Uptake of Recommended Vaccines During Pregnancy Among Publicly and Privately Insured People in the United States, December 2020-September 2022.

Abstract

<b>Objectives.</b> To estimate maternal COVID-19, influenza, and pertussis vaccine uptake during pregnancy by insurance type and identify factors characterizing those vaccinated and unvaccinated. <b>Methods.</b> We conducted a US cohort study of pregnant individuals (for pregnancies ending December 11, 2020-September 30, 2022) using insurance claims data. We calculated vaccination probability using Kaplan-Meier methods and identified factors associated with vaccination through binomial regression with inverse probability weights. <b>Results.</b> Among 695 887 pregnant individuals (median age = 32 years for privately and 27 years for publicly insured), the cumulative probability of COVID-19 vaccination was 43.0% (privately insured) and 11.8% (publicly insured). We observed marked disparities between influenza (33.2% vs 14.2%) and pertussis (70.3% vs 42.8%) vaccination. Only 6.8% (privately insured) and 1.1% (publicly insured) received all 3 vaccines. COVID-19 and influenza vaccination odds were lower among drug and tobacco users. People with high-risk medical conditions, particularly the publicly insured, commonly were vaccinated. <b>Conclusions.</b> Marked vaccine uptake disparities exist between privately and publicly insured pregnant people. Understanding structural barriers, particularly for Medicaid enrollees, is critical to improving maternal vaccine access. (<i>Am J Public Health</i>. 2025;115(3):354-363. https://doi.org/10.2105/AJPH.2024.307899).