Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis

Influenza vaccination hesitancy and related factors among pregnant and breastfeeding women: A cross-sectional study

Achieving safe influenza vaccination coverage among pregnant and breastfeeding women is a global health goal due to the potential risks of serious influenza for both mother and child. However, vaccine hesitancy remains a significant barrier to vaccination uptake. Since anxiety represents a determinant in vaccine decision-making, this study aimed to assess influenza vaccination hesitancy and anxiety levels in this population and to explore the association between women's characteristics, their reluctance, and anxiety levels. A multicentre, cross-sectional study was conducted between February and June 2022 using structured phone interviews to assess: (1) socio-demographics and clinical history; (2) anti-flu vaccination status, previous anti-flu vaccination, and Sars-CoV-2 infection history; (3) insights into influenza vaccination during pregnancy; (4) attitudes toward anti-flu vaccination, using the Vaccination Attitudes Examination (VAX) Scale; (5) anxiety levels, measured by the Self-Rating Anxiety Scale (SAS). Among the 387 participants, 22.8% were already vaccinated or expressed willingness to be vaccinated against influenza, and 54% had an anxiety disorder. While anxiety was not significantly associated with vaccine hesitancy, ongoing pregnancy emerged as an independent predictor of anxiety. Higher educational levels, ongoing pregnancy, already being vaccinated or willingness to get vaccinated, and being employed were associated with reduced vaccine hesitancy, while prior SARS-CoV-2 infection with increased hesitancy. Fear of unpredictable events and lack of healthcare professionals' recommendations emerged as reasons for vaccine reluctance. Given the low coverage rates, these findings highlight the need for health services to enhance vaccination efforts and provide clear recommendations to counter misinformation and ensure accurate vaccine safety information.

Challenges and opportunities of vaccination during pregnancy: perspectives of 20 healthcare professionals

Vaccination during pregnancy is crucial due to increased maternal vulnerability to infectious diseases. However, uptake of recommended vaccines (influenza, pertussis, COVID-19) remains suboptimal, particularly among disadvantaged groups. This qualitative study explored healthcare professionals' (HCPs) perspectives, selected purposively, on factors influencing maternal vaccination in London. Data from a workshop transcript and an online quality improvement survey involving 15 GPs, two midwives, two obstetricians and one pharmacist were thematically analysed. HCPs highlighted that pregnant women perceive the benefits of pertussis vaccination more positively than other vaccines. Clear, consistent communication and integrating vaccinations into routine antenatal care were identified as essential for improving accessibility and convenience. The critical role of midwives influencing vaccination decisions was emphasised. While recognising the potential of AI-based technologies to disseminate vaccine information, concerns were raised about trust, digital literacy and information quality, highlighting the need for tailored, reliable strategies to boost maternal vaccination rates and improve health outcomes.

An exploration of women's decision-making processes around accepting or declining vaccinations in pregnancy: A qualitative descriptive study

OBJECTIVE

To explore women's perceptions and experiences of accepting or declining vaccinations in pregnancy, and to identify factors that influence vaccination uptake.

DESIGN

A qualitative descriptive interview-based study.

SETTING

The maternity unit of a rural hospital in the Republic of Ireland.

PARTICIPANTS

A purposive sample of eight women who were pregnant, aged 18 and over, who were receiving antenatal care through the public healthcare system. Half of the participants accepted vaccinations, while the other half declined, reflecting varying levels of vaccine hesitancy.

METHODS

Semi structured interviews (n=8) were conducted between July 2022 and August 2022 and analysed using thematic analysis.

FINDINGS

The study offers insight into women's decision-making processes on vaccinations in pregnancy. Five main themes were identified (1). Maternal Instincts in the Shadow of Uncertainty, (2). Lack of Balanced Information, (3). Misinformation: Difficult to Ignore, (4). Navigating Fear and Social Pressures, (5). Perceived Benefits Outweighing Risk.

KEY CONCLUSIONS

The decision-making process around vaccination in pregnancy is complex and multifaceted, influenced by various factors that can either hinder or promote uptake rates. Participants expressed complex emotions, associated fears and anxieties, and highlighted the necessity for more balanced and transparent dialogues with healthcare professionals. They emphasised the need for the dissemination of high-quality objective evidence from health authorities. This, they felt, would help facilitate genuine informed decision making, and ease the burden of feelings of uncertainty.

IMPLICATIONS FOR PRACTICE

The provision of balanced, reliable, evidence-based information made available through multiple sources, alongside open and non-judgemental conversations with healthcare professionals is essential to support women in making informed decisions. Consequently, healthcare professionals require education and training to effectively communicate vaccination information clearly, empathetically, and in a way that is tailored to individual needs.

Reliability and validity study of the "5Cs" hesitancy scale for maternal influenza vaccination among pregnant and postpartum women

BACKGROUND

Maternal influenza vaccine hesitancy plays a vital role in the low rates of vaccination. However, instruments to appropriately assess perinatal influenza vaccine hesitancy are unavailable. This study aimed to develop the Maternal Influenza Vaccine Hesitancy Scale based on the 5C vaccination hesitancy scale, containing the subscales of confidence, complacency, constraints, calculative, and collective responsibility, and to provide a preliminary overview of the current hesitancy on maternal influenza vaccination in China.

