(623) Dimensions of COVID-19 Vaccine Uptake in Pregnant People: A Mixed Methods Approach

Objective: Population-based COVID-19 vaccines have been a highly debated medical innovation. Rationale for vaccine uptake is well-researched in the general population but poorly studied in pregnant people who have historically incorporated different dimensions of risk analysis in their medical decision-making due to their pregnancy status. While provider recommendation is the single most important driver of Tdap and influenza vaccination during pregnancy, the role of the healthcare provider has been less clear regarding COVID-19 vaccinations. This study addresses this gap in knowledge through a mixed-methods approach that analyzes COVID-19 vaccine uptake through EMR review and in-depth, semi-structured interviews.

Study Design: A systematic retrospective medical chart review was performed for 915 patients who received prenatal care and delivered at an academic health care center between August 2021 and August 2022 alongside five semi-structured interviews with people who received prenatal care and delivered in Central Virginia that explored their experience of pregnancy during COVID-19 and their decision-making process around the COVID-19 vaccine.

Results: Concurrent analysis of medical records and interviews revealed that discussion of the COVID-19 vaccine with the healthcare team was not associated with changes in vaccination uptake (p=0.604, logistic regression). Instead, pregnant people discussed how they incorporated anecdotal, informal discussions with trusted others into their decision-making process. Age, total number of prenatal visits, and influenza vaccine uptake were positively correlated with COVID-19 vaccine uptake, while prior COVID-19 infections during pregnancy were negatively correlated with COVID-19 vaccine uptake. Lastly, risk tolerance during pregnancy was seen as a finite resource, and its allocation was altruistic

Conclusion: The findings of this study, one of the first to characterize risk analysis and COVID-19 vaccine hesitancy in pregnant people, indicate that not only vaccine hesitancy but also medical decision-making in pregnant people is more complex than previously thought.