Pregnant women are at increased risk of severe illness from coronavirus disease 2019 (COVID-19) if infected, prompting the World Health Organization (WHO) to recommend vaccination of pregnant women with a COVID-19 vaccine. In this study, we aimed to identify factors significantly associated with accepting or rejecting prenatal COVID-1 9 vaccination among pregnant women in Taiwan in order to inform efforts to improve vaccination rates in this population. Study subjects consisted of pregnant women receiving prenatal care at any one of three study hospitals in Taiwan during October 2022 -February 2023. Inclusion criteria for study subjects were being aged >= 18 years, being pregnant, having no history of a mental health disorder and being willing and able to complete a study questionnaire. The minimum number of subjects calculated to be needed for the study was 500. Each subject was asked to complete a questionnaire asking about subject demographics, subject knowledge about COVID-19 and the COVID-19 vaccine, where they obtained that knowledge, subject attitude about COVID-19 vaccination during pregnancy and their reasons for receiving or refusing the vaccine. Subjects who answered "received vaccination" or "plan to be vaccinated" in response to the question "Would you receive or have you already received the COVID-1 9 vaccine during this pregnancy?" were considered to have "Received" the vaccine. Subjects who responded "refused vaccination" or "undecided about vaccination" were considered as having "Refused" the vaccine. The questions about attitude were scored and divided into high and low scores. The results of the questionnaire were analyzed by Chi-square tests, t -tests, and multivariate logistic regression analysis to determine the factors significantly associated with receiving prenatal COVID-1 9 vaccination. A total of 594 subjects were included in the study. The mean (+/- standard deviation) age of study subjects was 31.3 (+/- 5.5 ) years. 90.7% of subjects were married, 55.7% had a college/ university education and 78.8% were employed. 43.0% of subjects were in their third trimester of pregnancy, 50.7% had a planned pregnancy and 78.3% had no history of a miscarriage. 72.4% of subjects had received prenatal COVID-19 vaccination. On multiple logistic regression analysis, 6 factors were significantly associated with prenatal COVID-19 vaccination: subjects aged >= 40 years were significantly less likely to receive the vaccine than subjects aged <25 years (adjusted odds ratio (aOR) = 0.288, 95% confidence intervals (CI): 0.099-0.837, p= 0.022); subjects who reported having good health were significantly more likely to receive the vaccine than subjects reporting poor health (aOR = 4.948, 95% CI: 2.309-10.604, p< 0.001); subjects who reported exercising regularly during pregnancy were significantly more likely to receive the vaccine than subjects who said they did not exercise regularly (aOR = 2.843, 95% CI: 1.747-4.627, p< 0.001); subjects who reported receiving an annual influenza vaccine during the previous 3 years were significantly more likely to receive prenatal COVID-19 vaccination than subjects who reported not having an influenza vaccine (aOR = 2.707, 95% CI: 1.241-5.906, p= 0.012); subjects who received prenatal care at Hospital C were significantly less like to receive the vaccine than subjects who received prenatal care at Hospital A (aOR = 0.251, 95% CI: 0.143-0.441, p< 0. 001); and subjects who had a high attitude score regarding prenatal COVID-19 vaccination were significantly more likely to receive the vaccine than subjects who had a low attitude score (aOR = 2.673, 95% CI: 1.458-4.899, p= 0.001). The main reasons subjects gave for receiving prenatal COVID-1 9 vaccination were concern about the impact of the pandemic (70.7% ) and worry about the complications of COVID-19 (67.4%). The main reason for refusing to receive the vaccine was concern about the safety and side effects of the vaccine (67.1%). In summary, the receipt of prenatal COVID-19 vaccination was associated with younger maternal age, having good self -perceived health, exercising regularly during pregnancy, having previously received influenza vaccination, receiving prenatal care from a hospital promoting prenatal COVID-1 9 vaccination and having a good attitude about prenatal COVID-19 vaccination. We conclude groups that should be targeted to improve prenatal vaccination rates are older women, the administration of Hospital C, women who had not previously received an influenza vaccine, women who had poor perceived health, women who did not exercise regularly and women with a negative attitude about prenatal vaccination. Further studies are needed to determine what interventions would be best to reach these target groups and to determine if these efforts will result in improved vaccination rates.