METHODS

A cross-sectional survey, from January to March 2024, was carried out among 2035 pregnant and postpartum women from nine provincial-level administrative divisions representing eastern, central, western, and northeastern areas of China. Reliability was evaluated by internal consistency reliability and split-half reliability, and a Cronbach's alpha coefficient > 0.7 was considered acceptable. Construct validity was assessed using confirmatory factor analysis (CFA), with good model fit defined as root mean square error of approximation (RMSEA) < 0.100, normed fit index (NFI) > 0.9, comparative fit index (CFI) > 0.9, and Tucker-Lewis index (TLI) > 0.9.

RESULTS

Confirmatory factor analysis results supported the five-factor structure of the scale (RMESA = 0.098, CFI = 0.921, TLI = 0.903, NFI = 0.918). The Cronbach's alpha coefficients for the scale as well as the subscales ranged from 0.802 to 0.958. Among five subscales, collective responsibility (2.73 ± 0.63) scored highest, while complacency (2.16 ± 0.69) and constraints (2.17 ± 0.69) were the lowest.

CONCLUSIONS

The Maternal Influenza Vaccine Hesitancy Scale developed in this study is a reliable and valid instrument to measure the influenza vaccine hesitancy of pregnant and postpartum women. It is recommended that interventions including health education and improving the access to the vaccination service be carried out to reduce the maternal influenza vaccination hesitancy.

Maternal Immunization: Current Evidence, Progress, and Challenges

Maternal immunization is a key strategy for protecting pregnant individuals and newborns from infectious diseases. This review examines the mechanisms and benefits of maternal immunization, with a focus on transplacental IgG transfer and immune system interactions. We provide an overview of current recommendations and the safety and efficacy profiles of maternal vaccines, including influenza, tetanus-diphtheria-acellular pertussis (Tdap), respiratory syncytial virus (RSV), COVID-19, and hepatitis B. Additionally, we analyze the barriers to maternal immunization, such as misinformation, vaccine hesitancy, and disparities in healthcare access, while exploring potential strategies to overcome these challenges through targeted educational initiatives, improved provider communication, and policy-driven interventions aimed at increasing vaccine confidence and accessibility. Finally, this review highlights recent innovations and future directions in maternal immunization, including emerging vaccines for Group B Streptococcus and cytomegalovirus. Expanding immunization programs and advancing research on maternal-fetal immunity are essential to optimizing vaccination strategies, improving public health outcomes, and reducing the global burden of infectious diseases.

Systematic review and meta-analysis of interventions to increase the uptake of vaccines recommended during pregnancy

Although immunization during pregnancy can protect mothers and their infants from vaccine-preventable morbidity and mortality, vaccination rates are often poor. We systematically reviewed the literature from inception to July 4, 2023, for randomized and non-randomized quasi-experimental studies estimating the effects of interventions to increase vaccination during pregnancy. Of 9331 studies screened, 36 met inclusion criteria, including 18 demand-side interventions, 11 supply-side interventions, and seven multi-level (demand and supply-side) interventions. Demand-side interventions commonly addressed patient education, showing modest improvement (pooled RR 1.18; 95% CI: 1.04, 1.33; I2 = 63.1%, low certainty). Supply-side interventions commonly implemented Assessment-Feedback-Incentive-eXchange interventions with little improvement (pooled RR 1.13; 95% CI: 0.96, 1.33; I2 = 94.0%, low certainty). Multi-level interventions were modestly effective in increasing vaccination (pooled RR 1.62; 95% CI: 1.09, 2.42; I2 = 97%, very low certainty). Interventions identified in the literature mostly resulted in low to moderate increases in vaccination with likely high heterogeneity and low to very low certainty in the findings.

Primary Healthcare Professionals' Knowledge and Attitudes Towards Meningococcal, Rotavirus, and HPV Vaccines in Children and Adolescents

Aim: This study aimed to evaluate the knowledge and attitudes of family physicians and family health personnel who are responsible for childhood vaccination services in primary care regarding meningococcal, rotavirus, and human papillomavirus vaccines. Methods: This cross-sectional study was conducted between October 2021 and January 2022. A total of 700 healthcare professionals from all geographical regions in Turkey were included in the study. The participants filled out an online questionnaire consisting of 39 questions created with Google Forms. Results: Of the participants, 340 (48.6%) are family physicians, and 360 (51.4%) are family health personnel. Most participants are from the Marmara region, Turkey's most densely populated region. The most recommended vaccine among the participants was rotavirus (84.3%), while the least recommended vaccine was human papilloma virus (47.6%). The number of family physicians recommending meningococcal and human papilloma virus vaccines was significantly higher than that of family health personnel (p < 0.001). Furthermore, there was a statistically significant correlation between seeing a patient with these viruses in one's professional life or considering the severity of these three diseases to be severe and recommending these vaccines (p < 0.001 for both). However, lack of knowledge about vaccines and doses, the high cost of vaccines, and concerns about side effects were among the reasons for not recommending vaccines. Conclusions: Healthcare professionals involved in childhood immunization should be trained to increase their knowledge and awareness on this issue. The training plan and curriculum should take into account the issues raised in our research, such as age, occupation, region of residence, and professional experience. In general, knowledge about the efficacy and safety of vaccines will help healthcare professionals develop their confidence in vaccines and willingness to recommend childhood vaccines to others.

