Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August-December 2020

Am J Perinatol. 2022 Jan;39(1):75-83. doi: 10.1055/s-0041-1735878. Epub 2021 Oct 1.


Objective: The aim of the study was to evaluate pregnant women's attitudes toward COVID-19 illness and vaccination and identify factors associated with vaccine acceptability.

Study design: This was a cross-sectional survey among pregnant women enrolled in a prospective COVID-19 cohort study in Salt Lake City, UT, Birmingham, AL, and New York, NY, from August 9 to December 10, 2020. Women were eligible if they were 18 to 50 years old and <28 weeks of gestation. Upon enrollment, women completed surveys regarding concerns about COVID-19 illness and likelihood of getting COVID-19 vaccine if one were available during pregnancy. Vaccine acceptability was defined as a response of "very likely" or "somewhat likely" on a 4-point Likert scale. Factors associated with vaccine acceptability were assessed with multivariable logistic regression.

Results: Of 939 pregnant women eligible for the main cohort study, 915 (97%) consented to participate. Among these 915 women, 39% self-identified as White, 23% Black, 33% Hispanic, and 4% Other. Sixty-two percent received an influenza vaccine last season. Seventy-two percent worried about getting sick with COVID-19. If they were to get sick, 92% worried about harm to their pregnancy and 80% about harm to themselves. Only 41% reported they would get a vaccine. Of women who were unlikely to get vaccinated, the most frequently cited concern was vaccine safety for their pregnancy (82%). Non-Hispanic Black and Hispanic women had lower odds of accepting a vaccine compared with non-Hispanic White women (adjusted odds ratios [aOR] 0.4, 95% CI 0.2-0.6 for both). Receipt of influenza vaccine during the previous season was associated with higher odds of vaccine acceptability (aOR 2.1, 95% CI 1.5-3.0).

Conclusion: Although most pregnant women worried about COVID-19 illness, <50% were willing to get vaccinated during pregnancy. Racial and ethnic disparities in plans to accept COVID-19 vaccine highlight the need to prioritize strategies to address perceived barriers among groups at high risk for COVID-19.

Key points: · Less than half of pregnant patients stated they would get a COVID-19 vaccine.. · Protecting their baby was the most common reason for acceptance and refusal of the COVID-19 vaccine.. · Patients of minority race/ethnicity and those without prior influenza vaccination were less likely to accept the COVID-19 vaccine..

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Black or African American / statistics & numerical data
  • COVID-19 / prevention & control*
  • COVID-19 Vaccines / adverse effects
  • Cross-Sectional Studies
  • Female
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Influenza Vaccines
  • Influenza, Human / prevention & control
  • Middle Aged
  • Patient Acceptance of Health Care / ethnology
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Pregnancy
  • Pregnant Women / psychology*
  • Prospective Studies
  • SARS-CoV-2
  • Surveys and Questionnaires
  • Vaccination / psychology*
  • Vaccination / statistics & numerical data
  • Vaccination Hesitancy / ethnology
  • Vaccination Hesitancy / statistics & numerical data*
  • White People / statistics & numerical data
  • Young Adult


  • COVID-19 Vaccines
  • Influenza Vaccines