Determinants of uptake of influenza vaccination among pregnant women - a systematic review

Vaccine. 2014 Aug 6;32(36):4602-13. doi: 10.1016/j.vaccine.2014.06.067. Epub 2014 Jul 2.


Background: Pregnant women have the highest priority for seasonal influenza vaccine. However, suboptimal coverage has been repeatedly noted in this population. To improve vaccine uptake, reviewing the determinants of vaccination is of increasing importance.

Methods: A detailed literature search was performed up to November 30, 2013 to retrieve articles related to uptake of influenza vaccination during pregnancy.

Results: Forty-five research papers were included in the review. Twenty-one studies assessed the coverage of seasonal influenza vaccination, 13 studies assessed coverage of A/H1N1 pandemic vaccination and 11 studies assessed both. Vaccination uptake ranged from 1.7% to 88.4% for seasonal influenza, and from 6.2% to 85.7% for A/H1N1 pandemic influenza. Many pregnant women were unaware that they were at high risk for influenza and its complications during pregnancy. They were also more likely to underestimate the threat of influenza to themselves and their fetus. Moreover, they had substantial concerns about the safety and efficacy of the influenza vaccine during pregnancy. Negative media reports contributed to the perception that influenza vaccination during pregnancy was risky and could result in adverse pregnancy outcomes. Although health care providers' (HCPs) recommendations were consistently associated with vaccine uptake, most did not recommend the vaccine to their pregnant clients.

Conclusions: Influenza vaccination uptake among pregnant women is suboptimal and HCPs rarely recommend it. Positive vaccination recommendations from HCPs as well as direct access to the vaccine would likely substantially improve vaccination acceptance.

Keywords: Attitudes; Beliefs; Health belief model; Pregnant women; Seasonal influenza; Vaccination.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Databases, Factual
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel
  • Humans
  • Influenza A Virus, H1N1 Subtype
  • Influenza Vaccines / therapeutic use*
  • Influenza, Human / prevention & control*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control
  • Randomized Controlled Trials as Topic
  • Vaccination / statistics & numerical data


  • Influenza Vaccines