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

Abstract

Objectives. To estimate maternal COVID-19, influenza, and pertussis vaccine uptake during pregnancy by insurance type and identify factors characterizing those vaccinated and unvaccinated. Methods. 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. Results. 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. Conclusions. 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. (Am J Public Health. 2025;115(3):354-363. https://doi.org/10.2105/AJPH.2024.307899).