Factors that influence vaccination communication during pregnancy: provider and patient perspectives using the theoretical domains framework

INTRODUCTION

Vaccination during pregnancy is recommended but uptake is low and evidence on the topic is limited.

AIMS

This study aimed to identify the drivers of current behavior and barriers to change for health care practitioners (HCPs) and pregnant patients in Canada.

METHODS

This study is an in-depth qualitative investigation of the factors influencing HCPs' vaccination communication during pregnancy, as well as factors influencing pregnant patients' vaccination uptake in Canada using the Theoretical Domains Framework. Three data sources were used: (1) perinatal HCP interviews before COVID-19; (2) perinatal HCP interviews regarding vaccine communication after COVID-19; and (3) survey of pregnant or lactating women after COVID-19.

RESULTS

Forty-seven interviews and 169 participant responses were included. Perinatal HCPs reported limited information on vaccine communication or difficulty keeping up-to-date ( Environmental context and resources ; Knowledge; Beliefs about capabilities ). HCPs lacked confidence and struggled with lack of training to address vaccine hesitancy without alienating patients ( Beliefs about capabilities; Skills ). Pregnant or lactating women struggled with the amount of information they felt was imposed on them, had concerns about the perceived negative consequences of vaccination, and felt pressure to understand what was best for them and their babies ( Knowledge; Beliefs about consequences; Social influences ).

CONCLUSIONS

Our study provides a theory-based approach to identify influencing factors that can be mapped to theory-based intervention components, improving the likelihood of intervention effectiveness. The study is the first step in adapting an existing intervention to improve vaccine communication during pregnancy, ultimately, increasing vaccination uptake.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A260.

Safety and Efficacy of Vaccination During Lactation: A Comprehensive Review of Vaccines for Maternal and Infant Health Utilizing a Large Language Model Citation Screening System

Newborns are born with an immature immune system, making them susceptible to infections early in life. Human milk provides essential nutrients and immunological factors that support infant immunity. Maternal vaccination during lactation has the potential to enhance these benefits by triggering an immune response in the mother, potentially extending protection to her child. However, lactating individuals are often excluded from vaccine trials, leading to uncertainties about vaccine safety and efficacy during the postpartum period. This study critically evaluates the effectiveness of vaccines in enhancing the immune-supporting properties of human milk and assesses their safety and efficacy for lactating mothers and their infants. By examining potential benefits alongside safety concerns, we aim to provide a comprehensive understanding of postpartum vaccination's impact on maternal and infant health. We utilized large-language models (LLMs) to enhance the review process and performed a structured literature search across Ovid/Medline, Embase, and Clarivate Analytics using terms like "breastfeeding", "postpartum", and "vaccination". A three-stage screening process involving human and LLM-assisted evaluation focused on postpartum vaccines and their implications for maternal and infant health. We identified 73 studies covering vaccines against COVID-19, cholera, influenza, pertussis, pneumococcal, rabies, polio, rotavirus, rubella, varicella, typhoid, smallpox, and yellow fever. Most vaccines, such as those for COVID-19 and influenza, appear safe and effective for postpartum use without requiring precautionary measures. However, caution is advised with vaccines such as the yellow fever vaccine, where temporary breastfeeding cessation is recommended. Overall, this review underscores the compatibility of most vaccines with lactation and suggests its benefits for both mother and infant.

Knowledge, Attitudes, and Practices Regarding Influenza and Pertussis Immunization During Pregnancy in Greece

BACKGROUND/OBJECTIVES

Vaccination against influenza and pertussis in pregnant women protects the mother and child through the transfer of protective antibodies across the placenta. However, pregnant women's vaccine hesitancy is a major barrier to achieve satisfactory vaccination coverage in many developed countries.

METHODS

Greek pregnant women's vaccination knowledge, attitudes, and practices were recorded. Structured questionnaires were administered to mothers of infants under the age of 12 months through their pediatricians. Sampling across the country's districts was applied to achieve geographic representativeness.

RESULTS

Questionnaires from 474 mothers were collected. Their mean age was 34 (±5) years. Vaccination uptake was 16.8% and 45.7%, for pertussis and influenza, respectively. During their recent pregnancy, 68.9% and 27.1% of the responders had been informed by their gynecologists regarding influenza and pertussis maternal immunization, respectively, indicating that gynecologists miss out on informing a significant rate of pregnant women. According to multiple logistic regression, women who gave birth during spring (OR: 2.29 vs. winter delivery, p = 0.042) and those with an MSc or PhD (OR: 2.93 vs. school graduates, p = 0.015) were more likely to receive influenza vaccination. Factors favoring influenza vaccination included doctor's recommendation (OR: 18.86, p < 0.001), being not/somewhat afraid of potential vaccine side effects during pregnancy (OR: 2.09, p = 0.012), considering the flu as relatively/very dangerous during pregnancy (OR: 8.05, p < 0.001), and considering the flu vaccine as relatively/completely safe (OR: 4.37, p < 0.001). Doctor's recommendation (OR: 29.55, p < 0.001) and considering pertussis a relatively/very serious risk to the mother's health during pregnancy (OR: 6.00, p = 0.002) were factors associated with pertussis vaccination during pregnancy.

