Background

Pregnant women are at an elevated risk for severe COVID-19, but nationwide rates of vaccination and its timing during pregnancy are not well documented in France.

Objectives

To assess COVID-19 vaccination rates among pregnant women in France, compare them to those of the general population, and analyse factors associated with vaccination status and timing.

Methods

A nationwide study using the EPI-MERES register, which includes all 1,203,454 pregnant women who delivered between April 2021 and December 2022 in France. Standardization by age and social index was used to compare vaccination rates with those of the general female population. Associations with sociodemographic factors, pregnancy monitoring indicators, and pre-existing comorbidities were measured using multivariable logistic regression.

Results

Overall, 52 % of pregnant women received at least one vaccine dose, with 62.1 % vaccinated before conception and 8.2 %, 20.9 %, and 8.8 % vaccinated in the 1st, 2nd, and 3rd trimester, respectively. Vaccination rates initially lagged behind those of the general population but converged by June 2022, with a six-month lag. Younger and more socially deprived women were less highly vaccinated. Unvaccinated women were more likely to be in their third pregnancy (aOR, 1.21 [1.19–1.22]), had fewer ultrasound scans (aOR, 0.71 [0; 70–0.73]), and less often took folic acid (aOR, 0.73 [0.72–0.74]). Women with comorbidities, such as obesity, diabetes, hypertension, antidepressant use, or chronic respiratory disease, were less likely to be unvaccinated (aORs ranged from 0.69 to 0.89).

Conclusions

Pregnant women in France were less highly vaccinated than the general population during crucial pandemic periods but eventually reached similar vaccination rates. Socioeconomic status and the level of prenatal care were strongly associated with low vaccine uptake. This should be a focus for future interventions and policy adjustments across all segments of this population.