MMWR, COVID-19 Vaccination Recommendations and Practices for Women of Reproductive Age by Health Care Providers — Fall DocStyles Survey, United States, 2022

Morbidity and Mortality Weekly Report

Weekly / Vol. 72 / No. 39 September 29, 2023

COVID-19 Vaccination Recommendations and Practices for Women of

Reproductive Age by Health Care Providers — Fall DocStyles Survey,

United States, 2022

Mehreen Meghani, MPH

; Beatriz Salvesen Von Essen

; Lauren B. Zapata, PhD

; Kara Polen, MPH

; Romeo R. Galang, MD

;

Hilda Razzaghi, PhD

; Dana Meaney-Delman, MD

; Grayson Waits, MPH

; Sascha Ellington, PhD

Abstract

Pregnant and postpartum women are at increased risk for

severe illness from COVID-19 compared with nonpregnant

women of reproductive age. COVID-19 vaccination is

recommended for all persons ≥6 months of age. Health care

providers (HCPs) have a unique opportunity to counsel women

of reproductive age, including pregnant and postpartum

patients, about the importance of receiving COVID-19,

influenza, and tetanus toxoid, reduced diphtheria toxoid,

and acellular pertussis (Tdap) vaccines. Data from the

Fall 2022 DocStyles survey were analyzed to examine the

prevalence of COVID-19 vaccination attitudes and practices

among HCPs caring for women of reproductive age, and to

determine whether providers recommended and offered or

administered COVID-19 vaccines to women of reproductive

age, including their pregnant patients. Overall, 82.9% of

providers reported recommending COVID-19 vaccination to

women of reproductive age, and 54.7% offered or administered

the vaccine in their practice. Among HCPs who cared for

pregnant patients, obstetrician-gynecologists were more likely

to recommend COVID-19 vaccination to pregnant patients

(94.2%) than were family practitioners or internists (82.1%)

(adjusted prevalence ratio [aPR] = 1.1). HCPs were more

likely to offer or administer COVID-19 vaccination on-site to

pregnant patients if they also offered or administered influenza

(aPR = 5.5) and Tdap vaccines (aPR = 2.3). Encouraging

HCPs to recommend, offer, and administer the COVID-19

vaccines along with influenza or Tdap vaccines might help

reinforce vaccine confidence and increase coverage among

women of reproductive age, including pregnant women.

Introduction

Pregnant and postpartum women are at increased risk for

severe COVID-19–associated illness compared with nonpreg-

nant women of reproductive age (1). COVID-19 vaccination*

before or during pregnancy is safe and effective and reduces

the risk for severe illness and adverse COVID-19–associated

* https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/

pregnancy.html

INSIDE

1052 Inequities in COVID-19 Vaccination Coverage

Among Pregnant Persons, by Disaggregated Race

and Ethnicity — Massachusetts, May 2021–

October 2022

1057 Eﬀectiveness of Maternal mRNA COVID-19

Vaccination During Pregnancy Against COVID-19–

Associated Hospitalizations in Infants Aged

<6 Months During SARS-CoV-2 Omicron

Predominance — 20 States, March 9, 2022–

May 31, 2023

1065 Inﬂuenza, Tdap, and COVID-19 Vaccination

Coverage and Hesitancy Among Pregnant

Women — United States, April 2023

1072 ACIP Updates: Recommendations for Use of

20-Valent Pneumococcal Conjugate Vaccine in

Children — United States, 2023

1073 QuickStats

Continuing Education examination available at

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Centers for Disease Control and Prevention

Morbidity and Mortality Weekly Report

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Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2023;72:[inclusive page numbers].

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1046

outcomes (2–4). Similarly, influenza

†

and tetanus toxoid,

reduced diphtheria toxoid, and acellular pertussis (Tdap)

vaccines are recommended and can be safely administered

during pregnancy. Health care providers (HCPs) have a unique

opportunity to counsel women of reproductive age, including

pregnant and postpartum patients, about the importance of

receiving COVID-19, influenza, and Tdap vaccinations (5,6).

