Association between acceptance of routine pregnancy vaccinations and COVID-19 vaccine uptake in pregnant patients

J Infect. 2023 Dec;87(6):551-555. doi: 10.1016/j.jinf.2023.10.010. Epub 2023 Oct 19.


Objective: COVID-19 vaccination is a key approach to reduce morbidity and mortality in pregnant patients and their newborns. Anti-vaccine sentiment has recently increased with unclear impact on pregnant patients. We examined the association between acceptance of tetanus-diphtheria-acellular pertussis (Tdap) and influenza vaccines, considered to be routine pregnancy vaccines, and COVID-19 vaccine acceptance. Secondarily, we identified other predictors of COVID-19 vaccine uptake and described pregnancy outcomes in patients who were and were not vaccinated during pregnancy.

Methods: A retrospective cohort study of all patients who delivered at a single site from December 2020 - March 2022. Demographic, pregnancy, neonatal, and vaccination data were abstracted from the electronic medical record, which imports vaccine history from the California Immunization Registry. The relationship between influenza and Tdap vaccine acceptance, other baseline characteristics, and COVID-19 vaccine uptake was assessed using univariable and multivariable regression analysis.

Results: Of the 7857 patients who delivered during the study period, 4410 (56.1%) accepted the COVID-19 vaccine. Of those who received the COVID-19 vaccine, 3363 (97.6%) and 3049 (88.5%) received influenza and Tdap vaccines, respectively. Patients were more likely to receive the COVID-19 vaccine if they had advanced maternal age, obesity, Asian race, and private insurance. After adjustment for baseline differences, COVID vaccine acceptance was associated with receipt of Tdap (aOR 2.10, 95% CI 1.90-2.33) and influenza vaccines (aOR 2.83, 95% CI 2.55-3.14). There were no differences in preterm birth, low birthweight, and NICU admission between patients who received and did not receive the COVID-19 vaccine.

Conclusion: Patients were more likely to accept COVID-19 vaccination if they received Tdap or influenza vaccinations. Older age, obesity, Asian race, and private insurance were independent predictors of vaccine uptake. Disparities in COVID-19 vaccination uptake bear further exploration to guide efforts in equitable and widespread vaccine distribution.

Keywords: COVID-19; COVID-19 vaccine; Influenza vaccine; Pregnancy; Tetanus-diphtheria-acellular pertussis vaccine; Vaccination; Vaccine hesitancy; Vaccine uptake.

MeSH terms

  • COVID-19 Vaccines* / administration & dosage
  • COVID-19 Vaccines* / adverse effects
  • COVID-19* / prevention & control
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / administration & dosage
  • Female
  • Humans
  • Infant, Newborn
  • Influenza Vaccines / administration & dosage
  • Influenza, Human
  • Obesity
  • Pregnancy
  • Premature Birth
  • Retrospective Studies
  • Vaccination
  • Whooping Cough


  • COVID-19 Vaccines
  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • Influenza Vaccines