Abstract

Background Maternal respiratory syncytial virus (RSV) vaccination has been introduced to protect infants from severe respiratory infections. However, its uptake and impact on perinatal outcomes are unknown in the UK. Objectives To evaluate uptake of RSV vaccine during pregnancy in a UK population. Methods and analysis This cross-sectional study was conducted at a tertiary maternity hospital in London. The participants included pregnant women who delivered between 1 September and 17 December 2024 (n=1157). For the analysis of vaccine uptake, the cohort included women eligible for vaccination who delivered beyond 28 weeks’ gestation and were at 36 weeks or less on 1 September 2024 (n=911). The main outcome measures were RSV vaccine uptake and its association with sociodemographic factors, perinatal outcomes including preterm birth (PTB), hypertensive disorders of pregnancy and stillbirth. Results Of 911 eligible women, 19% (n=173) received the RSV vaccine during pregnancy. Uptake increased significantly from 4% in September to 32% in December (p<0.001). Vaccinated women were older (median age 35 vs 32 years, p<0.001), more likely to be white (66.3% vs 46.5%, p<0.001), and from higher socioeconomic quintiles (Index of Multiple Deprivation quintile 5: 18.5% vs 11.2%, p=0.029). Smoking during pregnancy was less common in vaccinated women (0.6% vs 5.0%, p=0.016). Multivariable logistic regression identified older maternal age (p=0.001), higher socioeconomic status (IMD quintile 1 vs 5; adjusted OR (aOR) 0.28, 95% CI 0.08 to 0.81, p=0.030) and ethnicity (Asian: aOR 0.56, 95% CI 0.35 to 0.88, p=0.015, black: aOR 0.52, 95% CI 0.28 to 0.95, p=0.040, mixed: aOR 0.12, 95% CI 0.02 to 0.39, p=0.004) as independent predictors of vaccine uptake. PTB rates at <37 weeks were comparable between groups (9.6% vs 10.0%, p=0.980), but no vaccinated women experienced PTB<34 weeks compared with 3.2% of unvaccinated women (p=0.032). Caesarean section rates were higher among vaccinated women (52.0% vs 35.5%, p<0.001). No significant differences were observed in other perinatal outcomes. Conclusions RSV vaccine uptake shows significant increases over time, with disparities in uptake by ethnicity and socioeconomic status. Further research is needed to increase vaccination rates, particularly in disadvantaged groups, and evaluate perinatal outcomes.