CONCLUSIONS

The education of both expectant mothers and obstetricians is urgently needed in order to increase immunization coverage during pregnancy. The low influenza vaccination coverage among women delivering during winter and low pertussis immunization rates, in combination with low recommendation rates for both vaccines, strongly indicate that Greek obstetricians focus on maternal health alone. Their perspectives play an instrumental role in vaccine acceptance during pregnancy, shaping the immunization inclusion maps.

Pregnant women's choices for preventing respiratory syncytial virus (RSV)

INTRODUCTION

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in infants and can lead to severe respiratory distress, especially in very young infants. No specific treatments exist for RSV. However, new preventative strategies have become available including RSV vaccine for pregnant women and monoclonal antibody for infants. This study aimed to identify and understand barriers and facilitators to the uptake of a new RSV vaccine in pregnant women and determine their underlying choices for a maternal RSV immunisation program. Additionally, the study investigated choice for maternal vaccination or administration of a long-lasting monoclonal antibody to infants.

METHODS

Eligible participants were pregnant women residing in Australia and aged 18 years or older. Focus group discussions and individual online interviews were conducted and data were analysed using a thematic analysis approach.

RESULTS

A total of 34 pregnant women participated in online focus group discussions or interviews, with an average age of 34 years. The identified themes were categorised into four overarching domains: 1) motivators for vaccinating during pregnancy to safeguard their babies and prevent severe diseases, 2) barriers to vaccination including vaccine safety concerns, uncertainties regarding vaccine effectiveness, and vaccine hesitancy arising from COVID-19 vaccination experiences, 3) preferred vaccination promotion strategies, including constant reminders/prompts, personalised messages, campaign focusing on serious outcomes and using diverse/lay languages, recommendations from local obstetricians and health authorities, 4) clear vaccine recommendation policies and a preference for maternal immunisation over infant immunisation.

CONCLUSIONS

The maternal RSV vaccination was generally welcomed and preferred by pregnant women in our study comparing to other strategies. Preferences for RSV program promotion included diversity in languages, "nudge" reminders, and recommendations from healthcare providers.

Knowledge and Attitudes Regarding Respiratory Syncytial Virus (RSV) Prevention: A Systematic Review

Background: New strategies for respiratory syncytial virus (RSV) prevention are available and are in development, but their acceptance is crucial to their effectiveness. Objectives: This systematic review aims to summarize current quantitative and qualitative evidence regarding knowledge and attitudes relating to RSV prevention. Methods: Six databases (PubMed, Scopus, APA PsycArticles; APA PsycInfo; CINAHL Complete; Psychology and Behavioral Sciences Collection) and two preprint repositories (medRxiv and Preprints) were searched up until 23 December 2024 (PROSPERO: CRD42024602351). Results: Sixty-one articles were included, focusing on vaccination for the elderly and adults at risk (n = 10) or pregnant people (n = 24, of which 8 also examined preferences for maternal vs. infant immunization) and infant immunization (n = 27, of which 16 focused on palivizumab, with 6 focusing on adherence to its monthly administration). Eighteen articles assessed attitudes in healthcare professionals. Overall, findings showed limited knowledge and awareness of RSV but generally positive attitudes towards prevention strategies and moderate to high intentions and uptake rates. Protection against the disease and perceived severity promoted acceptance, whereas concerns about side effects hindered it. Maternal vaccination was more acceptable than infant immunization. Conclusions: Attitudes towards RSV prevention options were generally favorable. Should more options become available, preferences may depend on which options are available, their characteristics, and how they are framed and presented. These insights highlight the importance of education on RSV grounded in decision-making literature, while recognizing the likely favorable reception of preventive measures across target age-populations.

Do Pregnant Persons Want Influenza Vaccines? Knowledge, Attitudes, Perceptions, and Practices Toward Influenza Vaccines in 8 Low- and Middle-Income Countries

BACKGROUND

Vaccination is the most effective way to prevent influenza infection and adverse outcomes; despite global recommendations to vaccinate pregnant persons, access to influenza vaccines remains low. We explored knowledge, attitudes, and practices of pregnant persons to inform actions to improve vaccine uptake.

METHODS

We pooled data from cross-sectional surveys assessing pregnant persons' attitudes toward influenza vaccines in 8 low- and middle-income countries. Countries used standard methods to measure attitudes and intents toward influenza vaccination. We stratified by presence/absence of a national influenza vaccination program, income group, geographic region, and individual-level factors.

RESULTS

Our analysis included 8556 pregnant persons from 8 countries. Most pregnant persons (6323, 74%) were willing to receive influenza vaccine if it was offered for free. Willingness differed by presence of an existing influenza vaccination program; acceptance was higher in countries without programs (2383, 89%) than in those with programs (3940, 67%, P < .001).

