17 August 2022
Rates of COVID-19 vaccination among pregnant women are lower than in the general population for a range of reasons, but better communication from trusted professionals such as midwives and GPs could improve uptake, research led by Frimley Health NHS Foundation Trust has found.
Although COVID-19 vaccination has been recommended for pregnant women since April 2021 and no safety issues with vaccination during pregnancy have been observed, rates of vaccination are low among this group. Around one-half of pregnant women are estimated to have received the vaccine compared with more than three-quarters of women who are not pregnant.
The low uptake of COVID-19 vaccination among pregnant women is concerning because they are more likely to experience severe COVID-19 disease. They are three times more likely to be admitted to intensive care and have a 25% greater chance of dying as their non-pregnant counterparts. COVID-19 during pregnancy also results in a higher risk of pre-eclampsia, preterm birth, stillbirth and early neonatal death.
To discover the reasons for vaccine hesitancy among pregnant women and to learn more about strategies which may improve uptake, researchers from Frimley Health and London-based St George's University Hospitals NHS Foundation Trust surveyed pregnant women booked to attend antenatal clinics at Wexham Park Hospital in Berkshire and Frimley Park Hospital in Surrey. Both hospitals are run by Frimley Health.
Participants were asked about vaccination uptake, their reasons for hesitancy and their trusted sources of information. Wexham Park and Frimley Park hospitals serve a diverse population in terms of socioeconomic status and ethnicity.
Researchers found that most (66.2%) of the 441 survey respondents had received at least one dose of vaccine.
From those who had not had the vaccine, the most common reasons given included concerns about possible adverse effects of the vaccine on the unborn baby, future pregnancies or the mother; lack of information about the vaccines’ safety and effectiveness; and lack of trust in COVID-19 vaccines.
The most trusted sources of information were the patient’s GP and midwife (43%) and official health-related websites such as NHS (39%), but a significant minority (23%) also used social media for information, putting them at risk of being exposed to misinformation and conspiracy theories.
Based on the survey, the researchers have made recommendations that could improve vaccine uptake. These include ensuring that trusted practitioners such as GPs, midwives and obstetricians are trained to engage pregnant women in empathetic, transparent conversations about vaccination during routine care, respecting pregnant women’s concerns and addressing their information needs. Empathetic dialogue is considered especially important when speaking to pregnant women from ethnic minority groups with higher vaccine hesitancy.
The researchers also suggest training specific staff to act as vaccine champions and provide comprehensive and accurate information to pregnant women, particularly those who suggest complacency, perceiving they have a lower risk of risk of COVID-19 infection and severe disease. More broadly, pregnant women should also have access to vaccination at convenient times and locations, taking into account any barriers and sensitivities in particular communities.
Frimley Park Hospital based Consultant Obstetrician and Gynaecologist Dr Fatima Husain led the study alongside colleagues including Specialist Registrar Dr Veronica Powys, Dr Eleanor White and IT Specialist Midwife Roxanne Jones.
Dr Husain said: "The recommendations based on this study could improve both COVID-19 vaccine uptake and other routine immunisations, such as Pertussis and Influenza vaccines, during pregnancy. As a result of this survey, we have appointed vaccine champions at our hospital to inform women who may feel hesitant about vaccination."
She thanked Dr Jane Spring, retired Consultant in Obstetrics and Gynaecology, and the Vaccine team supported by Midwifery Screening Lead Katharine Franks in the antenatal clinics after this study’s findings and it is already making a difference.
The paper’s co-author, Dr Mohammad Razai, from the Population Health Research Institute at St George’s, said: “We hope that by sharing what we’ve learned, other healthcare professionals will consider how they can make sure that pregnant women receive information about vaccination from the most appropriate people.”
The researchers stress that the women who completed the survey may not be representative of the wider population of pregnant women. As the survey was voluntary it may have been completed by those who felt more comfortable with health professionals or vaccination in general.
The group also included comparatively fewer people of ethnic minorities (26%) than previous studies of COVID-19 vaccine uptake in pregnant women, which may have been another reason behind the comparatively high vaccination uptake.