Examining Discordance in Perceptions of COVID-19 and Influenza Vaccine Safety During Pregnancy Among a Cohort of US Adults

Background/Objectives: Vaccination is an important strategy to protect pregnant people, fetuses, and infants from severe influenza and COVID-19. However, as of April 2025 in the United States, only 14% of pregnant women had received the 2024–2025 COVID-19 vaccine, while influenza vaccine uptake among pregnant women was 38% compared to 57% in 2020. Our study assessed the perceived safety of receiving these vaccines during pregnancy within a community-based national cohort. Methods: Participants reported safety perceptions of vaccination during pregnancy and were categorized as (1) endorsing the safety of both COVID-19 and influenza vaccines, (2) endorsing the safety of only the influenza vaccine, (3) endorsing the safety of only the COVID-19 vaccine and (4) endorsing the safety of neither vaccine during pregnancy. We examined sociodemographics, behaviors, and beliefs correlated with these four categories. Log-binomial models were used to estimate the prevalence ratios of (a) endorsing the safety of only influenza vaccine versus endorsing the safety of both COVID-19 and influenza vaccines during pregnancy, and (b) endorsing safety of neither versus both vaccines during pregnancy. Results: In total, 40% of adults (N = 1725) endorsed the safety of both vaccines during pregnancy, 18% (N = 751) endorsed the safety of only the influenza vaccine, 4% (N = 183) endorsed the safety of only the COVID-19 vaccine, and 38% (N = 1621) did not endorse the safety of either vaccine during pregnancy. Participants who were non-Hispanic Black, reported inconsistent vaccination habits, and expressed low trust in government and healthcare providers were more likely to endorse the safety of only the influenza vaccine or neither vaccine compared with endorsing both vaccines. Conclusions: These findings highlight the need to build trust in the medical system, reduce access barriers, and use equitable, community-driven messaging to strengthen confidence in the safety of receiving the COVID-19 and influenza vaccines during pregnancy.