CONCLUSIONS

Most pregnant persons in middle-income countries, regardless of influenza vaccination program status, were willing to be vaccinated against influenza if the vaccine was provided free of charge. National investments in influenza vaccination programs present an opportunity to avert illness both in pregnant persons themselves and in their newborn babies.

Assessing Vaccine Coverage and Barriers to Immunization Among Pregnant Individuals in Uruguay: A Brief Report

This study evaluates vaccine coverage rates and identifies barriers to influenza and pertussis immunization among pregnant individuals in Uruguay. Despite free and accessible vaccination, coverage remains low due to lack of medical recommendations and unawareness. Enhancing healthcare professional training and public awareness is essential to improve immunization rates and safeguard maternal and infant health.

Vaccine Confidence During Pregnancy and the Impact of the COVID-19 Pandemic: A Wide Variety of Views Across the European Union

BACKGROUND

There is a wide variety of vaccination programs during pregnancy implemented in different European Union (EU) countries. The recent coronavirus disease 2019 (COVID-19) pandemic emphasized the need for efficient interventions to increase vaccine confidence during pregnancy since pregnant women were less likely to accept COVID-19 vaccination compared with nonpregnant women. This survey investigated the influence of the COVID-19 pandemic on vaccine confidence during pregnancy in 11 European countries.

METHODS

An online survey with questions on maternal vaccine confidence was distributed in 10 EU countries between March 29 and April 6, 2022. Via convenience sampling, 25 eligible participants per country were recruited. Subsequently, the survey was distributed in Flanders (Belgium) between October 14 and 26, 2022, delivering 480 eligible respondents. All participants were either pregnant or gave birth in the last 2 years.

RESULTS

Across all countries, vaccine confidence during pregnancy was found to be lower than vaccine confidence in general. Safety concerns were indicated as the most important reason to refuse vaccination during pregnancy. Participants with higher education and who were above 30 years old showed more confidence toward vaccination during pregnancy. A total of 15% of the participants indicated that the COVID-19 pandemic negatively impacted their confidence toward vaccines.

CONCLUSIONS

Vaccine confidence during pregnancy varies widely across the EU. However, across all surveyed countries, vaccine confidence during pregnancy is lower than vaccine confidence in general, and safety concerns appear to be the main driver of this. The COVID-19 pandemic negatively impacted the view on vaccination in a significant proportion of participants, indicating that vaccine implementation in a next pandemic should be tackled differently.

Provider Determinants of Maternal Influenza and Pertussis Vaccination Uptake in South Australia in a Tertiary Healthcare Setting

Background: In Australia, maternal influenza and pertussis vaccinations have been recommended for every pregnancy since 2010 and 2015, respectively. Aims: This study aimed to determine maternal influenza and pertussis vaccine uptake in South Australia and assess factors associated with vaccine uptake among pregnant women. Methods: This retrospective cohort study collected data from the South Australian Pregnancy Record (SAPR) or other medical records of women who delivered at the Women's and Children's Hospital from 2016 to 2018. Results: Of 2230 complete records, 53.5% received influenza vaccination and 66.5% pertussis vaccination. Maternal vaccine uptake significantly increased from 2016 to 2018: influenza 43.1-61.6%; pertussis 58.7-71.6%. Healthcare provider discussions with pregnant women about maternal vaccines more than doubled the likelihood of influenza (AOR 2.74, 95% CI: 2.21-3.39) and pertussis vaccine uptake (AOR 2.22, 95% CI: 1.77-2.78). Lower vaccine uptake was observed among women attending midwifery clinics (influenza: AOR 0.72, 95% CI: 0.58-0.90; pertussis: AOR 0.67, 95% CI: 0.54-0.84) or private maternity care (influenza: AOR 0.51, 95% CI: 0.34-0.77; pertussis: AOR 0.40, 95% CI: 0.27-0.60). Shared antenatal care increased the uptake of influenza (AOR 1.51, 95% CI: 1.12-2.04) and pertussis (AOR 1.39, 95% CI: 1.00-1.91). Additional adjustment for SAPR versions did not appreciably change the results, although attending private practice was no longer significantly associated with lower vaccine uptake. Conclusions: Maternal vaccine uptake varies depending on the antenatal care provider. This study identifies opportunities to improve vaccination access during pregnancy and emphasizes the need for targeted strategies to address provider-related barriers.

Structural equation modeling to evaluate the adult vaccine hesitancy scale for vaccines recommended during pregnancy

INTRODUCTION

Acceptance of recommended vaccines is lower among pregnant people compared to non-pregnant adults, yet no tool has specifically measured prenatal vaccine hesitancy. We evaluated the performance of an existing adult Vaccine Hesitancy Scale (aVHS) in measuring vaccine hesitancy toward routinely recommended prenatal vaccines.

METHODS

Between December 2021 and April 2022, we conducted a cross-sectional national online survey with 917 US postpartum adults 18-49 years old who had given birth in the past six months. Vaccine hesitancy was measured using the aVHS, a 10-item scale previously validated among the adult general population. Scores range from 10 to 50, with higher scores indicating greater vaccine hesitancy. Structural equation modeling (SEM) with weighted least squares means and variances adjusted (WLSMV) estimator was used to assess the fit of the aVHS structure. Construct validity was assessed by examining the correlation between the aVHS score and the self-reported receipt of recommended prenatal vaccines.

