Maternal Recall of Obstetric Office-Based Activities That Promote Antepartum Tetanus-Diphtheria-Acellular-Pertussis Vaccination

Henry H Bernstein; Shannon S Cleary; Victoria Chi; Margaret Sherin; Alix T Rosenberg; Cathie Spino

doi:10.1089/jwh.2023.0597

Maternal Recall of Obstetric Office-Based Activities That Promote Antepartum Tetanus-Diphtheria-Acellular-Pertussis Vaccination

J Womens Health (Larchmt). 2024 Apr 17. doi: 10.1089/jwh.2023.0597. Online ahead of print.

Authors

Henry H Bernstein^{1

2

3}, Shannon S Cleary^{2

4}, Victoria Chi^{2

5}, Margaret Sherin^{2

6}, Alix T Rosenberg^{1

2

3}, Cathie Spino⁷

Affiliations

¹ Department of Pediatrics, Northwell Health, New Hyde Park, NY, USA.
² Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA.
³ Zucker School of Medicine at Hofstra Northwell, 500 Hofstra University, Hempstead, NY, USA.
⁴ Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
⁵ Department of Pediatrics, Stanford Medicine, Stanford Hospital, Palo Alto, CA, USA.
⁶ Dartmouth College Geisel School of Medicine, Hanover, NH, USA.
⁷ Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.

PMID: 38629392
DOI: 10.1089/jwh.2023.0597

Abstract

Objective: To explore associations between maternal characteristics and recall of obstetric provider actions in promoting antepartum tetanus-diphtheria-acellular-pertussis (Tdap) vaccination. Methods: A convenience sample of 1,682 postpartum women was surveyed in this cross-sectional study. Maternal characteristics and recall of four obstetric provider actions (recommending antepartum Tdap vaccine, offering it in clinic, providing written information, and referring patients elsewhere for vaccination) were collected. Univariate and multivariable logistic regression analyses were performed to characterize the association between maternal characteristics and each provider action. Results: Among 1,604 surveys (95% of total collected), maternal recall of an obstetric provider recommending Tdap vaccination, offering it in clinic, providing written information, or referring patients elsewhere was 68%, 59%, 53%, and 15%, respectively. Multivariable analysis revealed specific maternal characteristics that increased odds of recalling at least one obstetric provider action promoting Tdap vaccination, including receipt of first trimester prenatal care (adjusted odds ratio [aOR] 1.77, 95% confidence interval [CI] = 1.06-2.97), primiparity (aOR 1.35, 95% CI = 1.05-1.75), private health insurance (aOR 1.56, 95% CI = 1.16-2.04), higher household income (aOR ranging from 1.71 to 2.10 for ≥$150,000 for two actions), and non-White, non-Hispanic race/ethnicity (aOR ranging from 1.49 to 1.74 for Asian non-Hispanic for two actions and aOR 1.71 for Black non-Hispanic). Conclusion: Prenatal care, parity, insurance type, household income, and race/ethnicity are associated with recall of obstetric provider activities that impact antepartum Tdap vaccine promotion. Obstetric providers should recommend this potentially life-saving vaccine with each pregnancy, irrespective of differences in maternal characteristics, and policymakers should work to combat systemic factors that may cause disparities in uptake.

Keywords: antepartum Tdap; health equity; obstetric provider.