Data from the Fall 2022 DocStyles survey were analyzed to

examine the attitudes and practices related to COVID-19 vac-

cination among HCPs caring for women of reproductive age,

and to ascertain whether providers recommended and offered

or administered the COVID-19 vaccines to pregnant patients.

Methods

The Fall 2022 DocStyles survey, administered during

August 19–September 30, 2022, was a web-based nonprobabil-

ity panel survey of U.S. HCPs

sampled from Sermo’s global

medical panel.** Quotas were predetermined to reach 1,000

family practitioners and internists, 250 obstetrician-gynecolo-

gists (ob-gyns), 250 pediatricians, and 250 nurse practitioners

and physician assistants. Eligible respondents practiced only in

†

https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm?s_cid = rr6703a1_w

https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm

DocStyles is commissioned by Porter Novelli Public Services. http://styles.

porternovelli.com

** Sermo’s global medical panel comprises 350,000 panelists who were verified

using a double opt-in sign-up process with telephone confirmation at place

of work. http://www.sermo.com

the United States, were actively seeing patients, had been prac-

ticing for ≥3 years, and provided care to women of reproduc-

tive age (female patients aged 15–49 years). Participation was

voluntary, and respondents received an honorarium ranging

from $55 to $65 depending on how many questions they were

asked. The survey was designed to ascertain provider attitudes

and practices on a broad range of health care topics, including

COVID-19 vaccination for women of reproductive age and

pregnant patients, and to determine whether HCPs recom-

mended and offered or administered COVID-19, influenza,

and Tdap vaccines during pregnancy.

Descriptive analyses were conducted to determine provider

characteristics (age, gender, number of years in practice, pri-

mary work setting, number of patients seen per week, and

percentage of patients who were pregnant during the previous

year) overall and by provider type. Prevalence of COVID-19

vaccination attitudes and practices with reference to women

of reproductive age overall and by selected provider char-

acteristics were estimated, and Pearson’s chi-square tests of

independence were used to identify differences among groups,

with p-values <0.05 considered statistically significant. Factors

associated with recommending and offering or administering

COVID-19 vaccines on-site to pregnant patients were exam-

ined using binomial regression (log-linked binomial) models;

provider characteristics and influenza and Tdap vaccination

attitudes and practices related to pregnant patients were con-

sidered as potential covariates. In multivariable modeling,

Morbidity and Mortality Weekly Report

1047

models were adjusted for the number of years in practice and

provider age and gender. Data were analyzed using SAS soft-

ware (version 9.4; SAS Institute). This activity was reviewed

by CDC, deemed not research, and was conducted consistent

with applicable federal law and CDC policy.

††

Results

Among 2,587 eligible HCPs, 1,752 (68%) completed the

survey (Table 1). The majority of respondents (57.2%) were

family practitioners or internists; ob-gyns, pediatricians, and

nurse practitioners or physician assistants each accounted for

14.3% of the sample. Nearly two thirds of survey respondents

(63.9%) worked in group outpatient settings and had been

in practice for >10 years (63.6%); approximately one half

(55.8%) were male, and 64.3% reported that 1%–10% of their

patients during the previous year were pregnant. Among ob-

gyns and pediatricians, 53.6% and 51.6%, respectively, were

female compared with fewer than one third (31.0%) of family

practitioners and internists. One half (50.8%) of ob-gyns had

been practicing for >20 years compared with approximately

one third (37.4%) of family practitioners or internists, 39.6%

of pediatricians, and 16.4% of nurse practitioners and physi-

cian assistants.

Overall, 82.9% of HCPs reported recommending COVID-19

vaccination to women of reproductive age (Table 2). The per-

centage of providers recommending COVID-19 vaccine varied

significantly by provider type, ranging from 90.8% of ob-gyns

and 90.4% of pediatricians to 76.0% of nurse practitioners

and physician assistants (p<0.001). Provider perceptions of

the importance of women of reproductive age staying up to

date with COVID-19 vaccinations also varied substantially by

provider type, ranging from 80.8% of ob-gyns to 55.6% of

nurse practitioners and physician assistants reporting that stay-

ing up to date was very important (p<0.001). The importance

of staying up to date with COVID-19 vaccination also varied

by the percentage of patients who were pregnant that providers

saw during the previous year. Among providers who reported

that none of their patients were pregnant, two thirds (67.8%)

reported that it was very important for women of reproductive

age to stay up to date compared with three quarters (75.5%)

of providers who reported that ≥11% of their patients during

the previous year were pregnant (p<0.05).

