COVID-19 Vaccine Attitudes Among Pregnant Women Receiving the Tdap Booster Suggest Differences by Age, Race, Insurance Type, and Education Level

Thumbnail Image



Journal Title

Journal ISSN

Volume Title


The Ohio State University

Research Projects

Organizational Units

Journal Issue


Introduction: Routine vaccinations of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine prevent the spread of Pertussis or whopping cough caused by the bacterial pathogen Bordetella pertussis. Current recommendations encourage pregnant women to receive the Tdap booster vaccine during each pregnancy in the third trimester (27-36 weeks) regardless of prior pregnancies. However, COVID-19 pandemic disruptions in the healthcare system and risks for COVID-19 infections have prompted pregnant women to consider the timing of routine vaccinations in the background of the COVID-19 pandemic. It is important to study how attitudes toward acceptance of the COVID-19 vaccine are reflected in the demographics and timing of pregnant women accepting a Tdap booster vaccine. Methods: In our study, pregnant women at two OB-GYN medical centers in Ohio completed a questionnaire prior to receiving a Tdap booster vaccination which collected data on race/ethnicity, age, vaccination history, and attitudes toward the benefits and risks of COVID-19 vaccination from January 27th, 2021- July 19th, 2022. The COVID-19 vaccine was available to pregnant women at these medical centers starting on March 4th, 2021, and the COVID-19 immunization record was collected with IRB approval. Results: All pregnant women who completed the survey received the Tdap vaccine, however, the proportion of pregnant women who expressed hesitancy to receiving the COVID-19 vaccine during their pregnancy was similar to those who were willing to receive the COVID-19 vaccine (48.3% vs 51.7%). This COVID-19 vaccine hesitancy was significantly correlated with not receiving the COVID-19 vaccine during the pregnancy or post-partum period (Fisher's exact test, p<0.00001). Of the pregnant individuals who eventually received the Tdap vaccine, (55.38%) received the primary COVID-19 vaccine series during pregnancy or in the post-partum period, and (47.62%) of these pregnant women did not receive the COVID-19 vaccine. The demographics associated with lower COVID-19 receipt were an education of a 12th-grade equivalent or less, public health insurance, an age younger than 24 years, and African American race. Among pregnant women who received both the COVID-19 vaccine and Tdap booster vaccines, (81.4%) of pregnant women received the COVID-19 vaccine prior to study enrollment and receipt of the Tdap booster. The first COVID-19 vaccine of the primary series was received on average 68 days prior to study enrollment (SD=66) and on average 81 days before the Tdap vaccine (SD= 67). Conclusions: All women received a Tdap booster as part of enrollment in the study, however, attitudes toward COVID-19 vaccination were polarized by age, race, education level, and health insurance type. This suggests that COVID-19 vaccine attitudes are distinct from general hesitancy to vaccines such as Tdap. Furthermore, the majority of women who received both vaccines appeared to prioritize the receipt of the COVID-19 vaccine over the Tdap vaccine in the timing of receipt. Continued outreach in these target demographic populations where low COVID-19 vaccination rates are evident is critical to protect the mother and infant.



vaccines, pregnancy, COVID-19, Tdap, hesitancy