COVID-19 vaccination in pregnancy: views and vaccination uptake rates in pregnancy, a mixed methods analysis from SAIL and the Born-In-Wales Birth Cohort.

BACKGROUND: Vaccine hesitancy amongst pregnant women has been found to be a concern during past epidemics. This study aimed to (1) estimate COVID-19 vaccination rates among pregnant women in Wales and their association with age, ethnicity, and area of deprivation, using electronic health record (EHR) data linkage, and (2) explore pregnant women's views on receiving the COVID-19 vaccine during pregnancy using data from a survey recruiting via social media (Facebook, Twitter), through midwives, and posters in hospitals (Born-In-Wales Cohort). METHODS: This was a mixed-methods study utilising routinely collected linked data from the Secure Anonymised Information Linkage (SAIL) Databank (Objective 1) and the Born-In-Wales Birth Cohort participants (Objective 2). Pregnant women were identified from 13th April 2021 to 31st December 2021. Survival analysis was utilised to examine and compare the length of time to vaccination uptake in pregnancy, and variation in uptake by; age, ethnic group, and deprivation area was examined using hazard ratios (HR) from Cox regression. Survey respondents were women who had a baby during the COVID-19 pandemic or were pregnant between 1st November 2021 and 24th March 2022 and participating in Born-In-Wales. Codebook thematic analysis was used to generate themes from an open-ended question on the survey. RESULTS: Population-level data linkage (objective 1): Within the population cohort, 8203 (32.7%) received at least one dose of the COVID-19 vaccine during pregnancy, 8572 (34.1%) remained unvaccinated throughout the follow-up period, and 8336 (33.2%) received the vaccine postpartum. Younger women (< 30 years) were less likely to have the vaccine, and those living in areas of high deprivation were also less likely to have the vaccine (HR = 0.88, 95% CI 0.82 to 0.95). Asian and Other ethnic groups were 1.12 and 1.18 times more likely to have the vaccine in pregnancy compared with White women (HR = 1.12, 95% CI 1.00 to 1.25) and (HR = 1.18, 95% CI 1.03 to 1.37) respectively. Survey responses (objective 2): 207 (69%) of participants stated that they would be happy to have the vaccine during pregnancy. The remaining 94 (31%) indicated they would not have the vaccine during pregnancy. Reasons for having the vaccine included protecting self and baby, perceived risk level, and receipt of sufficient evidence and advice. Reasons for vaccine refusal included lack of research about long-term outcomes for the baby, anxiety about vaccines, inconsistent advice/information, and preference to wait until after the pregnancy. CONCLUSION: Potentially only 1 in 3 pregnant women would have the COVID-19 vaccine during pregnancy, even though 2 in 3 reported they would have the vaccination, thus it is critical to develop tailored strategies to increase its acceptance rate and decrease vaccine hesitancy. A targeted approach to vaccinations may be required for groups such as younger people and those living in higher deprivation areas.

Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: A 'born in Wales' mixed methods study using routine data.

BACKGROUND: Pregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the pandemic impact on pregnancy experience, rates of primary childhood immunisations and the differences in birth outcomes in during 2020 to those of previous years. METHODS: Self-reported pregnancy experience: 215 expectant mothers (aged 16+) in Wales completed an online survey about their experiences of pregnancy during the pandemic. The qualitative survey data was analysed using codebook thematic analysis. Population-level birth outcomes in Wales: Stillbirths, prematurity, birth weight and Caesarean section births before (2016-2019) and during (2020) the pandemic were compared using anonymised individual-level, population-scale routine data held in the Secure Anonymised Information Linkage (SAIL) Databank. Uptake of the first three scheduled primary childhood immunisations were compared between 2019 and 2020. FINDINGS: The pandemic had a negative impact on the mental health of 71% of survey respondents, who reported anxiety, stress and loneliness; this was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives. There was no significant difference in annual outcomes including gestation and birth weight, stillbirths, and Caesarean sections for infants born in 2020 compared to 2016-2019. There was an increase in late term births (≥42 weeks gestation) during the first lockdown (OR: 1.28, p = 0.019) and a decrease in moderate to late preterm births (32-36 weeks gestation) during the second lockdown (OR: 0.74, p = 0.001). Fewer babies were born in 2020 (N = 29,031) compared to 2016-2019 (average N = 32,582). All babies received their immunisations in 2020, but there were minor delays in the timings of immunisations. Those due at 8-weeks were 8% less likely to be on time (within 28-days) and at 16-weeks, they were 19% less likely to be on time. INTERPRETATION: Whilst the pandemic had a negative impact on mothers' experiences of pregnancy. Population-level data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic.

Population birth outcomes and experiences of expectant mothers during the COVID-19 pandemic in Wales: a mixed methods study

Background Pregnancy can be a stressful time and the COVID-19 pandemic is thought to have heightened maternal stress. This study aimed to investigate the effect of the COVID-19 pandemic on population birth outcomes, uptake of primary immunisations, and expectant mothers' experiences of pregnancy in Wales. Methods In this mixed methods study we analysed stillbirths, prematurity, birthweight and caesarean section births before (2016–19) and during (2020) the pandemic using national routine anonymised data held in the Secure Anonymised Information Linkage Databank. Uptake of the first three scheduled primary immunisations were compared between 2019 and 2020. Immunisations were extracted from the routinely collected data in the National Community Child Health Database. We compared percentages between years the ran χ2 with Yates correction for the three percentages given. Expectant mothers (aged ≥16 years) in Wales completed an online survey about their experiences of pregnancy during the pandemic. Inclusion criteria was being aged 16 years or older and living in Wales. The qualitative survey data was analysed using codebook thematic analysis. Ethical approval was granted by Swansea University Ethics Committee and each participant provided written consent before answering any survey questions. Findings There was no significant difference between annual outcomes including gestation and birthweight, stillbirths, and caesarean sections for infants born in 2020 compared with 2016–19. Difference in gestation (moderate to late preterm difference –0·26%, 95% CI –0·52% to –0·01%). Difference in low birthweight 0·13% (0·00% to 0·26%). Difference in stillbirths –0·01% (–0·02% to 0·00%). Difference in caesarean sections –0·42% (–1·13% to 0·29%). There was an increase in late-term births (≥42 weeks gestation) during the first lockdown (odds ratio [OR] 1·28, p=0·019) and a decrease in moderate to late preterm births (32–36 weeks gestation) during the second lockdown (OR 0·74, p=0·001). Fewer babies were born in 2020 (n=29 031) compared with 2016–19 (n=32 582;mean [SD 1561]). All babies received their immunisations in 2020, but there were minor delays in the timings of vaccines. Those vaccinations due at 8-weeks were 8% less likely to be on time (within 28 days) and, at 16-weeks, they were 19% less likely to be on time. The pandemic had a negative effect on the mental health of 151 (72%) of 211 survey respondents, who reported feeling anxious, nervous, or depressed;this finding was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives. Interpretation The COVID-19 pandemic had a negative effect on mothers' experiences of pregnancy;however, population data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic. Funding Health Care Research Wales