RESULTS

SEM indicated acceptable fit (RMSEA: 0.098; CFI: 0.983; TLI: 0.978; SRMR: 0.040) of the data to the two-factor model: (1) lack of vaccine confidence, and (2) perceived vaccine risks. For the paths from the two factors to the vaccine acceptance, lack of vaccine confidence was significantly correlated with influenza vaccine acceptance (β = -0.41, p < 0.001) and COVID-19 vaccine acceptance (β = -0.64, p < 0.001), while perceived vaccine risk was significantly linked with Tdap vaccine acceptance (β = -0.57, p < 0.001) and influenza vaccine acceptance (β = -0.25, p < 0.001). Additionally, pregnant people with higher aVHS scores were less likely to receive recommended prenatal vaccines.

DISCUSSION

Although the aVHS offered acceptable measurement of prenatal vaccine hesitancy, a scale that measures pregnancy-specific concerns may offer more tailored measurement for this unique population.

Respiratory syncytial virus (RSV) prevention: Perception and willingness of expectant parents in the Netherlands

BACKGROUND

Respiratory syncytial virus (RSV) is a leading cause of infant respiratory disease. Recent approval of preventive measures like a long-acting monoclonal antibody and a maternal vaccine signals a potential shift in early-life RSV infection control. However, success hinges on acceptance.

METHODS

We conducted a cross-sectional survey among pregnant women and partners in the Netherlands, recruited via healthcare professionals, social media platforms, and the 9-Months Fair. The survey assessed willingness and motivation for maternal RSV vaccination and neonatal RSV immunization, including strategy preferences and informational needs.

RESULTS

In total 1001 pregnant women (mean age: 31.1 years) and their partners (mean age: 33.2 years) completed the survey. On average, they were 24 weeks pregnant at the time, and 54.6 % had no other children yet. The majority was Dutch-born (95.2 % of women); with 68.3 % of women having completed higher education and with overall strong pro-vaccination attitudes (93.9 % of partners intended to vaccinate their expected newborn). The overall acceptability to vaccination and immunization was high, with 87 % of respondents indicating they would (likely) accept both strategies. A positive attitude towards both methods was associated with previous experience with severity of RSV, intention to vaccinate the newborn and parental vaccination status during childhood and current pregnancy. When the choice was given, the majority of participants, in particular those with children and the intention to breastfeed, favoured maternal vaccination over passive immunization of infants (75.3 % of the pregnant and 71.6 % of the partners). A majority of the respondents cited optimal protection for the child and knowledge of RSV as important factors for accepting RSV prophylaxis.

CONCLUSIONS

While most participants would accept both strategies for RSV protection of their infant, a majority, especially those with other children, favoured maternal vaccination, due to concerns about infant safety and awareness of RSV severity.

Pertussis vaccination coverage in women at two months postpartum and associated factors in France, National Perinatal Survey 2021

BACKGROUND

Pertussis vaccination in young mothers aims to protect neonates through cocooning. We estimated pertussis vaccination coverage (VC) in women at two months postpartum in France in 2021, and the proportion of women who got vaccinated in the first two months postpartum; associated determinants were studied.

METHODS

We used data from the 2021 National Perinatal Surveys conducted in metropolitan France (ENP 2021) and French overseas territories (ENP-DROM 2021). Multivariate poisson regressions were employed to study the following determinants: age, educational level, monthly household income, socio-professional situation, birth country, parity, health professional who monitored pregnancy, influenza vaccination during pregnancy, region of residence, prenatal care consultations, having health insurance, having a partner, and having a chronic pathology. Results were weighted.

RESULTS

The study sample comprised 7999 women. Estimated pertussis VC at two months postpartum was 66.8 % (95 %CI [65.5-68.0]). VC was significantly lower in i) unemployed women (vs. executives/managers, intermediate and higher intellectual professionals), ii) those on low income (vs. high), and iii) those with two or more children (vs. primiparous). It was significantly higher in i) women born in France, ii) those vaccinated against influenza during pregnancy, iii) those who received pre-natal care from a private midwife, and iv) those with more prenatal consultations. The proportion of women vaccinated against pertussis in the two-month postpartum period (33.4 % [31.7-35.9]) was significantly lower in i) women on low incomes, ii) unemployed women, iii) women with health insurance, and iv) multiparous women. It was significantly higher in those vaccinated against influenza during pregnancy.

DISCUSSION - CONCLUSION

Pertussis VC in women at two months postpartum in 2021 was insufficient and was marked by social and territorial inequalities in health. Vaccination for pregnant women has been recommended in France since 2022. A study monitoring the impact of this new recommendation is essential.

Exploring parental perspectives: Maternal RSV vaccination versus infant RSV monoclonal antibody

Respiratory Syncytial Virus poses a significant global public health threat, particularly affecting infants aged less than one year of age. Recently, two forms of passive immunization against infant RSV have been developed and brought to market; nirsevimab a long-acting monoclonal antibody (mAb) and RSV-PreF, a maternal RSV vaccine. The acceptability and uptake of these products will play a pivotal role in determining the success of any national immunization strategy aimed at safeguarding infants from RSV. It is crucial at this time to reflect on the factors that influence parental decisions surrounding immunization to facilitate more informed discussions, enhance healthcare communication, and contribute to the design of effective RSV prevention strategies that resonate with the concerns and aspirations of parents worldwide.

