Strategies for increasing uptake of vaccination in pregnancy in high-income countries: A systematic review

Vaccine. 2018 May 11;36(20):2751-2759. doi: 10.1016/j.vaccine.2018.04.013. Epub 2018 Apr 13.


Introduction: Vaccination in pregnancy is an effective method to protect against disease for the pregnant woman, foetus and new born infant. In England, it is recommended that pregnant women are vaccinated against pertussis and influenza. Improvement in the uptake of both pertussis and influenza vaccination among pregnant women is needed to prevent morbidity and mortality for both the pregnant women and unborn child.

Aim: To identify effective strategies in increasing the uptake of vaccination in pregnancy in high-income countries and to make recommendations for England.

Methods: A systematic review of peer reviewed literature was conducted using a keyword search strategy applied across six databases (Medline, Embase, PsychInfo, PubMed, CINAHL and Web of Science). Articles were screened against an inclusion and exclusion criteria and papers included within the review were quality assessed.

Results and conclusions: Twenty-two articles were included in the review. The majority of the papers included were conducted in the USA and looked at strategies to increase influenza vaccination in pregnancy. There is limited high quality evidence for strategies in high-income countries to increase coverage of pertussis and influenza vaccination in pregnancy. A number of strategies have been found to be effective; reminders about vaccination on antenatal healthcare records, midwives providing vaccination, and education and information provision for healthcare staff and patients. Future interventions to increase vaccination in pregnancy should be evaluated to ensure efficacy and to contribute to the evidence base.

Keywords: Influenza vaccine; Maternal vaccination; Pertussis vaccine; Pregnancy; Strategies; Vaccine hesitancy.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Developed Countries
  • England
  • Female
  • Health Personnel / education
  • Humans
  • Infant, Newborn
  • Influenza, Human / prevention & control*
  • Midwifery
  • Patient Education as Topic
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control*
  • United States
  • Vaccination Refusal*
  • Vaccination*
  • Whooping Cough / prevention & control*