Authors (including presenting author) :
Li YY(1)(2), Lok WY(1)(2), Kong CW(1)(2), To WWK(1)(2)
Affiliation :
(1)Department of Obstetrics and Gynaecology, United Christian Hospital, (2)Department of Obstetrics and Gynaecology, Tseung Kwan O Hospital
Introduction :
The global pandemic of COVID-19 has been affecting many countries worldwide for over 18 months and is still ongoing. The first reported case was in Wuhan, China in December 2019. Subsequently, there are increasing numbers of confirmed cases of COVID-19 all over the world as well as in Hong Kong, and have included pregnant women at all gestations. The pandemic has continued due to the lack of definitive treatment, failure of infection control measures and emergence of mutating strains of the virus.
At the early phase of the pandemic, there was still many uncertainties towards the infection caused by this novel coronavirus. A local cross-sectional survey study performed by our unit in 2020 has shown high levels of worry and anxiety among pregnant women towards potential COVID-19 infection during pregnancy, the adverse effects on their pregnancy, and the fear of vertical transmission to the neonates. While our results have demonstrated deficit knowledge of these women on COVID-19, universal screening during admission to hospital for delivery was apparently highly acceptable to them. Based on our data, we have accordingly adjusted our patient education materials, as well as logistics in the organization of our obstetric services in our unit, including the implementation of universal screening of COVID-19 among asymptomatic pregnant women upon admission and allowing husband-accompanying-labour after the partners have been screened negative.
The development of COVID-19 vaccines was long awaited and expected to shed light on the pandemic situation. The COVID-19 vaccination programme in Hong Kong was launched since 26 February 2021. Two types of vaccines were available including inactivated virus vaccine namely CoronaVac,Sinovac since the beginning of the programme and mRNA vaccine namely Comirnaty,BioNTech which were made available since 10 March 2021. Along with public education and promotion, the vaccinating rate has reached 72% for at least one dose and approaching 70% for two doses for the general population in Hong Kong at the time of writing. Since the COVID-19 vaccines were first available, there has been debate on whether pregnant women should be vaccinated as limited data regarding the safety and efficacy were available. In May 2021, the Hong Kong College of Obstetricians and Gynaecologists has resolved to publicly support and encourage COVID-19 vaccination in pregnant women as a preventive measure, but has not recommend routine vaccination in pregnant women unless after individualized assessment and counselling.
Objectives :
It has been over a year since the last local survey study and with the availability of the new COVID-19 vaccines, pregnant women may have a different perception towards the pandemic. By exploring their latest understandings and concerns on COVID-19 and its vaccines, targeted education and modification of current clinical policies could be made to improve our response to this persistent public health crisis. This study aimed to evaluate the current opinions of pregnant women on the obstetric services provided during this juncture of the pandemic with particular reference to their acceptance to COVID-19 vaccination during pregnancy, to identify any significant changes compared to our previous survey one year ago.
Methodology :
This cross-sectional study was conducted in the antenatal clinics of the United Christian Hospital (UCH) and Tseung Kwan O Hospital (TKOH) in the Kowloon East Cluster of Hong Kong. The questionnaires were distributed to a consecutive cohort of the pregnant women when they attended the antenatal follow up in the two obstetric outpatient clinics from August to October 2021. The questionnaires were self-administrated and were available in either Chinese or English versions in printed forms. The first part of the questionnaire collected basic demographic data from the recruited women. The remaining parts comprised of four domains consisting of 34 questions, 4 of which had multiple parts. The three domains included questions on (i) knowledge on COVID-19 and its vaccine in pregnancy, (ii) attitudes and behaviours of pregnant women and their partners towards COVID-19 and (iii) opinions on the provision of obstetric services during COVID-19. The questions were answered in the formats of either binary (Yes/No), 3 options (Yes/No/unsure), 4-point Likert scale, or choosing the available answers provided as appropriate. The SPSS (Windows version 20.0; IBM Corp, Armonk [NY], United States) was used for data entry and analysis. Continuous variables were analysed by t test, whereas discrete variables were analysed by the Chi squared test or Fisher’s exact test. A P value of < 0.05 was considered to be statistically significant. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines were followed in the preparation of this article.
Result & Outcome :
From 16 August 2021 to 15 October 2021, a total of 816 completed questionnaires were included for analysis. Pregnant women were less worried about COVID-19 in the current survey as compared to the last survey (48.2% Vs 83.1%). They have significant knowledge gap and concerns about COVID-19 vaccines. Nearly half of the participants believed that pregnant women cannot have COVID-19 vaccination (49.3%) and it is unsafe to fetus (44.7%). Most of them had not been vaccinated (87.6%) and only 1.7% of them would consider vaccination during pregnancy. Around half of the participants hoped their husbands would be allowed to make visits to the antenatal or postnatal wards (52.0%) and paediatric ward (48.3%) if vaccinated.
New knowledge added by this study:
• With better adaptation and the current stable situation in Hong Kong, the anxiety of pregnant women towards COVID-19 has been partially alleviated compared with the first year of pandemic
• Pregnant women desired a relaxation on the hospital visiting policy and their partners would consider vaccination if peripartum visits were allowed.
• The incentive for vaccination during pregnancy remained low due to the significant knowledge gap and concerns on the safety of the vaccines of pregnant women.
Implications for clinical practice or policy:
• The feasibility of changing public hospital policy on peripartum visits for pregnant women under strict infective control measures and periodic evaluation should be explored.
• Pamphlets and online material on the use of COVID-19 vaccines in pregnancy can be developed and provided to pregnant women to reduce their anxiety and hesitation about these vaccines.
• The knowledge and acceptance of COVID-19 vaccine are important even if most women will be vaccinated before their pregnancy, as booster doses may be needed especially with the emerging of new strains of the virus.
