{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:57:15Z","timestamp":1790654235969,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Pregnant people in Canada during the pandemic faced complex decision-making related to COVID-19 exposure risks and the safety of mitigation measures, including vaccines. To help inform future infectious disease\u2013health promotion, we assessed pandemic pregnancy experiences and COVID-19 risk mitigation strategies. Methods: Respondents, pregnant at any time after January 2020 in Canada, completed an online, cross-sectional, descriptive survey from September 2021 to February 2022. Logistic regression was used to identify predictive factors associated with COVID-19 vaccine uptake and history of infection. Results: A purposive sample of predominantly non-racialized, high socioeconomic status women (n = 564), 58.2% primigravid during the pandemic, reported high COVID-19 vaccine uptake (87.4%). Educational attainment beyond high school predicted COVID-19 vaccination (college AOR: 2.72, CI: 1.24\u20135.94, p &lt; 0.001; university AOR 4.01, CI: 1.91\u20138.40, p &lt; 0.001; post-graduate university AOR: 7.31, CI: 2.84\u201318.81, p &lt; 0.001). Immigrant status reduced the likelihood of COVID-19 vaccination (AOR: 0.20; CI: 0.09\u20130.49, p &lt; 0.001). Racialized participants were 2.78-fold more likely to report infection (CI:1.19\u20136.50, p = 0.018). Conclusions: COVID-19 vaccination uptake was very high; however, vaccine hesitancy was evident among immigrants, with racialized participants more likely to report a history of COVID-19 infection. Tailored public health messaging using a health equity lens may yield more robust vaccine uptake for future infectious respiratory disease outbreaks.<\/jats:p>","DOI":"10.3390\/ijerph22030425","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T04:29:18Z","timestamp":1741926558000},"page":"425","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pandemic Pregnancy Experiences and Risk Mitigation Behaviors: COVID-19 Vaccination Uptake in Canada"],"prefix":"10.3390","volume":"22","author":[{"given":"Sigourney","family":"Shaw-Churchill","sequence":"first","affiliation":[{"name":"Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6041-0197","authenticated-orcid":false,"given":"Karen P.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1001\/jama.2020.14033","article-title":"COVID-19 in Canada: Experience and Response","volume":"324","author":"Detsky","year":"2020","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1001\/jama.2021.14797","article-title":"COVID-19 in Canada: Experience and Response to Waves 2 and 3","volume":"326","author":"Detsky","year":"2021","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e224160","DOI":"10.1001\/jamahealthforum.2022.4160","article-title":"COVID-19 in Canada\u2014The fourth through seventh waves","volume":"3","author":"Detsky","year":"2022","journal-title":"JAMA Health Forum"},{"key":"ref_4","unstructured":"CDC (2024, January 25). If You Are Pregnant, Breastfeeding, or Caring for Young Children|COVID-19|CDC. CDC 2020, Available online: https:\/\/stacks.cdc.gov\/view\/cdc\/89836."},{"key":"ref_5","unstructured":"Public Health Agency of Canada (2009). What Mothers Say: The Canadian Maternity Experiences Survey, Public Health Agency of Canada. Available online: https:\/\/www.canada.ca\/content\/dam\/phac-aspc\/migration\/phac-aspc\/rhs-ssg\/pdf\/survey-eng.pdf."},{"key":"ref_6","unstructured":"Statistics Canada (2024, January 25). The Daily. Births. Available online: https:\/\/www150.statcan.gc.ca\/n1\/daily-quotidien\/220928\/dq220928d-eng.htm."},{"key":"ref_7","unstructured":"Statistics Canada (2024, January 25). The Daily. Births. Available online: https:\/\/www150.statcan.gc.ca\/n1\/daily-quotidien\/230926\/dq230926a-eng.htm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/S0140-6736(20)30365-2","article-title":"What are the risks of COVID-19 infection in pregnant women?","volume":"395","author":"Qiao","year":"2020","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1017\/S1049023X11000100","article-title":"Infectious respiratory disease outbreaks and pregnancy: Occupational health and safety concerns of Canadian nurses","volume":"26","author":"Phillips","year":"2011","journal-title":"Prehosp. Disaster Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijid.2019.12.019","article-title":"Vaccinating pregnant women against influenza needs to be a priority for all countries: An expert commentary","volume":"92","author":"Buchy","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_11","unstructured":"National Advisory Committee on Immunization (NACI) 2020 (2024, January 25). Archived 2: Recommendations on the Use of COVID-19 Vaccines [2020-12-23]. Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/immunization\/national-advisory-committee-on-immunization-naci\/recommendations-use-covid-19-vaccines\/december-23-2020.html."},{"key":"ref_12","unstructured":"ACOG The American College of Obstetricians and Gynecologists 2021 (2024, January 25). Maternal Immunization Task Force and Partners Urge that COVID-19 Vaccine be Available to Pregnant Individuals. Available online: https:\/\/www.acog.org\/news\/news-releases\/2021\/02\/maternal-immunization-task-force-and-partners-urge-that-covid-19-vaccine-be-available-to-pregnant-individuals."},{"key":"ref_13","unstructured":"Poliquin, V., Castillo, E., Boucoiran, I., Wong, J., Watson, H., Yudin, M., Money, D., Van Schalkwyk, J., Elwood, C., and on on behalf of the Infectious Disease Committee of the Society of Obstetricians and Gynaecologists of Canada (2025, January 25). Society of Obstetricians and Gynaecologists of Canada (SOGC) Statement on COVID-19 Vaccination in Pregnancy 2020. Available online: https:\/\/www.drtanyawilliams.com\/Resources\/SOGC_Statement_on_COVID-19_Vaccination_in_Pregnancy.pdf."},{"key":"ref_14","unstructured":"Center for Disease Control and Prevention (CDC) (2025, March 12). COVID-19 Vaccines While Pregnant or Breastfeeding 2021, Available online: https:\/\/stacks.cdc.gov\/view\/cdc\/110584."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11069-019-03584-6","article-title":"From SARS to pandemic influenza: The framing of high-risk populations","volume":"98","author":"Phillips","year":"2019","journal-title":"Nat. Hazards"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1016\/j.jogc.2018.05.042","article-title":"A Systematic review of barriers to vaccination during pregnancy in the Canadian context","volume":"41","author":"Poliquin","year":"2019","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1093\/aje\/kwaa165","article-title":"Individual and neighborhood factors associated with failure to vaccinate against influenza during pregnancy","volume":"189","author":"Zerbo","year":"2020","journal-title":"Am. J. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3923","DOI":"10.1016\/j.vaccine.2022.05.053","article-title":"Between persuasion and compulsion: The case of COVID-19 vaccination in Canada","volume":"40","author":"Gagnon","year":"2022","journal-title":"Vaccine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s10654-021-00728-6","article-title":"COVID-19 vaccine acceptance among pregnant women and mothers of young children: Results of a survey in 16 countries","volume":"36","author":"Skjefte","year":"2021","journal-title":"Eur. J. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e061477","DOI":"10.1136\/bmjopen-2022-061477","article-title":"COVID-19 vaccine hesitancy among pregnant women: A systematic review and meta-analysis","volume":"12","author":"Bhattacharya","year":"2022","journal-title":"BMJ Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"547","DOI":"10.17269\/s41997-022-00641-9","article-title":"COVID-19 vaccine uptake and intention during pregnancy in Canada","volume":"113","author":"Reifferscheid","year":"2022","journal-title":"Can. J. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E1034","DOI":"10.9778\/cmajo.20210273","article-title":"SARS-CoV-2 vaccine uptake and reasons for hesitancy among Canadian pregnant people: A prospective cohort study","volume":"10","author":"Gorgui","year":"2022","journal-title":"CMAJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1016\/j.vaccine.2023.01.073","article-title":"Temporal trends and determinants of COVID-19 vaccine coverage and series initiation during pregnancy in Ontario, Canada, December 2020 to December 2021: A population-based retrospective cohort study","volume":"41","author":"Fell","year":"2023","journal-title":"Vaccine"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ramlawi, S., Muldoon, K.A., Dunn, S.I., Murphy, M.S.Q., Dingwall-Harvey, A.L.J., Rennicks White, R., Fakhraei, R., Wen, S.W., Walker, M.C., and Fell, D.B. (2022). Worries, beliefs and factors influencing perinatal COVID-19 vaccination: A cross-sectional survey of preconception, pregnant and lactating individuals. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-14617-4"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Januszek, S.M., Faryniak-Zuzak, A., Barna\u015b, E., \u0141ozi\u0144ski, T., G\u00f3ra, T., Siwiec, N., Szczerba, P., Januszek, R., and Kluz, T. (2021). The approach of pregnant women to vaccination based on a COVID-19 systematic review. Medicina, 57.","DOI":"10.3390\/medicina57090977"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.puhe.2023.06.016","article-title":"Low education predicts large increase in COVID-19 mortality: The role of collective culture and individual literacy","volume":"221","author":"Zhuo","year":"2023","journal-title":"Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Yasmin, F., Najeeb, H., Moeed, A., Naeem, U., Asghar, M.S., Chughtai, N.U., Yousaf, Z., Seboka, B.T., Ullah, I., and Lin, C.