Among all respondents, approximately one half (54.7%)

reported offering or administering COVID-19 vaccination on-

site to women of reproductive age in their practice; this varied

substantially by provider type, with 65.2% of pediatricians and

41.6% of ob-gyns offering or administering COVID-19 vaccine.

††

45 C.F.R. part 46; 21 C.F.R. part 56; 42 U.S.C. Sect.

241(d), 5 U.S.C. Sect.

552a, 44 U.S.C. Sect.

3501 et seq.

Offering or administering COVID-19 vaccine also varied by

the number of years in practice. Among providers practicing for

3–10 years, 60.0% offered or administered the vaccine compared

with 48.9% of those practicing for ≥20 years (p<0.05).

Among 1,538 providers who cared for pregnant patients, most

recommended all three vaccines (COVID-19: 82.9%; influenza:

89.4%; and Tdap: 78.1%) (Supplementary Figure, https://

stacks.cdc.gov/view/cdc/133101). The percentage of ob-gyns

who recommended COVID-19 vaccination to their pregnant

patients (94.2%) was higher than that of family practitioners and

internists (82.1%; aPR = 1.1) (Table 3). Recommendations for

COVID-19 vaccination were more prevalent among providers

who also recommended influenza vaccine (90.0%; aPR = 3.7)

and Tdap vaccine (89.8%; aPR = 1.5), and among those who

offered or administered the influenza (88.2%; aPR = 1.4) and

Tdap (88.7%; aPR = 1.3) vaccines.

Most providers also offered or administered all three vaccines

on-site to pregnant patients in their practice (COVID-19:

53.5%; influenza: 80.7%; and Tdap: 71.9%). (Supplementary

Figure, https://stacks.cdc.gov/view/cdc/133101). However,

approximately one third (39.7%) of ob-gyns offered or admin-

istered COVID-19 vaccine on-site, compared with approxi-

mately one half of family practitioners and internists (55.9%;

aPR = 0.7). Providers were more likely to offer or administer

COVID-19 vaccination on-site if they also recommended

influenza (56.2%; aPR = 1.8) and Tdap (56.1%; aPR = 1.3)

vaccines, and if they also offered or administered influenza

(63.5%; aPR = 5.5) and Tdap (63.5%; aPR = 2.3) vaccinations

in their practice (Table 3).

Discussion

The Fall 2022 DocStyles survey reported that most HCPs

recommend that women of reproductive age be vaccinated

against COVID-19, and the percentage was highest among

ob-gyns. However, one in five family practitioners and inter-

nists did not recommend COVID-19 vaccination to women of

reproductive age. This finding is consistent with other surveys

on provider attitudes and practices regarding vaccination,

wherein ob-gyns were more likely than were other HCPs to

recommend both human papillomavirus vaccine (HPV) and

COVID-19 vaccines to women of reproductive age (7,8). Most

providers also felt that it was very important that women of

reproductive age stay up to date with COVID-19 vaccination.

However, one in five providers felt that it was only somewhat

important that women of reproductive age stay up to date

with COVID-19 vaccination, despite evidence that these

women delay vaccination or remain unvaccinated. Staying up

to date with COVID-19 vaccination is especially important

because vaccines and recommendations are frequently updated

Morbidity and Mortality Weekly Report

1048

TABLE 1. Characteristics of health care providers, overall and by provider type — Fall DocStyles, United States, 2022

Characteristic

Provider type, no. (%)*

Total

N = 1,752

FP or internist

n = 1,002

Pediatrician

n = 250

Ob-gyn

n = 250

NP or PA

n = 250

Age, median, yrs (range) 47 (25–85) 47 (26–84) 47 (29–75) 50 (29–85) 40 (25–71)

