Pregnant women's perspectives on severe acute respiratory syndrome coronavirus 2 vaccine

Background: Since COVID-19 vaccines have been distributed, a debate has raised on whether pregnant women should get the vaccine. No available data exist so far regarding safety, efficacy and toxicology of these vaccines when administered during pregnancy. Most of the Obstetrics and Gynecology societies suggested that pregnant could agree to be vaccinated, after a thorough counseling of risks and benefits with their gynecologists, thus leading to an autonomous decision. Objective: The aim of this study was to evaluate the attitude to COVID-19 vaccination in pregnant and breastfeeding women in Italy. Study design: A survey was made at University of Naples Federico II and University of Rome Tor Vergata Ospedale Cristo Re on pregnant and breastfeeding women asking their perspectives on the available vaccines after reading the recommendations issued by our national Obstetrics, Gynecology and Neonatology societies. The questionnaire included 12 items finalized to evaluate general features of the women and 6 items specifically correlated to their attitudes towards the SARS-COV-2 vaccination. Chi square (χ2) or Fisher exact tests were used to compare group differences of categorical variables and Wilcoxon signed rank or Mann Whitney U test for continuous variables. The study was approved by the Institutional Review Boards of the University of Naples Federico II (ref. no. 409/2020), and University of Rome Tor Vergata Ospedale Cristo Re (ref. #Ost4-2020). Results: Most of the included women did not agree to eventually receive SARS-COV-2 vaccine during pregnancy (40, 28.2% vs 102, 71.8%). Being pregnant was considered a determinant factor to refuse the vaccine prophylaxis (99, 69.7% vs 43, 30.3%; χ2= 24.187, p<0.001), even if a very large percentage declared to be generally in favor of vaccines (128, 90.1% vs 14, 9.9%; χ2= 6.091, p=0.014) and most of them confirmed they received or would receive other recommended vaccines during pregnancy (75, 52.8% vs 67, 47.2%; χ2= 10.996, p=0.001). Conclusion: Urgent data are needed on safety, efficacy and toxicology of SARS-COV-2 vaccines during pregnancy to modify this trend and to help obstetricians during the counselling. Furthermore, pregnant women should be included in future vaccine development trials to not incur again in such uncertainty.