Factors associated with adherence to the COVID-19 vaccine in pregnant women

cross-sectional and analytical study with 348 postpartum women in shared accommodation at the Municipal Maternities of Recife-PE. Data was collected through interviews during the months of June to September 2022. Pearson’s Chi-Square or Fisher’s Exact tests and the Poisson regression model were applied for statistical analysis.

Results:

17.2% of pregnant women adhered to the complete vaccination schedule, and adherence was associated with access to the internet/TV/radio (p-value = 0.011), routine prenatal vaccination (p-value = 0.019), safety of the efficacy of the COVID-19 vaccine and partner support (p-value = 0.020). Postpartum women without access to the internet/TV/radio, and who feel confident about the effectiveness of the vaccine, had higher prevalence rates for adhering to COVID-19 vaccination, with PRs of 2.56 and 3.25, respectively.

Conclusion:

there was evidence of low adherence to the vaccination schedule against COVID-19 during the gestational period, considering the number of recommended doses and the interval between them. Therefore, professionals in their clinical practice must make pregnant women aware of the importance of immunization and compliance with the vaccination schedule.

Descriptors:
Pregnant Women; Pandemics; SARS-CoV-2; Immunization Programs; COVID-19 Vaccines; Vaccination Coverage

Highlights:

(1) Maternal vaccination plays a significant role in preventing and combating maternal morbidity.

(2) Some factors may influence acceptance or hesitancy of the COVID-19 vaccine during pregnancy.

(3) Safety regarding the effectiveness of vaccination against COVID-19 during pregnancy is a factor associated with adherence to COVID-19 vaccines.

(4) Postpartum women without access to the internet/TV/radio have 2.56 times the risk of adhering to the COVID-19 vaccination schedule.

(5) Health education helps to increase the level of knowledge and acceptance of the vaccine by pregnant women.

Variables	n	%	*p-value ^ * p-value of the Chi-square test for proportion comparison;**
Application of the COVID-19 vaccine
Yes	331	95.1	<0.001
No	17	4.9
Start of the vaccination schedule
Before pregnancy	281	80.7	<0.001
During pregnancy	50	14.4
Not applicable	17	4.9
Type of vaccine administered during pregnancy
Pfizer	209	60.1	<0.001
Sinovac	40	11.5
Pfizer and Sinovac	13	3.7
Others	10	2.9
Not applicable	76	21.8
Number of doses recorded on the vaccination card ^† † Number of observations is smaller than the sample size, as some participants did not respond to the evaluated item
1 ^st dose	29	8.8	-
2 ^nd dose	145	43.8
3 ^rd dose (booster)	152	45.9
4 ^th dose (2 ^nd booster)	5	1.5
Postpartum women with a primary regimen able to receive the booster dose ^† † Number of observations is smaller than the sample size, as some participants did not respond to the evaluated item
Yes	115	80.4	<0.001
No	28	19.6
Difficulty scheduling the vaccine ^† † Number of observations is smaller than the sample size, as some participants did not respond to the evaluated item
Yes	13	3.8	<0.001
No	333	96.2
Difficulty accessing the vaccine ^† † Number of observations is smaller than the sample size, as some participants did not respond to the evaluated item
Yes	22	6.4	<0.001
No	324	93.6
Adherence to the COVID-19 vaccination schedule
Yes	61	17.5	<0.001
No	287	82.5
Reason for non-adhesion
Insufficient number of doses	174	60.7	-
Interval higher than recommended	96	33.4
Did not take any doses	17	5.9

Variables of access to information and personal experience	Adherence to the vaccination schedule		p-value
	YES	NO	p-value
Safety regarding the effectiveness of vaccination against COVID-19 during pregnancy
Yes	54(22.2%)	189(77.8%)	*<0.001 ^ * p-value of the Chi-square test for independence;**
No	7(6.7%)	98(93.3%)
Guidance on the vaccine to prevent COVID-19 during prenatal consultations
Yes	46(18.9%)	197(81.1%)	0.296 ^* * p-value of the Chi-square test for independence;
No	15(14.3%)	90(85.7%)
Confidence in the guidance received during prenatal care
Yes	19(19.0%)	81(81.0%)	1.000 ^† † p-value of Fisher’s Exact test;
No	4(18.2%)	18(81.8%)
Vaccination reduces the risk of hospital admission/complications ^‡ ‡ Number of observations is smaller than the sample size, as some participants did not respond to the evaluated item
Yes	55(19.4%)	229(80.6%)	0.063 ^* * p-value of the Chi-square test for independence;
No	6(9.5%)	57(90.5%)
Concern about the occurrence of a reaction or adverse effects from the vaccine ^‡ ‡ Number of observations is smaller than the sample size, as some participants did not respond to the evaluated item
Yes	30(16.1%)	156(83.9%)	0.430 ^* * p-value of the Chi-square test for independence;
No	31(19.4%)	129(80.6%)
Fear of pregnancy complications after the COVID-19 vaccine
Yes	15(12.9%)	101(87.1%)	0.093 ^* * p-value of the Chi-square test for independence;
No	46(20.3%)	181(79.7%)
Partner support to take the vaccine ^‡ ‡ Number of observations is smaller than the sample size, as some participants did not respond to the evaluated item
Yes	48(21.0%)	181(79.0%)	0.020 ^* * p-value of the Chi-square test for independence;
No	11(10.5%)	94(89.5%)
Useful media and social networks to clarify doubts about vaccination
Yes	49(17.9%)	225(82.1%)	0.738 ^* * p-value of the Chi-square test for independence;
No	12(16.2%)	62(83.8%)
Presence of people vaccinated against COVID-19 at home
Yes, all	49(18.4%)	218(81.6%)	0.929 ^† † p-value of Fisher’s Exact test;
Yes, most	9(15.5%)	49(84.5%)
Yes, few	2(12.5%)	14(87.5%)
No	1(14.3%)	6(85.7%)

Variables	PR ^* * PR = Prevalence ratio;	CI ^† † CI = Confidence interval; (95%)	p-value ^‡ ‡ p-value of the Wald test
Access to the internet, TV, radio
Yes	1.00
No	2.56	1.41 – 4.66	0.002
Safety regarding the effectiveness of vaccination against COVID-19 during pregnancy
Yes	3.25	1.54 – 6.86	0.002
No	1.00

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Conflict of interest: the authors have declared that there is no conflict of interest.