Gender

†

Female 761 (43.4) 311 (31.0) 129 (51.6) 134 (53.6) 187 (74.8)

Male 977 (55.8) 681 (68.0) 120 (48.0) 115 (46.0) 61 (24.4)

No. of patients seen per week

1–50 265 (15.1) 142 (14.2) 30 (12.0) 29 (11.6) 64 (25.6)

51–100 962 (54.9) 532 (53.1) 144 (57.6) 149 (59.6) 137 (54.8)

101–200 407 (23.2) 239 (23.9) 66 (26.4) 59 (23.6) 43 (17.2)

201–500 118 (6.7) 89 (8.9) 10 (4.0) 13 (5.2) 6 (2.4)

Percentage of patients who were pregnant during the previous year

0 214 (12.2) 73 (7.3) 95 (38.0) 8 (3.2) 38 (15.2)

1–10 1,126 (64.3) 790 (78.8) 141 (56.4) 29 (11.6) 166 (66.4)

≥11 412 (23.5) 139 (13.9) 14 (5.6) 213 (85.2) 46 (18.4)

No. of years practicing

3–10 637 (36.4) 356 (35.5) 73 (29.2) 66 (26.4) 142 (56.8)

11–19 473 (27.0) 271 (27.1) 78 (31.2) 57 (22.8) 67 (26.8)

≥20 642 (36.6) 375 (37.4) 99 (39.6) 127 (50.8) 41 (16.4)

Primary work setting

Individual outpatient practice 298 (17.0) 163 (16.3) 27 (10.8) 55 (22.0) 53 (21.2)

Group outpatient practice or clinic 1,119 (63.9) 634 (63.3) 181 (72.4) 171 (68.4) 133 (53.2)

Inpatient practice or hospital 335 (19.1) 205 (20.5) 42 (16.8) 24 (9.6) 64 (25.6)

U.S. Census Bureau region

Northeast 426 (24.3) 257 (25.8) 68 (27.2) 45 (18.0) 56 (22.4)

Midwest 383 (21.9) 217 (21.7) 52 (20.8) 54 (21.6) 60 (24.0)

South 565 (32.3) 303 (30.2) 77 (30.8) 88 (35.2) 97 (38.8)

West 378 (21.6) 225 (22.5) 53 (21.2) 63 (25.2) 37 (14.8)

Abbreviations: FP = family practitioner; NP = nurse practitioner; Ob-gyn = obstetrician-gynecologist; PA = physician assistant.

* Percentages might not sum to 100 because of rounding.

†

Fourteen health care providers were excluded from gender-stratified analyses because when asked their gender, they did not report male or female but instead

responded “prefer to self-identify”; therefore, the denominator for gender is 1,738.

https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf

in order to provide optimal protection.

§§

Staying up to date

might be particularly important for pregnant and especially

recently pregnant women who are at higher risk for severe

COVID-19–associated illness or adverse pregnancy outcomes.

This analysis found that provider-reported recommenda-

tion for COVID-19 vaccine to pregnant patients was strongly

associated with reported recommendation for influenza and

Tdap vaccines. Most providers offered or administered the

COVID-19 vaccines on-site, and offering or administer-

ing COVID-19 vaccine to pregnant patients was strongly

associated with recommending and offering or administer-

ing influenza and Tdap vaccines. A strong provider recom-

mendation for vaccination has been shown to be effective in

improving acceptance of HPV (9) and COVID-19 vaccines

(10). As COVID-19 vaccine availability in primary care set-

tings increases, and as more providers are tasked with offering

or administering COVID-19, influenza, and Tdap vaccines,

provider recommendations will continue to play an important

role in motivating vaccination acceptance among women of

§§

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html

reproductive age, especially to those who are pregnant. Previous

studies on vaccination coverage among pregnant patients have

found that influenza, Tdap, and COVID-19 vaccination

coverage remains highest among women who report receiving

a provider recommendation or offer for vaccination (6,10).

