Temporal trends and determinants of COVID-19 vaccine coverage and series initiation during pregnancy in Ontario, Canada, December 2020 to December 2021: A population-based retrospective cohort study

Fell, Deshayne B.; Török, Eszter; Sprague, Ann E.; Regan, Annette K.; Dhinsa, Tavleen; Alton, Gillian D; Dimanlig-Cruz, Sheryll; MacDonald, Shannon E.; Buchan, Sarah A; Kwong, Jeffrey C.; Wilson, Sarah E.; Håberg, Siri E.; Gravel, Christopher A.; Wilson, Kumanan; Dunn, Sandra; Shah, Prakesh S.; El-Chaâr, Darine; Barrett, Jon; Walker, Mark; Okun, Nannette; Dougan, Shelley

doi:10.1016/j.vaccine.2023.01.073

Cited by 5 publications

(7 citation statements)

References 38 publications

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“…Despite this evidence, vaccine coverage of pregnant women has been lower than in nonpregnant women of reproductive age in many regions, especially among younger women and women living in areas with higher socioeconomic deprivation . Uncertainty about vaccine safety for the infant is one of the most frequently reported reasons for lack of intent to get vaccinated during pregnancy .…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] Despite this evidence, vaccine coverage of pregnant women has been lower than in nonpregnant women of reproductive age in many regions, especially among younger women and women living in areas with higher socioeconomic deprivation. 11,12 Uncertainty about vaccine safety for the infant is one of the most frequently reported reasons for lack of intent to get vaccinated during pregnancy. 13,14 Data from large populations on infant outcomes following exposure to COVID-19 vaccines in utero are of high importance and could bolster vaccine confidence in pregnant women but are limited at this stage.…”

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confidence: 99%

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Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy

Jorgensen,

Drover,

Fell

et al. 2023

JAMA Pediatr

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ImportanceThe study team previously showed that maternal mRNA COVID-19 vaccination during pregnancy confers protection against SARS-CoV-2 infection and COVID-19–related hospital admission in newborns and young infants. In this study, the study team evaluated newborn and early infant safety outcomes following maternal messenger RNA (mRNA) COVID-19 vaccination during pregnancy, for which there is limited comparative epidemiological evidence.ObjectiveTo determine if maternal mRNA COVID-19 vaccination during pregnancy is associated with adverse newborn and early infant outcomes.Design, Setting, and ParticipantsThis population-based retrospective cohort study took place in Ontario, Canada, using multiple linked health administrative databases. Singleton live births with an expected delivery date between May 1, 2021, and September 2, 2022, were included. Data were analyzed from January 2023 through March 2023.ExposureMaternal mRNA COVID-19 vaccination (1 or more doses) during pregnancyMain Outcomes and MeasuresSevere neonatal morbidity (SNM), neonatal death, neonatal intensive care unit (NICU) admission, neonatal readmission, and hospital admission up to 6 months of age. The study team calculated inverse probability of treatment weighted risk ratios (RRs) and fit weighted Cox proportional hazards regression models comparing outcomes in infants of mothers who received COVID-19 vaccination during pregnancy with those who received no COVID-19 vaccine doses before delivery.ResultsIn total, 142 006 infants (72 595 male [51%]; mean [SD] gestational age at birth, 38.7 [1.7] weeks) were included; 85 670 were exposed to 1 or more COVID-19 vaccine doses in utero (60%). Infants of vaccinated mothers had lower risks of SNM (vaccine exposed 7.3% vs vaccine unexposed 8.3%; adjusted RR [aRR], 0.86; 95% CI, 0.83-0.90), neonatal death (0.09% vs 0.16%; aRR, 0.47; 95% CI, 0.33-0.65), and NICU admission (11.4% vs 13.1%; aRR, 0.86; 95% CI, 0.83-0.89). There was no association between maternal vaccination during pregnancy and neonatal readmission (5.5% vs 5.1%; adjusted hazard ratio, 1.03; 95% CI, 0.98-1.09) or 6-month hospital admission (8.4% vs 8.1%; adjusted hazard ratio, 1.01; 95% CI, 0.96-1.05).Conclusions and RelevanceIn this population-based cohort study in Ontario, Canada, maternal mRNA COVID-19 vaccination during pregnancy was associated with lower risks of SNM, neonatal death, and NICU admission. In addition, neonatal and 6-month readmissions were not increased in infants of mothers vaccinated during pregnancy.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy

Jorgensen,

Drover,

Fell

et al. 2023

JAMA Pediatr

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“… 34 , 35 Similar patterns of association have also been observed in studies assessing COVID-19 vaccine coverage during pregnancy. 20 , 22 , 25 , 36 , 37 Some of the sociodemographic subgroups in which vaccine initiation after delivery was lowest in our study (e.g., rural residence, lower neighborhood income, and higher neighborhood material deprivation) may reflect individuals who have less access to health services during pregnancy, even within the context of a publicly funded healthcare system. 38 Healthcare providers play a critical role in enhancing vaccination rates in the obstetric population both by providing access to vaccination, as well as by providing information and education to their patients about safety and effectiveness of vaccination during pregnancy.…”

