• Devon Greyson, Rebecca Correia, Michelle Howard, Elizabeth K Darling, David Kirkwood, Amie Davis, Caroline Mniszak, Aaron Jones, Monica Molinaro, and Meredith Vanstone.
• School of Population and Public Health (Greyson, Mniszak), University of British Columbia; Vaccine Evaluation Center (Greyson), British Columbia Children's Hospital Research Institute, Vancouver, BC; Department of Family Medicine (Correia, Howard, Davis, Molinaro, Vanstone), and Department of Obstetrics and Gynecology (Darling), and ICES McMaster (Darling, Jones), and Department of Health Research Methods, Evidence and Impact (Darling, Jones), McMaster University, Hamilton, Ont.; Institute for Health Sciences Education (Kirkwood, Molinaro), McGill University, Montréal, Que.; Centre for Health Economics and Policy Analysis (Vanstone), McMaster University, Hamilton, Ont. devon.greyson@ubc.ca.
• CMAJ. 2024 Sep 30; 196 (32): E1100E1113E1100-E1113.

BackgroundHesitancy about vaccination during pregnancy posed challenges to SARS-CoV-2 vaccination efforts. We aimed to examine rates of SARS-CoV-2 vaccination among Ontario residents who gave birth in early 2022, and to compare rates of SARS-CoV-2 vaccine uptake with rates of tetanus, diphtheria, and pertussis (Tdap) and influenza vaccination during pregnancy in 2019, 2021, and 2022.MethodsWe conducted a population-based retrospective cohort study to describe vaccination rates among pregnant and comparable nonpregnant populations in Ontario using linked administrative data. Provincially insured females who had a live, in-hospital birth from Jan. 1 to Mar. 31 in 2019, 2021, or 2022 were our primary cohort. Using log-binomial regression, we tested associations between SARS-CoV-2 (2022) and Tdap and influenza (2019, 2021, 2022) vaccination status, with birth group and covariates. We compared SARS-CoV-2 vaccination status with the status of a matched cohort of nonpregnant females and conducted subgroup analyses by age and prenatal clinician type.ResultsAmong birthing people, 78.7% received their first SARS-CoV-2 vaccine dose and 74.2% received a second dose. The rate was significantly higher among nonpregnant comparators (dose 1: relative risk [RR] 0.94, 95% confidence interval [CI] 0.93-0.94; dose 2: RR 0.91, 95% CI 0.90-0.91). However, the rate of SARS-CoV-2 vaccination uptake among birthing people was higher than uptake of Tdap or influenza vaccination. Tetanus, diphtheria, and pertussis vaccination increased over time from 22.2% in 2019 to 32.6% in 2022, and influenza vaccination rose to 35.3% in 2021 but returned to prepandemic levels in 2022 (27.7%). Vaccination rates were lower among pregnant people who were young, multiparous, or residents of rural or economically deprived areas for all 3 vaccines.InterpretationRates of SARS-CoV-2 vaccination were lower among pregnant people than among nonpregnant comparators but were higher than rates of routinely recommended Tdap and influenza vaccinations. Pandemic urgency may have overcome a great deal of hesitancy about vaccinating against SARS-CoV-2 during pregnancy in 2022, but uptake of routinely recommended vaccines in pregnancy remains a challenge.Trial RegistrationClinicaltrials.gov, no. NCT05663762.© 2024 CMA Impact Inc. or its licensors.

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