Safety of COVID-19 Vaccine a Concern for Pregnant Women

Concern about safety is the most common reason that pregnant women in Canada have not accepted the coronavirus vaccine, new research indicates.

A cross-sectional survey of 193 pregnant women found that the majority accepted the vaccine. The most common reason (89.1%) for acceptance was the desire to protect their family from the coronavirus.

"We really need to continue to explore what can be done to help support pregnant people in their vaccine decision-making and make the process of vaccination as easy as possible for them," lead author Laura Reifferscheid, RN, a PhD candidate at the University of Alberta in Edmonton, Canada, told Medscape Medical News.

The study was published online April 27 in the Canadian Journal of Public Health.

Safety vs Sickness

Pregnant people who are infected with SARS-CoV-2 have increased risk of morbidity and mortality, compared with people who are not pregnant. Adverse outcomes in this population have included preeclampsia and preterm birth.

The current researchers conducted a web-based survey from May 28 through June 7, 2021 to provide a "snapshot" of attitudes about the COVID-19 vaccine among pregnant women in Canada, said Reifferscheid. The survey included 193 pregnant women, of whom 57.5% (n = 110) had received or planned to get the vaccine.

"There are many factors involved in vaccine decision-making during pregnancy," said Reifferscheid. "Overwhelmingly, safety is the biggest concern among people who got the vaccine, as well as people who didn’t get it."

Focusing on the 81 survey respondents who said they wouldn't get the vaccine, 73 (90.1%) of them cited concerns over vaccine safety — specifically the risk of potential harm to themselves or their fetus — and 66 (81.5%) said the vaccine had been developed too quickly because of the pandemic. Other reasons they gave for not getting the vaccine were the newness of the vaccine (77.8%, n = 63), concerns that it won't work (22.2%, n = 18) and a lack of trust in vaccines in general (13.6%, n = 11).

Conversely, the 110 survey respondents who either got or intended to get the vaccine offered these reasons for their decision: to protect their family and themselves from COVID-19 (89%, n = 98; and 88.1%, n = 97, respectively); to end the pandemic and return to normal life (57%, n = 63); and to prevent community spread (53.7%, n = 59). A much smaller percentage, 13.6% (n = 15), said their decision was based on recommendations from experts or healthcare providers.

"When we took a look at the association between different perceptions about the vaccine and vaccine acceptance, we found that concerns about safety definitely outweighed the concerns about getting sick from the virus," Reifferscheid said.

The study also identified factors associated with vaccine acceptance. In a multivariate analysis, women who self-identified as Indigenous; those employed in a high-risk occupation other than healthcare; and those who had confidence in COVID-19 vaccine safety (as opposed to being neutral or disagreeing that the vaccines were safe), were the only significant factors. Sociodemographic characteristics, having a self-reported chronic illness, or perceiving a barrier to vaccine access were not associated with vaccine acceptance.

Messaging Matters

At the time the survey was circulated, the "safety information was still pretty limited," said Reifferscheid. In December 2020, Canada's National Advisory Committee on Immunization (NACI) issued an advisory that pregnant women shouldn't be offered the COVID-19 vaccine unless individual benefits were deemed to outweigh the risks. A month later, NACI said pregnant women could get the vaccine. In May 2021, NACI recommended that pregnant women get the mRNA vaccine.

"We know there was still a lot of confusion and hesitancy, not just among pregnant people, but also among vaccine providers about whether they should offer the vaccine to pregnant people or not, and even about how to talk to them about the vaccine," Reifferscheid added.

The study offers insights about the latter question, she continued. "Any messaging about vaccination during pregnancy needs to be really clear not just about safety for the individual, but also for the fetus and child," said Reifferscheid.

Messaging also needs to be clear about the benefits of vaccination — "what the disease risk is to both the mother and their fetus is and how effective the vaccine is at reducing those risks," she said.

The way in which the message is delivered is also important. "It's not useful to be judgmental or preachy about vaccinations," Reifferscheid said. "Pregnant people are exposed to conflicting information all the time about what is safe and what is not safe during pregnancy, so it's totally fair for them to have questions or concerns and it's totally fair to expect conversations around those questions and concerns."

In general, clinicians can communicate effectively by focusing on the benefits of getting the vaccine (rather than the risks of not getting it), understanding that the health of the fetus is a pregnant woman's primary concern, and refraining from judgment about the patient's choice, according to the researchers.

A Greater Willingness?

Recent unpublished research from the International COVID-19 Awareness and Responses Evaluation (iCARE) study has shown a greater willingness of pregnant women in Canada to get the COVID-19 vaccine, said Eva Suarthana, MD, PhD, a research physician in reproductive epidemiology at McGill University in Montreal, Canada, and an iCARE collaborator.

The iCARE study surveyed more than 100,000 participants. "Between June 2021 and February 2022, we had 289 participants who identified themselves as pregnant during the survey," Suarthana said. "The percentages of the vaccinated pregnant participants were consistently above 80% over time," she said. "Vaccinated" was defined as having one or two doses of a two-dose vaccine or one dose of single-dose vaccine.

"The good news is that this uptake is much higher than the 57.5% reported COVID-19 vaccine acceptance from the survey by Reifferscheid and colleagues," Suarthana said.

The Canadian Institutes of Health Research funded the study. Reifferscheid and Suarthana have disclosed no relevant financial relationships.

Can J Public Health. Published online April 27, 2022. Full text

Richard Mark Kirkner is a medical journalist based in suburban Philadelphia.

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