Section: Discussionmentioning

confidence: 75%

“…8 Although COVID-19 vaccination during pregnancy has been found to be effective against SARS-CoV-2 infection in pregnant individuals, 9 , 10 has been associated with a lower incidence of SARS-CoV-2 infection in newborns, 11–13 and has not been associated with adverse pregnancy or birth outcomes (e.g., preterm birth, small-for-gestational-age at birth, and stillbirth), 14–19 vaccine coverage in the pregnant population in 2021 was lower than in the general population of women of reproductive age in many settings, 20 , 21 including in Ontario, Canada. 22 Lower uptake of the COVID-19 vaccine primary series by pregnant people in 2021 may have reflected safety concerns at that time, 23–25 potentially leading some people to postpone vaccination until after giving birth. Similar to influenza vaccination during pregnancy, COVID-19 vaccine hesitancy among pregnant people is likely influenced by a variety of factors such as low perceived effectiveness of the vaccine, lack of confidence in vaccine safety, and misconceptions about the disease or vaccine.…”

Section: Introductionmentioning

confidence: 99%

Temporal trends and determinants of COVID-19 vaccine series initiation after recent pregnancy

Török

Dhinsa

Dimanlig-Cruz

et al. 2023

Human Vaccines & Immunotherapeutics

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During the rapid deployment of COVID-19 vaccines in 2021, safety concerns may have led some pregnant individuals to postpone vaccination until after giving birth. This study aimed to describe temporal patterns and factors associated with COVID-19 vaccine series initiation after recent pregnancy in Ontario, Canada. Using the provincial birth registry linked with the COVID-19 vaccine database, we identified all individuals who gave birth between January 1 and December 31, 2021, and had not yet been vaccinated by the end of pregnancy, and followed them to June 30, 2022 (follow-up ranged from 6 to 18 months). We used cumulative incidence curves to describe COVID-19 vaccine initiation after pregnancy and assessed associations with sociodemographic, pregnancy-related, and health behavioral factors using Cox proportional hazards regression to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Among 137,198 individuals who gave birth in 2021, 87,376 (63.7%) remained unvaccinated at the end of pregnancy; of these, 65.0% initiated COVID-19 vaccination by June 30, 2022. Lower maternal age (<25 vs. 30–34 y aHR: 0.73, 95%CI: 0.70–0.77), smoking during pregnancy (vs. nonsmoking aHR: 0.68, 95%CI: 0.65–0.72), lower neighborhood income (lowest quintile vs. highest aHR: 0.79, 95%CI: 0.76–0.83), higher material deprivation (highest quintile vs. lowest aHR: 0.74, 95%CI: 0.70–0.79), and exclusive breastfeeding (vs. other feeding aHR: 0.81, 95%CI: 0.79–0.84) were associated with lower likelihood of vaccine initiation. Among unvaccinated individuals who gave birth in 2021, COVID-19 vaccine initiation after pregnancy reached 65% by June 30, 2022, suggesting persistent issues with vaccine hesitancy and/or access to vaccination in this population.

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“…Despite known risks of COVID-19 during pregnancy and the broad, unequivocal support for COVID-19 vaccination during pregnancy from a variety of professional organizations, COVID-19 vaccination rates among pregnant women remain lower than that of the general population. Evidence shows that pregnant women infected with COVID-19 are at an increased risk of maternal death, mechanical ventilation, critical care admissions, miscarriages, perinatal mortality, and preterm birth [ 5 ]. In a large prospective cohort study, vaccination in pregnancy and in the postpartum period has been shown to reduce the risk of COVID-19-related maternal and perinatal mortality and morbidity [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Social Media Misinformation about Pregnancy and COVID-19 Vaccines: A Systematic Review

Malik,

Bauer-Maison,

Guarna

et al. 2024

Med Princ Pract

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Objective: To identify common social media misconceptions about COVID-19 vaccination in pregnancy, explain the spread of misinformation, and identify solutions to guide clinical practice and policy. Methodology: A systematic review was conducted and the databases Embase and Medline were searched from December 2019 until February 8, 2023, using terms related to social media, pregnancy, COVID-19 vaccines and misinformation. The inclusion criteria were: original research studies and discuss misinformation about COVID-19 vaccination during pregnancy on social media. The exclusion criteria were: review articles, no full-text, and not published in English. Two independent reviewers conducted screening, extraction, and quality assessment. Results: Our search identified 76 articles, and 3 fulfilled eligibility criteria. Included studies were of moderate and high quality. The social media platforms investigated included Facebook, Google Searches, Instagram, Reddit, Tik Tok, and Twitter. Misinformation was related to concerns regarding vaccine safety, and its association with infertility. Misinformation was increased due to lack of content monitoring on social media, exclusion of pregnant women from early vaccine trials, lack of information from reputable health sources on social media, and others. Suggested solutions were directed at pregnancy care providers (PCP) and public health/government. Suggestions included integrating COVID-19 vaccination information into antenatal care, PCPs and public health should increase their social media presence to disseminate information, address population-specific vaccine concerns in a culturally relevant manner, and others. Conclusion: Increased availability of information from reputable health sources through multiple channels could increase COVID-19 vaccine uptake in the pregnant population and help combat misinformation.

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Temporal trends and determinants of COVID-19 vaccine coverage and series initiation during pregnancy in Ontario, Canada, December 2020 to December 2021: A population-based retrospective cohort study

Cited by 5 publications

References 38 publications

Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy

Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy

Temporal trends and determinants of COVID-19 vaccine series initiation after recent pregnancy

Social Media Misinformation about Pregnancy and COVID-19 Vaccines: A Systematic Review

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