HCPs are among the most trusted sources for information on

vaccines, and provider recommendation or offer of vaccination

is a strong predictor of vaccination (6,10). HCPs should be

encouraged to recommend and offer or administer COVID-19

vaccine to women of reproductive age. All HCPs, regardless of

provider type, should emphasize the importance of adhering to

vaccination recommendations for women of reproductive age.

Limitations

The findings in this report are subject to at least four limita-

tions. First, DocStyles is a voluntary opt-in panel survey, and

sampling is not population-based or random. Therefore,

findings might not be generalizable to the U.S. population of

HCPs. Second, survey data are self-reported, and responses

might be subject to recall, social desirability, or other reporting

biases. Third, data are from fall 2022 and might not reflect

Morbidity and Mortality Weekly Report

1049

TABLE 2. Prevalence of health care provider attitudes and practices regarding COVID-19 vaccination among women of reproductive age,*

overall and by health care provider characteristics — Fall DocStyles, United States, 2022

Characteristic

(no. of respondents)

Survey question, no. (row %)

Do you recommend that women

of reproductive age* get

COVID-19 vaccinations?

In general, how important do you think it is

for women of reproductive age to stay up to date

with their COVID-19 vaccines?

Does your practice offer or

administer COVID-19 vaccines

on-site to women of

reproductive age?

Yes No

Very

important

Somewhat

important

Not too

important

Not at all

important Yes No

Provider type

†

Total (1,752) 1,453 (82.9) 299 (17.1) 1,230 (70.2) 393 (22.4) 73 (4.2) 56 (3.2) 958 (54.7) 794 (45.3)

FP or internist (1,002) 810 (80.4) 192 (19.2) 692 (69.1) 242 (24.2) 38 (3.8) 30 (3.0) 569 (56.8) 433 (43.2)

Pediatrician (250) 226 (90.4) 24 (9.6) 197 (78.8) 40 (16.0) 10 (4.0) 3 (1.2) 163 (65.2) 87 (34.8)

Ob-gyn (250) 227 (90.8) 23 (9.2) 202 (80.8) 39 (15.6) 5 (2.0) 4 (1.6) 104 (41.6) 146 (58.4)

NP or PA (250) 190 (76.0) 60 (24.0) 139 (55.6) 72 (28.8) 20 (8.0) 19 (7.6) 122 (48.8) 128 (51.2)

No. of years in practice

3–10 (637) 521 (81.8) 116 (18.2) 445 (69.9) 141 (22.1) 31 (4.9) 20 (3.1) 380 (60.0) 257 (40.4)

11–19 (568) 398 (84.1) 75 (15.9) 319 (67.4) 123 (26.0) 18 (3.8) 13 (2.8) 264 (55.8) 209 (44.2)

≥20 (642) 534 (83.2) 108 (16.8) 466 (72.6) 129 (20.1) 24 (3.7) 23 (3.6) 314 (48.9) 328 (51.1)

Percentage of patients seen during previous year who were pregnant

0 (214) 170 (79.4) 44 (20.6) 145 (67.8) 44 (20.6) 14 (6.5) 11 (5.1) 101 (47.2) 113 (52.8)

1–10 (1,126) 927 (82.3) 199 (17.7) 774 (68.7) 261 (23.2) 51 (4.5) 40 (3.6) 626 (55.6) 500 (44.4)

≥11 (356) 356 (86.4) 56 (13.6) 311 (75.5) 88 (21.4) 8 (1.9) 5 (1.2) 231 (56.1) 181 (43.9)

Gender

¶,

Female (761) 650 (85.4) 111 (14.6) 567 (74.5) 142 (18.7) 23 (3.0) 29 (3.8) 409 (53.8) 352 (46.3)

Male (977) 792 (81.1) 185 (18.9) 655 (67.0) 245 (25.1) 50 (5.1) 27 (2.8) 544 (55.7) 433 (44.3)

Abbreviations: FP = family practitioner; NP = nurse practitioner; Ob-gyn = obstetrician-gynecologist; PA = physician assistant.

* Women of reproductive age were defined as female patients aged 15–49 years.

