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Objective This study aimed to evaluate the rates of vaccination against infectious diseases (Tetanus, Diphtheria, and Pertussis [Tdap] and influenza) in pregnancy during the coronavirus disease 2019 (COVID-19) pandemic compared to contemporary historical controls.

Study Design This was a retrospective cohort study comparing rates of Tdap and influenza vaccination in pregnant people who received care at NYU Langone Health and delivered from September 1, 2020, to January 31, 2021 (“COVID cohort”) to the same period the prior year (“2019 cohort”). Demographic information, trimester of initiation of prenatal care, insurance status, and medical comorbidities were evaluated. Outcomes were analyzed using chi-square, Fisher's exact test, and multivariable logistic regression, with significance of p < 0.05.

Results In total, 1,713 pregnant people were included. Compared to historical controls, the COVID cohort differed in age, race, timing of initiation of prenatal care, insurance status, and medical comorbidities. After adjusting for these covariates, pregnant people were significantly more likely to accept influenza vaccine in the COVID cohort (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.27–2.29) and had similar Tdap acceptance (aOR 1.5, 95% CI 0.99–2.17). However, this trend was not observed for the entire obstetric population; public insurance status and medical comorbidities were associated with lower vaccine rates during the pandemic. For those who had public insurance, rates of influenza vaccination decreased from 83% in 2019 to 40% during COVID (aOR 0.16, 95% CI 0.10–0.24) and for Tdap rates decreased from 93 to 54% (aOR 0.13, 95% CI 0.08–0.21).

Conclusion During the COVID-19 pandemic era, pregnant people at large were more likely to accept the influenza vaccine. However, this trend did not apply to Tdap, and high-risk groups with public insurance and medical comorbidities. This study highlights potential disparities in vaccination rates, which need to be accounted for when evaluating national vaccine trends. These data support increased efforts in vaccine counseling for high-risk populations.

Key Points

Antenatal flu vaccination increased during the pandemic.

Antenatal Tdap vaccination was unchanged during the pandemic.

High-risk pregnant patients had decreased vaccine uptake.

High-risk subgroups were not included in overarching vaccination trends.

Keywords coronavirus - influenza - maternal immunity - pandemic - health care disparities - pregnancy - Tdap - vaccination Publication History

Received: 05 January 2023

Accepted: 06 October 2023

Accepted Manuscript online:
10 October 2023

Article published online:
21 November 2023

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