Perceptions of COVID-19 Vaccination During Pregnancy in a Cohort of US Adults (CHASING COVID) in 2023.

Objective: Pregnant women are at higher risk of severe COVID-19, and vaccination significantly reduces the risk of severe infection. Despite its benefits, only 13% of pregnant women in the U.S. had received the updated 2024-25 vaccine by December 2024, with uptake varying across sociodemographic groups. This study examines perceptions on COVID-19 vaccination during pregnancy among U.S. adults enrolled in the Chasing Covid Cohort, analyzing responses across 16 surveys between March 2020 and December 2023 (N=4488). Methods: Key variables included sociodemographic characteristics, susceptibility to severe COVID-19 disease, perceived worry about COVID-19, individual and household vaccination status, symptoms of anxiety and depression, trusted information sources, and having a regular healthcare provider. Perceptions of vaccine safety and efficacy during pregnancy were measured using five Likert-scale statements, categorized into agreement, uncertainty, and disagreement. Exploratory factor analysis identified two constructs-safety and efficacy-which were analyzed in relation to participant characteristics using bivariate analysis and chi-square tests, and multivariable robust Poisson regression models. Results: Among all respondents and women of reproductive age, less than half (40%) perceived the COVID-19 vaccine as safe during pregnancy, and just over half recognized its efficacy. Individuals with a personal physician and those who trusted public health institutions or healthcare providers were more inclined to agree with the vaccine's safety and efficacy. Conclusions: These findings highlight the influence of demographic factors on vaccine perceptions, the potential impact of social networks during pregnancy, and the critical role of trust in public health institutions in promoting vaccine uptake.