†

Pearson’s chi-square tests for independence. Statistically significant (p<0.05) when compared across provider characteristic.

Pearson’s chi-square tests for independence. Statistically significant (p<0.05) when compared across provider characteristic for the question, “Does your practice

offer or administer COVID-19 vaccines on-site to women of reproductive age?”

Pearson’s chi-square tests for independence. Statistically significant (p<0.05) when compared across provider characteristic for the question, “In general, how

important do you think it is for women of reproductive age to stay up to date with their COVID-19 vaccines?”

** Fourteen health care providers were excluded from gender-stratified analyses because when asked their gender, they did not report male or female but instead

responded “prefer to self-identify”; therefore, the denominator for gender is 1,738.

current provider recommendations or practices. Finally, the

reasons that some HCPs might not recommend COVID-19

vaccination to women of reproductive age are unknown and

were not assessed.

Implications for Public Health Practice

COVID-19 vaccination is recommended for pregnant

patients to prevent severe illness and adverse pregnancy out-

comes (10), and HCPs are uniquely positioned to provide

vaccination recommendations. Provider recommendation for

vaccination is strongly associated with patient acceptance of

vaccine and with vaccination coverage. Encouraging HCPs to

recommend, offer, and administer COVID-19 vaccines, along

with influenza or Tdap vaccines, might help reinforce vaccine

confidence and increase vaccination coverage among women

of reproductive age, including pregnant women. Ensuring that

women of reproductive age receive these vaccines as recom-

mended is critical to reduce the incidence of these diseases

and their associated complications among pregnant women

and newborns.

Summary

What is already known about this topic?

COVID-19 vaccination is recommended for all persons

≥6 months of age. Pregnant women are at increased risk for

severe COVID-19 compared with other reproductive-aged

women. Health care provider (HCP) recommendations are

important for increasing vaccination coverage.

What is added by this report?

Although most (82.9%) surveyed HCPs recommended that

women of reproductive age stay up to date with COVID-19

vaccines, only 54.7% offered or administered the vaccine in

their practice. HCPs were more likely to offer or administer

COVID-19 vaccination on-site to pregnant patients if they also

offered or administered influenza (adjusted prevalence ratio

[aPR] = 5.5) and tetanus toxoid, reduced diphtheria toxoid, and

acellular pertussis (Tdap) vaccines (aPR = 2.3).

What are the implications for public health practice?

Encouraging HCPs to recommend, offer, and administer

COVID-19 vaccines along with influenza or Tdap vaccines might

help reinforce vaccine confidence and increase coverage among

women of reproductive age, including pregnant women.

Morbidity and Mortality Weekly Report

1050

TABLE 3. Factors associated with recommending and offering or administering COVID-19 vaccination on-site to pregnant patients among

health care providers caring for pregnant patients (N = 1,538) — Fall DocStyles, United States, 2022

Characteristic

Recommend that pregnant patients

receive COVID-19 vaccine

Offer or administer COVID-19 vaccination

on-site to pregnant patients

No. (%) PR (95% CI) No. (%) PR (95% CI)

Yes No Unadjusted Adjusted* Yes

†

Unadjusted Adjusted*

Provider type

FP or internist 763 (82.1) 166 (17.9) Ref Ref 519 (55.9) 410 (44.1) Ref Ref

Pediatrician 137 (88.4) 18 (11.6) 1.1 (1.0–1.1) 1.1 (1.0–1.1) 103 (66.5) 52 (33.6) 1.2 (1.0–1.3) 1.2 (1.1–1.3)

Ob-gyn 228 (94.2) 14 (5.8) 1.1 (1.1–1.2) 1.1 (1.1–1.2) 96 (39.7) 146 (60.3) 0.7 (0.6–0.8) 0.7 (0.6–0.9)

NP or PA 147 (69.3) 65 (30.7) 0.8 (0.8–0.9) 0.9 (0.8–0.9) 104 (49.1) 108 (50.9) 0.9 (0.8–1.0) 0.8 (0.7–1.0)

