COVID-19 vaccine acceptance low among mothers in SG

Pregnant and lactating women in Singapore generally have low acceptance of the COVID-19 vaccine due to safety concerns, reports a recent study.

“Factors affecting low vaccine acceptability among both pregnant and lactating women included a low perceived infection risk and concerns of unknown safety for the mother and child,” the researchers said. “Addressing safety concerns and infection risk may help improve COVID-19 vaccine acceptance among pregnant and lactating women in Singapore.”

An anonymous, online survey on the perception of the COVID-19 vaccine and its acceptance by pregnant and lactating women at a tertiary maternal and child hospital in Singapore was performed from 1 March 2021 to 31 May 2021. The research team collected data on participant demographics and knowledge. They then evaluated these factors for their association with vaccine acceptance.

Overall, 201 pregnant and 207 lactating women responded to the survey. Vaccine acceptance rates were 30.3 percent in pregnant women and 16.9 percent in lactating mothers. [Singapore Med J 2024;65:494-501]

For pregnant women who expressed uncertainty or were unwilling to receive the vaccine, their primary concern was safety of the vaccine during pregnancy (92.9 percent). For lactating mothers, they cited the potential long-term negative effects of vaccination on the breastfeeding child (75.6 percent).

The following factors showed a positive association with vaccine acceptance: lower monthly household income or education level, appropriate knowledge regarding vaccine mechanism, and higher perceived maternal risk of COVID-19.

Notably, most pregnant (70.0 percent) and lactating women (83.7 percent) were willing to be vaccinated only when they were provided with more safety data during pregnancy and breastfeeding.

Safety concern

Many studies found safety concerns of mothers about their child’s health or their own as the main reason why pregnant women and lactating mothers have low vaccine acceptance. [Am J Obstet Gynecol MFM 2021;3:100403; Int J Environ Res Public Health 2021;18:3367; MMWR Morb Mortal Wkly Rep 2021;70:895-899; Int J Gynecol Obstet 2021;154:291-296; Am J Obstet Gynecol MFM 2021;3:100399]

“Similarly, the lack of safety data of the COVID-19 vaccine was a significant factor affecting vaccine acceptability in our population,” the researchers said. 

“Pregnant women were concerned about general safety of the vaccine during pregnancy, while lactating mothers were concerned about the possible long-term side effects that the vaccine could have on their child,” they added.

The finding on safety concerns of the participants were not surprising, given that both pregnant and lactating women were not included in the initial mRNA-based vaccine trials, resulting in limited available data on safety and efficacy in this population.

However, observational data from other countries have demonstrated the safety of mRNA-based vaccines in pregnant and lactating women without any noticeable short- or medium-term adverse effect to the foetus or child. [Obstet Gynecol 2021;138:281-283; Am J Obstet Gynecol 2021;225:303.e1-17; N Engl J Med 2021;384:2273-2282; Breastfeed Med 2021;16:697-701; Breastfeed Med 2021;16:702-709]

“Dissemination of this safety and efficacy data in a timely manner is the key to increasing vaccine uptake in these populations,” the researchers said.