Facilitators and barriers to maternal immunization and strategies to improve uptake in low-income and lower-middle income countries: A systematic review

Maternal immunization (MI) is an emerging strategy to combat infant mortality in low-income (LIC) and lower-middle income countries (LMIC). We conducted a systematic review to identify the facilitators and barriers to MI and strategies that improve uptake in LICs and LMICs. We searched PubMed, Cochrane Library, and Scopus for quantitative, qualitative, and mixed-methods studies published in English from January 1, 2011, to October 31, 2021, from all LICs and LMICs. Data was appraised using the Mixed Methods Appraisal Tool. 55 studies were included. The major barriers were low knowledge and concern of vaccine safety among pregnant women and healthcare providers (HCP). HCP's recommendation, maternal knowledge, vaccine confidence and ≥4 antenatal care (ANC) visits facilitated uptake. The key strategies encompassed health financing, reminders, intersectoral coordination, integration, community engagement, capacity building, and education. Community-based delivery models were effective. Tailored programs are needed to improve ANC access, and educate pregnant women and HCPs.

Effectiveness of cocoon strategy vaccination on prevention of influenza-like illness in young infants

During the initial half-year of their existence, infants cannot receive the influenza vaccine, yet they face the greatest susceptibility to severe influenza complications. In this study, we seek to determine whether influenza vaccination of maternal and household contacts is associated with a reduced risk of influenza-like illness (ILI) and severe acute respiratory infection (SARI) in infants. This work was prospectively conducted during the influenza season. A total of 206 infants were included in this study. The percentage of infants with only the mother vaccinated is 12.6% (n:26), and the percent of infants with all household contacts vaccinated is 16% (n:33). Among the infants with only the mother vaccinated, the effectiveness of influenza vaccine is estimated as 35.3% for ILI and 41.3% for SARI. Among infants with all household contacts vaccinated, the effectiveness is estimated as 48.9% for ILI and 76.9% for SARI. Based on the results of multivariate logistic regression analysis, all-household vaccination is a protective factor against SARI (OR: 0.07 95% CI [0.01-0.56]), household size (OR: 1.75, 95% CI [1.24-2.48]) and presence of secondhand smoke (OR: 2.2, 95% CI [1.12-4.45]) significant risk factors for SARI in infants. The mother alone being vaccinated is not a statistically significant protective factor against ILI (OR: 0.46, 95% CI [0.19-1.18]) or SARI (OR: 0.3, 95% CI [0.11-1.21]). Along with the obtained results and analysis, this study provides clear evidence that influenza vaccination of all household contacts of infants aged 0-6 months is significantly associated with protecting infants from both ILI and SARI.

Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression

BACKGROUND

In low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries.

METHODS

Data from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study.

RESULTS

In low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women.

CONCLUSIONS AND RECOMMENDATIONS

This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.

Predictors of maternal pertussis vaccination acceptance among pregnant women in Norway

Maternal vaccination against pertussis is safe and provides effective protection against pertussis for the newborn, but the vaccine coverage rate remains generally low. Norway is currently planning for introduction of routine maternal pertussis vaccination. To assess maternal pertussis vaccination acceptance among pregnant Norwegian women, we surveyed women at 20-40 weeks gestation in 2019. Among the 1,148 pregnant women participating in this cross-sectional study, 73.8% reported they would accept pertussis vaccination during pregnancy if it was recommended, 6.9% would not accept and 19.2% were undecided. Predictors for low likelihood of accepting pertussis vaccination during pregnancy included low confidence in health authorities and in maternal pertussis vaccination safety and effectiveness, low awareness and adherence to influenza vaccination during pregnancy, and low awareness of pertussis vaccination. The major reasons reported for not accepting or being undecided about maternal pertussis vaccination were lack of information on vaccine safety for both mother and child. Most women reported that they would consult their general practitioner or a midwife for information if they were offered maternal pertussis vaccination. General practitioners and midwives were also regarded as the most trustworthy sources of information if the women were in doubt about accepting vaccination. We conclude that information addressing safety concerns and raising awareness about maternal pertussis vaccination could increase acceptance of maternal pertussis vaccination. Our findings highlight the pivotal role of the antenatal and primary health care services in providing such information to pregnant women.

