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Am J Perinatol
DOI: 10.1055/a-2798-2960
Original Article

Factors Associated with Inpatient COVID-19 Vaccine Uptake for Pregnant and Postpartum People

Authors

  • Emily R. Burdette 

    1   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States
    2   Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Massachusetts, United States
    3   Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware United States

  • Andrea Pelletier

    2   Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Massachusetts, United States

  • Taylor S. Freret

    4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States
    5   Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

  • Ilona T. Goldfarb

    4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States
    6   Stanford Health Care, Stanford, California, United States

  • Saba H. Berhie

    7   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, United States
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Abstract

Objective

This study aimed to evaluate inpatient COVID-19 vaccine uptake among pregnant and postpartum patients.

Study Design

Retrospective cohort study of patients admitted to the antepartum and postpartum services of two academic hospitals between April 2021 and July 2022. Patients were classified as “sufficiently vaccinated” (fully vaccinated or not yet due for an additional dose) or “eligible for vaccination” on admission. We used chi-square, independent samples t-test, and Wilcoxon's rank sum test to compare characteristics between the groups on admission. We used logistic regression to analyze factors associated with inpatient vaccination for antepartum and postpartum patients.

Results

Among 886 antepartum and 12,036 postpartum patients, 341 (38.5%) and 6,327 (52.6%) were sufficiently vaccinated at the time of admission, respectively. Factors associated with vaccination status on admission included age, race, ethnicity, marital status, insurance, smoking status, trimester of prenatal care initiation, obstetric history, comorbidities, and receipt of Tdap and influenza vaccinations during pregnancy. Among 545 eligible antepartum patients, 30 (5.5%) were vaccinated inpatient. Factors associated with inpatient antepartum vaccination included receipt of influenza vaccination during pregnancy (adjusted odds ratio [aOR] = 7.95, 95% confidence interval [CI]: 2.94–21.46), length of stay (aOR = 1.07, 95% CI: 1.03–1.11), and abruption (aOR = 6.20, 95% CI: 1.78–21.62). Among 5,709 eligible postpartum patients, 527 (9.2%) were vaccinated inpatient. Factors associated with inpatient postpartum vaccination included Black race (aOR = 1.45, 95% CI: 1.09–1.95), initiation of prenatal care in the second trimester compared with the first (aOR = 1.38, 95% CI: 1.08–1.77), gestational diabetes (aOR = 1.70, 95% CI: 1.25–2.30), receipt of Tdap (aOR = 1.47, 95% CI: 1.02–2.13) and influenza (aOR = 1.66, 95% CI: 1.32–2.09) vaccinations during pregnancy, and length of stay (aOR = 1.05, 95% CI: 1.00–1.11).

Conclusion

Despite the availability of inpatient vaccination, COVID-19 vaccine uptake in this peripartum population was low. General vaccine acceptance and increased length of stay were associated with inpatient vaccination.

Key Points

  • Inpatient vaccine access did not increase uptake.

  • Vaccine uptake was associated with length of stay.

  • General vaccine acceptance was linked to inpatient vaccination.

Keywords

COVID-19 vaccination - inpatient vaccination - vaccine acceptance - vaccine hesitancy

Contributors' Statement

E.B.: conceptualization, data curation, investigation, methodology, visualization, writing—original draft; A.P.: conceptualization, data curation, formal analysis, methodology, software, writing—review and editing; T.S.F.: investigation, methodology, writing—review and editing; I.G.: conceptualization, methodology, supervision, writing—review and editing; S.B.: conceptualization, data curation, methodology, supervision, writing—review and editing.


Note

This research was presented as a poster at the Society for Maternal-Fetal Medicine 43rd Annual Pregnancy Meeting in San Francisco, California, United States, on February 6–11, 2023.


Supplementary Material



Publication History

Received: 17 November 2025

Accepted: 27 January 2026

Article published online:
20 February 2026

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