Social media has a reputation as a playground for extreme vaccine views and alarmist rhetoric, but, according to a study published yesterday in PLOS Global Public Health, pregnant women discussing the tetanus, diphtheria, and pertussis (Tdap) vaccine on the social media platform Reddit were often looking for more practical things: clear answers, reassurance, and stories of other women navigating similar questions. 

The study identified fewer outright instances of vaccine hesitancy and refusal than have often been observed for other vaccines. 

For the study, researchers from Purdue University analyzed English-language posts on Reddit from October 2020 through October 2023, looking for the words Tdap, pertussis, whooping cough, and pregnant. Pertussis is also called whooping cough.

After identifying 173 relevant posts, the team filtered them based on three inclusion criteria—that the post was from a pregnant woman’s perspective, that the post was created before the baby was born, and that maternal Tdap vaccination was the post’s primary concern—and selected 86 posts for analysis.

Because infants younger than 2 months are too young to be vaccinated for pertussis, vaccination during pregnancy allows for the transfer of protective antibodies to the fetus. The US Centers for Disease Control and Prevention (CDC) recommends Tdap administration during the third trimester of every pregnancy, yet only an estimated 55.4% of pregnant women in the United States received the vaccine in 2023.

Questions center on timing, safety

After analyzing the posts, the team identified four main themes: 

• Information seeking
• Vaccine hesitancy
• Regulation and public policy
• Concerns about contact between newborns and unvaccinated people

Questions about when to receive Tdap were particularly common. Some women reported receiving varying recommendations from different healthcare providers, while others said their provider hadn’t discussed the vaccine with them at all. Others had questions about how long protection lasts, whether another dose was needed if they had recently been vaccinated, and whether the vaccine was safe for the fetus. 

Safety concerns were prominent, with women asking about potential side effects and the safety of receiving more than one vaccine at once. Some questioned whether the vaccine was necessary.

Family pushback a source of stress

The most common theme among pregnant women who posted on Reddit was responses from family and friends, describing pushback from people over getting vaccinated before having contact with newborns. Women described disagreements with partners, parents, and in-laws and sought advice on how to deal with these conflicts and set boundaries with family and friends. 

“Many pregnant women faced resistance from their families regarding the Tdap vaccine, which often resulted in significant stress for the poster and hesitation regarding enforcement of vaccination,” write the researchers. 

Many pregnant women faced resistance from their families regarding the Tdap vaccine, which often resulted in significant stress for the poster and hesitation.

Based on these findings, the researchers call for future studies on pregnant women’s safety concerns and the causes of vaccine hesitation. They also recommended research into pregnant women’s experience setting boundaries around vaccination for adults in close contact with newborns, a source of significant stress for pregnant women “that remains an underexplored area in both research and policy.”

In addition, the researchers note, general awareness of the Tdap vaccine among adults is limited, so public health campaigns should work to raise awareness about the importance of the vaccine for pregnant women and those who will come into close contact with newborns.