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Covid-19: Vaccine uptake during pregnancy has increased but deprived areas lag behind, data show

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2932 (Published 26 November 2021) Cite this as: BMJ 2021;375:n2932

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  1. Elisabeth Mahase
  1. The BMJ

No fully vaccinated pregnant women were admitted to intensive care with covid-19 in England between February and the end of September 2021, the UK Health Security Agency (UKHSA) has reported.

The agency also carried out an analysis of women who gave birth up to August 2021 and found there was a similar very low risk of stillbirth, prematurity, and low birth weight in vaccinated and unvaccinated women.

UKHSA head of immunisation Mary Ramsay said, “Every pregnant woman who has not yet been vaccinated should feel confident to go and get the jab, and that this will help to prevent the serious consequences of catching covid-19 in pregnancy. This accumulating evidence will also allow midwives and other health professionals to provide better information to pregnant women and help to drive uptake higher.”

Covid-19 during late stages of pregnancy has been linked to an increased risk of severe disease requiring hospital and intensive care admission, and unvaccinated pregnant women have been found to have a substantially higher risk of needing hospital treatment for covid than those who are vaccinated. Between February and September 2021, 98% of the 1714 pregnant women admitted to hospital with symptomatic covid were unvaccinated.1

The UKHSA’s latest surveillance report2 showed that between January and August 2021 a total of 355 299 women gave birth, of whom 24 759 (22%) had received at least one dose of covid-19 vaccine before delivery. But while vaccine coverage in the pregnant population is increasing, uptake in younger women, those in the most deprived areas, and in ethnic minority communities, particularly in black women, still lags.

Data show that women living in the most deprived areas in England were the least likely (7.8% uptake) to have been vaccinated with at least one dose of covid-19 vaccine before they gave birth, with those in the least deprived areas the most likely (26.5%). In terms of ethnicity, black pregnant women were the least likely to be vaccinated at the time of birth (5.5%), followed by women of Asian ethnicity (13.5%) and mixed ethnicity (14%). This compared with white women at 17.5%.

Looking at birth outcomes, the analysis found that the stillbirth rate for vaccinated women who gave birth was around 3.35 per 1000, compared with 3.60 for unvaccinated women. For low birthweight, 5.36% of unvaccinated women experienced this compared with 5.28% in vaccinated women.

The proportion of premature births was 6.51% for vaccinated and 5.99% for unvaccinated women. The UKHSA said the “small differences” between groups could be explained by differences in the women eligible for and taking up the vaccine, as women first eligible for vaccination were more likely to be older and to have an underlying medical condition—putting them at higher general risk of certain pregnancy outcomes, such as prematurity.

BMA interim representative body chair Latifa Patel said, “Some 98% of pregnant women who go into hospital with covid have not been vaccinated. This shows clearly how important it is to be protected against the virus. Pregnant women must be able to have a conversation with a healthcare professional they trust about the risks of not having the vaccine. Women must be allowed to raise their concerns and talk personally about their own situation, and know that their healthcare professional will give them the time that they need.

“We also call on the government and UKHSA to ensure that all communication about vaccination in pregnancy is clear, targeted, open, and accessible so that women can feel confident in their decision making.”

The BMJ asked UKHSA whether the dataset included transgender men who had given birth over this period, but received no response.

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