How Has Pregnancy Affected Vaccine Decisions?

There were plenty of unknowns earlier on in the COVID-19 pandemic, making the choice around vaccination a trickier one for pregnant Canadians.


When making the decision to get vaccinated against COVID-19, one of the main deciding factors for many people is knowing that vaccinations will help prevent viral transmission. This, in conjunction with data showing very low rates of adverse effects in healthy individuals, makes vaccination an easy decision for most adults.

Yet for women who were pregnant during the pandemic, getting vaccinated held the extra weight of knowing their decision could directly impact the health of their unborn infant. Pregnancy is a time in one’s life when everything from diet to medication is heavily scrutinized and regulated to ensure the health and safety of the infant.

On the one hand, severe SARS-CoV-2 infection has the potential to be very damaging to the growth and development of an infant. On the other hand, COVID-19 vaccines are relatively new, and at least at the beginning of the pandemic, potential adverse effects related to pregnancy were not studied in heavy detail.

This is why Laura Reifferscheid, a PhD student in the University of Alberta‘s Faculty of Nursing, was interested in learning about the factors influencing vaccine acceptance and uptake among pregnant women in Canada. Reifferscheid is a student in the lab of Dr. Shannon E. MacDonald, whose research focuses on collecting evidence to support best immunization practices and policies.

In this study, Reifferscheid and colleagues conducted a cross-national survey of almost 200 women, asking questions related to vaccine hesitancy, safety, acceptance, and outcomes. The survey was undertaken in 2021, and the study was recently published in the Canadian Journal of Public Health.

What did pregnant Canadians have to say?

Reifferscheid and colleagues used a national polling company to distribute their survey to over 400,000 Canadians. The end pool of 193 respondents made up a representative sample of Canada’s political and geographical distribution.

In addition to asking questions about vaccine acceptance, they also explored the sociodemographic identities of participants and the rationale surrounding vaccine-related decisions.

The researchers found that approximately 57.5% of women were classified as “vaccine acceptant”, determined by either having already received the COVID-19 vaccine, or having the intent to receive the vaccine while pregnant. On the other hand, 7.8% of participants had no intention of receiving the vaccine, while the remaining 34.7% indicated that they would either receive the vaccine after giving birth or were undecided about receiving it at all.

What was the driving force in vaccine acceptance?

Interestingly, the strong recommendations from the government and the National Advisory Committee on Immunization (NACI) for pregnant women to receive the vaccine had little to do with the majority of participants choosing to get vaccinated. Instead, most women cited a desire to protect themselves and their loved ones from severe disease as motivating factors.

Safety and concern for personal health and for the infant’s health were also top of the list of reasons for participants who chose not to get vaccinated. 90.1% of women who were either undecided or had no intention of getting vaccinated indicated that they weren’t confident in the safety of the available COVID-19 vaccines. These views seemed to be specific to COVID-19 vaccines, as only 13% of this group indicated a mistrust of vaccines in general.

Where do we go from here?

Although the majority of pregnant women polled in this study had either already been vaccinated or indicated that they intended to be vaccinated soon, and this study reported a higher vaccine uptake among pregnant women compared to others, it was still important to these researchers to identify areas where vaccine uptake and acceptance could be improved in the pregnant population.

For example, although many studies have shown that COVID-19 vaccines are safe and effective, few studies have examined in detail short and long-term effects of these vaccines on pregnant women and their infants. This is especially important, given that COVID-19 vaccines have set the precedent for widespread use of mRNA vaccines.

Furthermore, this study found that recommendation from a healthcare provider was among the top three reasons for vaccine acceptance in pregnant women. This highlights the importance of understanding patient-healthcare provider relationships, and which factors influence healthcare provider recommendations.

When COVID-19 vaccines became publicly available in Canada, NACI initially stated that pregnant women should not take the vaccine. This was updated a few weeks later to say that pregnant women actually should get vaccinated, indicating that the risk of adverse effects associated with severe COVID-19 disease outweighed any risk of vaccine-induced adverse reactions.

To date, research has shown that COVID-19 vaccination is safe and effective in both pregnant and non-pregnant people. There is also no evidence to indicate that vaccination causes fertility problems in either men or women.

However, as this study by Reifferscheid and colleagues has shown, the decision to get vaccinated is based on many factors in addition to vaccine safety. Consideration of all of these factors in tandem should be encouraged when it comes to public immunization programs and policies.

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Salma is a PhD student in the Department of Immunology at the University of Toronto, where she also completed her MSc and HBSc. She is passionate about equity, accessibility and transparency in science, and is excited about helping highlight Canadian research!