No. of years practicing

3–10 475 (83.6) 93 (16.4) 1.0 (1.0–1.1) 0.9 (0.9–1.0) 328 (57.8) 240 (42.3) 1.2 (1.1–1.4) 0.9 (0.8–1.1)

11–19 343 (83.9) 66 (16.1) 1.0 (1.0–1.1) 1.0 (0.9–1.0) 227 (55.5) 182 (44.5) 1.2 (1.0–1.3) 0.9 (0.8–1.1)

≥20 457 (81.5) 104 (18.5) Ref Ref 267 (47.6) 294 (52.4) Ref Ref

Provider age, yrs

<50 810 (84.7) 146 (15.3) Ref Ref 557 (58.3) 399 (41.7) Ref Ref

≥50 465 (80.0) 117 (20.1) 0.9 (0.9–1.0) 0.9 (0.9–1.0) 265 (45.5) 317 (54.5) 0.8 (0.7–0.9) 0.8 (0.6–0.9)

Provider gender

Female 533 (84.1) 101 (15.9) 1.0 (1.0–1.1) 1.0 (0.9–1.1) 338 (53.3) 296 (46.7) 1.0 (0.9–1.1) 1.0 (0.9–1.1)

Male 731 (82.1) 159 (17.9) Ref Ref 477 (53.6) 413 (46.4) Ref Ref

Recommend influenza vaccine to pregnant patients

Yes 1,236 (90.0) 139 (10.1) 3.8 (2.9–4.9) 3.7 (2.8–4.9) 773 (56.2) 602 (43.8) 1.9 (1.5–2.4) 1.8 (1.4–2.3)

No 39 (23.9) 124 (76.1) Ref Ref 49 (30.1) 114 (69.9) Ref Ref

Recommend Tdap vaccine to pregnant patients

Yes 1,078 (89.8) 123 (10.2) 1.5 (1.4–1.7) 1.5 (1.4–1.7) 674 (56.1) 527 (43.9) 1.3 (1.1–1.5) 1.3 (1.1–1.4)

No 197 (58.5) 140 (41.5) Ref Ref 148 (43.9) 189 (56.1) Ref Ref

Offer or administer influenza vaccine to pregnant patients

Yes 1,095 (88.2) 146 (11.8) 1.5 (1.3–1.6) 1.4 (1.3–1.6) 788 (63.5) 453 (36.5) 5.5 (4.0–7.6) 5.5 (4.0–7.6)

No 180 (60.6) 117 (39.4) Ref Ref 34 (11.5) 263 (88.6) Ref Ref

Offer or administer Tdap vaccine to pregnant patients

Yes 981 (88.7) 125 (11.3) 1.3 (1.2–1.4) 1.3 (1.2–1.4) 702 (63.5) 404 (36.5) 2.3 (2.0–2.7) 2.3 (1.9–2.7)

No 294 (68.1) 138 (31.9) Ref Ref 120 (27.8) 312 (72.2) Ref Ref

Abbreviations: FP = family practitioner; NP = nurse practitioner; Ob-gyn = obstetrician-gynecologist; PA = physician assistant; PR = prevalence ratio; Ref = referent

group; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine.

* Adjusted for number of years practicing, provider age, and provider gender.

†

Percentages might not sum to 100 because of rounding.

Four health care providers were excluded from gender-stratified analyses because when asked their gender, they did not report male or female but instead responded

“prefer to self-identify”; therefore, the denominator for gender is 1,534.

Corresponding author: Mehreen Meghani, MM[email protected].

Immunization Services Division, National Center for Immunization and

Respiratory Diseases, CDC;

Division of Reproductive Health, National Center

for Chronic Disease Prevention and Health Promotion, CDC;

Division of

Birth Defects and Infant Disorders, National Center on Birth Defects and

Developmental Disabilities, CDC;

Oak Ridge Institute for Science and

Education, Oak Ridge, Tennessee;

Influenza Division, National Center for

Immunization and Respiratory Diseases, CDC.

All authors have completed and submitted the International

Committee of Medical Journal Editors form for disclosure of potential

conflicts of interest. No potential conflicts of interest were disclosed.

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