015. Using convenience sampling, participants completed a questionnaire that included questions on demographic items, self-assessed pregnancy risk, receipt of annual influenza vaccine, and the 15-item Parents Attitudes About Childhood Vaccines survey, a validated tool to identify vaccine-hesitant parents. We used multivariable logistic regression to determine the association of demographic characteristics, pregnancy risk, and influenza vaccine receipt with vaccine hesitancy after controlling for variables significant in univariable analyses.

Results: Six hundred ten expectant mothers and 38 expectant fathers completed the Parents Attitudes About Childhood Vaccines survey. Overall, 50 of 610 expectant mothers (8.2%; 95% confidence interval [CI], 6.1%-10.7%) were vaccine-hesitant. Expectant mothers were primarily non-Hispanic white, 30 years old or older, and married. The odds of being vaccine-hesitant were 2.2 times greater (95% CI, 1.2-4.1) among expectant mothers with a college level of education or less compared with those with more than a 4-year degree. The odds of being vaccine-hesitant were 7.4 times greater (95% CI, 3.9-14.0) among expectant mothers who do not receive an annual influenza vaccine compared with those who do.

Conclusions: Our findings suggest the need to identify and address vaccine hesitancy among expectant parents before birth.

Keywords: Parental Attitudes About Childhood Vaccines survey; pregnancy; vaccine; vaccine hesitancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Attitude to Health*
  • Cross-Sectional Studies
  • Fathers*
  • Female
  • Humans
  • Influenza Vaccines / therapeutic use
  • Influenza, Human / prevention & control
  • Logistic Models
  • Male
  • Mothers*
  • Multivariate Analysis
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control
  • Pregnancy, High-Risk
  • Pregnant Women
  • Prevalence
  • Texas
  • Vaccination Refusal / statistics & numerical data*
  • Young Adult


  • Influenza Vaccines