A scoping review of global COVID-19 vaccine hesitancy among pregnant persons
Imaima Casubhoy,
Alyssa Kretz,
Heang-Lee Tan,
Laura A. St Clair,
Maclaine Parish,
Hana Golding,
Susan J. Bersoff-Matcha,
Catherine Pilgrim-Grayson,
Leah Berhane,
Andrew Pekosz,
Heba H. Mostafa,
Andrea L. Cox,
Irina Burd,
Sabra L. Klein,
Rosemary Morgan
Affiliations
Imaima Casubhoy
Department of International Health, Johns Hopkins University Bloomberg School of Public Health
Alyssa Kretz
Department of International Health, Johns Hopkins University Bloomberg School of Public Health
Heang-Lee Tan
Department of International Health, Johns Hopkins University Bloomberg School of Public Health
Laura A. St Clair
W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health
Maclaine Parish
W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health
Hana Golding
Division of Viral Products, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration
Susan J. Bersoff-Matcha
Office of Women’s Health, U.S. Food and Drug Administration
Catherine Pilgrim-Grayson
Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine-Division of Urology, Obstetrics, and Gynecology, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration
Leah Berhane
Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine-Division of Urology, Obstetrics, and Gynecology, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration
Andrew Pekosz
W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health
Heba H. Mostafa
Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine
Andrea L. Cox
W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health
Irina Burd
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine
Sabra L. Klein
Department of International Health, Johns Hopkins University Bloomberg School of Public Health
Rosemary Morgan
Department of International Health, Johns Hopkins University Bloomberg School of Public Health
Abstract Uptake of the COVID-19 vaccine among pregnant persons is lower than the general population. This scoping review explored pregnant people’s attitudes towards the COVID-19 vaccine, reasons for vaccine hesitancy, and whether attitudes about COVID-19 vaccines differ by country of origin. A scoping review was conducted across PubMed, Embase, CINHAL, and Scopus. Inclusion criteria were articles published in English from 2019–2022 focused on attitudes towards COVID-19 vaccination among pregnant persons. Data analysis was done via the 5Cs framework for vaccine hesitancy: Constraints, Complacency, Calculation, Confidence, and Collective Responsibility. 44 articles were extracted. A lack of confidence in vaccine safety was the most prevalent theme of hesitancy among pregnant persons. This was largely driven by a lack of access to information about the vaccine as well as mistrust of the vaccine and medical professionals. Meanwhile, vaccine acceptance was mostly driven by a desire to protect themselves and their loved ones. Overall, COVID-19 vaccine hesitancy among pregnant persons continues to be high. Vaccine hesitancy is primarily driven by fear of the unknown side effects of the vaccine on pregnant persons and their fetuses along with a lack of information and medical mistrust. Some differences can be seen between high income and low- and middle-income countries regarding vaccine hesitancy, showing that a single solution cannot be applied to all who are vaccine hesitant. General strategies, however, can be utilized to reduce vaccine hesitancy, including advocating for inclusion of pregnant persons in clinical trials and incorporating consistent COVID-19 vaccine counseling during prenatal appointments.