-Y. (2021). COVID-19 vaccine hesitancy in the United States: A systematic review. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.770985"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"21582440221147022","DOI":"10.1177\/21582440221147022","article-title":"Antecedents and consequences of misinformation sharing behavior among adults on social media during COVID-19","volume":"13","author":"Malik","year":"2023","journal-title":"Sage Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1001\/jama.2022.2404","article-title":"Widespread misinformation about infertility continues to create COVID-19 vaccine hesitancy","volume":"327","author":"Abbasi","year":"2022","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2138047","DOI":"10.1080\/21645515.2022.2138047","article-title":"Models of determinants of COVID-19 vaccine hesitancy in non-pregnant and pregnant population: Review of current literature","volume":"18","author":"Tostrud","year":"2022","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.pcl.2022.11.004","article-title":"Maternal vaccination and vaccine hesitancy","volume":"70","author":"Rand","year":"2023","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bajgain, B.B., Bajgain, K.T., Badal, S., Aghajafari, F., Jackson, J., and Santana, M.-J. (2020). Patient-reported experiences in access primary healthcare among immigrant population in Canda: A rapid literature review. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17238724"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/S1701-2163(16)35078-2","article-title":"Comparison of maternity experiences of Canadian-born and recent and non-recent immigrant women: Findings from the Canadian Maternity Experiences Survey","volume":"33","author":"Kingston","year":"2011","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1007\/s10903-022-01337-5","article-title":"COVID-19 pandemic and im\/migrants\u2019 elevated health concerns in Canada: Vaccine hesitancy, anticipated stigma, and risk perception of accessing care","volume":"24","author":"Lin","year":"2022","journal-title":"J. Immigr. Minor Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"335","DOI":"10.21767\/2049-5471.100073","article-title":"Canadian Indigenous women\u2019s perspectives of maternal health and health care services: A systematic review","volume":"13","author":"Sharma","year":"2016","journal-title":"Divers Equal Health Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12978-019-0729-2","article-title":"The Giving Voice to Mothers study: Inequity and mistreatment during pregnancy and childbirth in the United States","volume":"16","author":"Vedam","year":"2019","journal-title":"Reprod. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"E643","DOI":"10.9778\/cmajo.20210228","article-title":"Prevalence of SARS-CoV-2 infection among obstetric patients in Ottawa, Canada: A descriptive study","volume":"10","author":"Fakhraei","year":"2022","journal-title":"CMAJ Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"m3320","DOI":"10.1136\/bmj.m3320","article-title":"Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: Living systematic review and meta-analysis","volume":"370","author":"Allotey","year":"2020","journal-title":"BMJ"},{"key":"ref_39","unstructured":"(2022). Update to living systematic review on COVID-19 in pregnancy. BMJ, 377, o1205."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"103706","DOI":"10.1016\/j.midw.2023.103706","article-title":"Perinatal mental health and women\u2019s lived experience of the COVID-19 pandemic: A scoping review of the qualitative literature 2020\u20132021","volume":"123","author":"Jin","year":"2023","journal-title":"Midwifery"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Mullins, E., McCabe, R., Bird, S.M., Randell, P., Pond, M.J., Regan, L., Parker, E., McClure, M., and Donnelly, C.A. (2022). Tracking the incidence and risk factors for SARS-CoV-2 infection using historical maternal booking serum samples. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0273966"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/3\/425\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:53:25Z","timestamp":1760028805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/3\/425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,14]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["ijerph22030425"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22030425","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,14]]}}}