COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy

Eight Integrated Health Care Organizations, United States, December 14, 2020-May 8, 2021

Hilda Razzaghi, PhD; Mehreen Meghani, MPH; Cassandra Pingali, MPH, MS; Bradley Crane, MS; Allison Naleway, PhD; Eric Weintraub, MPH; Tat'Yana A. Kenigsberg, MPH; Mark J. Lamias; Stephanie A. Irving, MHS; Tia L. Kauffman, MPH; Kimberly K. Vesco, MD; Matthew F. Daley, MD; Malini DeSilva, MD; James Donahue, DVM, PhD; Darios Getahun, MD, PhD; Sungching Glenn, MS; Simon J. Hambidge, MD, PhD; Lisa Jackson, MD; Heather S. Lipkind, MD; Jennifer Nelson, PhD; Ousseny Zerbo, PhD; Titilope Oduyebo, MD; James A. Singleton, PhD; Suchita A. Patel, DO

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(24):895-899. 

In This Article

Abstract and Introduction

Introduction

COVID-19 vaccines are critical for ending the COVID-19 pandemic; however, current data about vaccination coverage and safety in pregnant women are limited. Pregnant women are at increased risk for severe illness and death from COVID-19 compared with nonpregnant women of reproductive age, and are at risk for adverse pregnancy outcomes, such as preterm birth.[1–4] Pregnant women are eligible for and can receive any of the three COVID-19 vaccines available in the United States via Emergency Use Authorization.* Data from Vaccine Safety Datalink (VSD), a collaboration between CDC and multiple integrated health systems, were analyzed to assess receipt of ≥1 dose (first or second dose of the Pfizer-BioNTech or Moderna vaccines or a single dose of the Janssen [Johnson & Johnson] vaccine) of any COVID-19 vaccine during pregnancy, receipt of first dose of a 2-dose COVID-19 vaccine (initiation), or completion of a 1- or 2-dose COVID-19 vaccination series. During December 14, 2020–May 8, 2021, a total of 135,968 pregnant women were identified, 22,197 (16.3%) of whom had received ≥1 dose of a vaccine during pregnancy. Among these 135,968 women, 7,154 (5.3%) had initiated and 15,043 (11.1%) had completed vaccination during pregnancy. Receipt of ≥1 dose of COVID-19 vaccine during pregnancy was highest among women aged 35–49 years (22.7%) and lowest among those aged 18–24 years (5.5%), and higher among non-Hispanic Asian (Asian) (24.7%) and non-Hispanic White (White) women (19.7%) than among Hispanic (11.9%) and non-Hispanic Black (Black) women (6.0%). Vaccination coverage increased among all racial and ethnic groups over the analytic period, likely because of increased eligibility for vaccination and increased availability of vaccine over time. These findings indicate the need for improved outreach to and engagement with pregnant women, especially those from racial and ethnic minority groups who might be at higher risk for severe health outcomes because of COVID-19.[4] In addition, providing accurate and timely information about COVID-19 vaccination to health care providers, pregnant women, and women of reproductive age can improve vaccine confidence and coverage by ensuring optimal shared clinical decision-making.

VSD is a collaboration between CDC's Immunization Safety Office and nine integrated health care organizations in seven U.S. states; eight sites provide data and one additional site provides subject matter expertise.§ Among the eight sites providing data, the integrated health care organizations serve 11.6 million insured persons, including approximately 2.7 million women aged 18–49 years. To monitor vaccination coverage and safety, CDC obtains COVID-19 vaccination data from the VSD sites' electronic health records, health insurance claims, and state immunization information systems. A dynamic pregnancy algorithm, based on International Classification of Diseases, Tenth Edition (ICD-10) diagnosis codes, procedure codes, estimated dates of delivery, and last menstrual period dates from electronic health records was used to identify pregnancies weekly.[5] Because the algorithm identifies pregnancies based on coded health care utilization data, pregnancies are generally identified at approximately 8–10 weeks' gestational age. COVID-19 vaccination status was captured for all pregnant women identified from December 14, 2020, when the first COVID-19 vaccine received Emergency Use Authorization, through May 8, 2021. This analysis focused on COVID-19 vaccination during pregnancy. Pregnant women who completed vaccination before pregnancy (1,073) were excluded from this study to ascertain willingness of women to receive the COVID-19 vaccine while pregnant. Receipt of ≥1 dose of a COVID-19 vaccine was defined as receipt of either first or second dose of the Moderna or Pfizer-BioNTech vaccines or receipt of a single dose of the Janssen vaccine during pregnancy. Vaccination initiation was defined as receipt of the first dose of the Moderna or Pfizer-BioNTech vaccines during pregnancy. Vaccination completion was defined as receipt of the second dose (for women who received the first dose before pregnancy) or both doses of Moderna or Pfizer-BioNTech vaccines or 1 dose of Janssen vaccine during pregnancy. COVID-19 vaccination initiation and completion during pregnancy were estimated by age, race and ethnicity, and vaccine type. All analyses were performed using SAS software (version 9.4; SAS Institute). This activity was reviewed by CDC and VSD sites and was conducted consistent with applicable federal law and CDC policy.

A total of 135,968 pregnant women were identified in VSD during December 14, 2020–May 8, 2021 (Table). Among pregnant women, race and ethnicity data were complete for 93.8% and age data were complete for 100%. White women accounted for 34.0% of pregnancies, and Hispanic women for 32.9%. A larger proportion of pregnant Hispanic women were aged 18–24 years (47.4%) compared with pregnant White (25.4%) and Asian (3.9%) women. Among pregnant women, 16.3% received ≥1 dose of a COVID-19 vaccine; 5.3% initiated, and 11.1% completed vaccination during pregnancy. Vaccination increased with age, with highest rates of ≥1 dose observed among women aged 35–49 years (22.7%) and lowest rates among those aged 18–24 years (5.5%). Receipt of ≥1 dose was highest among Asian women (24.7%), followed by White women (19.7%), and lowest among Black women (6.0%) and Hispanic women (11.9%). The highest rates of receipt of ≥1 dose during pregnancy were reported for Pfizer-BioNTech (8.7%), followed by Moderna (7.0%), and Janssen (0.6%) vaccines. Cumulative receipt of ≥1 dose of a COVID-19 vaccine during pregnancy has increased weekly since March 13, 2021, (when these data were first reported to CDC) among all pregnant women and across all racial and ethnic groups (Figure).

Figure.

Cumulative COVID-19 vaccination coverage (receipt of ≥1 dose*) among pregnant women, overall and by race and ethnicity§ — Vaccine Safety Datalink, United States, March 13–May 8, 2021
Abbreviation: NH = non-Hispanic.
*Receipt of first or second dose of the Pfizer-BioNTech or Moderna vaccines or a single dose of the Janssen (Johnson & Johnson) vaccine.
All pregnant women identified in the Vaccine Safety Datalink during December 14, 2020–May 8, 2021. These estimates do not exclude pregnant women who completed COVID-19 vaccination before pregnancy.
§"Other, NH" includes American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and Multiple or Other races.
Cumulative vaccination data from the Vaccine Safety Datalink were first reported to CDC on March 13, 2021, and included vaccines administered since December 14, 2020; thus, data reported during December 14, 2020–March 12, 2021, could not be displayed by week.

*https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e2.htm
§ https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/
45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

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