Abstract: Pregnant women are at greater risk for severe COVID-19 disease and are a priority group for vaccination. Trinidad and Tobago (TTO) introduced COVID-19 vaccination for pregnancy in August 2021, however uptake is presumed to be low. The objective was to determine the COVID-19 vaccine acceptance and uptake rates among pregnant women in TTO and reasons for vaccine hesitancy.This was a cross-sectional study on 448 pregnant women conducted at specialized antenatal clinics within the largest Regional Health Authority in TTO, and at one private institution from February 1 to May 6, 2022. Participants completed an adapted WHO questionnaire on reasons for COVID-19 vaccine hesitancy. Logistic regression was used to assess factors affecting vaccination decisions.The vaccine acceptance and uptake rates in pregnancy were 26.4% and 23.6%, respectively. The main reason for vaccine hesitancy was lack of research on the COVID-19 vaccine in pregnancy (70.2%), where 75.5% of women believed the vaccine would harm their babies and 71.2% believed there was not enough data. Women seeking care in the private sector (OR: 5.24, 95% CI: 1.41-19.43) and who had comorbidities (OR: 3.72, 95% CI: 11.57-8.83) were more likely to take the vaccine, while Venezuelan non-nationals (OR: 0.09, 95% CI: 0.01-0.71) were less likely to take the vaccine. Older women (OR: 1.80, 95% CI: 1.12-2.89), women with tertiary education (OR: 1.99, 95% CI: 1.25-3.19), and women seeking care in the private sector (OR: 9.45, 95% CI: 4.36-20.48) were more likely to accept the vaccine.Lack of confidence in the vaccine was the main reason for hesitancy, which may reflect paucity of research, lack of knowledge or misinformation of the vaccine in pregnancy. This highlights the need for more targeted public education campaigns and promotion of the vaccine by health institutions. The knowledge, attitudes, and beliefs of pregnant women obtained from this study can guide the development of vaccination programs in pregnancy.
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