Vaccination of pregnant women: an overview of European policies and strategies to promote it

Maternal immunization is a valuable tool for protecting mother and unborn child from vaccine-preventable diseases. However, the implementation of strategies for vaccinating pregnant women has only recently gained traction. This work is aimed at providing an overview of European vaccination strategies and gathering evidence on interventions enhancing vaccination knowledge, attitudes, and behaviors (KAB) in pregnant women. To summarize current pregnancy vaccination strategies in Europe, we consulted literature, institutional national health system websites, and the ECDC Vaccine Scheduler. The review of evidence on interventions targeting pregnant women's vaccination KAB was performed by searching primary studies on PubMed and Web of Science. The 27 EU member states offer various vaccinations in pregnancy, but only 10 recommend all of these: tetanus, pertussis, diphtheria, influenza, and COVID-19, albeit with different administration schedules. The literature review included 7 studies, 3 from Italy and 4 from other European countries (UK, Netherlands, Greece, Poland, and Ukraine). They were conducted in various settings such as childbirth preparation courses, prenatal visits, and online platforms, and all included educational interventions providing information on vaccine safety and efficacy during pregnancy. Knowledge about vaccines and vaccine-preventable diseases, generally low in the pre-intervention period, increased post-intervention, with a rise in awareness of the risks associated with infectious diseases and the recommended vaccines, a reduction in vaccine-related misinformation, and a greater propensity to vaccinate both newborns and themselves. Furthermore, there was a significant increase in adherence to recommended vaccinations, particularly among those with higher educational levels. However, vaccine hesitancy persisted, influenced by factors such as fear of adverse events and the lack of recommendations from healthcare providers. Variations in pregnancy vaccination strategies across Europe emphasize the importance of establishing a unified framework to optimize maternal and fetal health outcomes through evidence-based policies. Educational interventions may positively impact pregnant women's KAB, therefore promoting vaccination uptake.

'It has been the hardest decision of my life': a mixed-methods study of pregnant women's COVID-19 vaccination hesitancy

OBJECTIVE

To explore psychological factors influencing decision-making regarding COVID-19 vaccination among pregnant women.

DESIGN

Cross-sectional mixed-methods online survey comprising sociodemographic factors, health beliefs, trust and anticipated regret, and open-ended qualitative questions. Pregnant respondents living in the UK or Ireland (n = 191) completed the online survey during June and July 2021.

MAIN OUTCOME MEASURES

Intention to vaccinate against COVID-19 during pregnancy, with response options yes (vaccine accepting), no (vaccine resistant), unsure (vaccine hesitant). Qualitative questions about perceived benefits and risks of COVID-19 vaccination during pregnancy.

RESULTS

Multivariate analysis of correlates of vaccine hesitancy and resistance revealed independent associations for perceived barriers to the COVID-19 vaccine, anticipated regret, and social influences. Most respondents described making a decision regarding COVID-19 vaccination in the absence of satisfactory information or guidance from a health care professional. Vaccine hesitant and resistant respondents reported significantly greater barriers to the COVID-19 vaccination than vaccine accepting respondents. Concerns about the vaccine focussed on the speed of its development and roll-out and lack of evidence regarding its safe use in pregnancy.

CONCLUSION

Participants who did not intend to be vaccinated against COVID-19 in pregnancy focused on vaccine fears as opposed to virus fears. Results indicate that pregnant women need balanced vaccine information and unequivocal health care provider recommendation to aid maternal vaccination decision-making.

Vaccine decision-making among pregnant women: a protocol for a cross-sectional mixed-method study in Brazil, Ghana, Kenya and Pakistan

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited from either 2 or 3 maternity hospitals and/or clinics that represent a diverse population in terms of socio-economic and urban/rural status. Data collection includes cross-sectional surveys in pregnant women and semi-structured in-depth interviews with both pregnant and postpartum women. The instruments were designed to identify attitudinal, behavioral, and social correlates of vaccine uptake during and after pregnancy, including the decision-making process related to COVID-19 vaccines, and constructs such as risk perception, self-efficacy, vaccine intentions, and social norms. The aim is to recruit 400 participants for the survey and 50 for the interviews in each country. Qualitative data will be analyzed using a grounded theory approach. Quantitative data will be analyzed using descriptive statistics, latent variable analysis, and prediction modelling. Both the quantitative and qualitative data will be used to explore differences in attitudes and behaviors around maternal immunization across pregnancy trimesters and the postpartum period among and within countries. Each country has planned dissemination activities to share the study findings with relevant stakeholders in the communities from which the data is collected and to conduct country-specific secondary analyses.

Attitudes towards Maternal Immunisation of Polish Mothers: A Cross-Sectional, Non-Representative Study

INTRODUCTION

Vaccination protects pregnant women against dangerous infectious diseases and contributes to disease prevention for the child until their vaccination schedule begins. Vaccination behaviour is related to attitudes concerning vaccine prevention.

MATERIALS AND METHODS

This cross-sectional, non-representative study was conducted among Polish mothers using a diagnostic survey. We used the Vaccination Attitudes Examination (VAX) Scale. The author's questionnaire included questions concerning experiences with adult and maternal vaccinations, as well as sociodemographic data.

RESULTS

Among the 375 respondents, more than half (n = 208, 55.47%) received at least one vaccine during pregnancy. The majority of respondents had a university education (n = 356, 94.93%). There was no statistically significant difference in terms of receiving vaccines during pregnancy between respondents with and without a healthcare education (p = 0.230). A logistic regression model indicated that women who were vaccinated outside pregnancy for COVID-19 (OR 4.61, 2.60-8.22) and influenza (OR 7.14, 3.58-14.25) were statistically significantly more likely to be vaccinated during pregnancy. There were statistically significant differences between women who were vaccinated during pregnancy and those who did not receive maternal immunisation in three subscales of the VAX Scale: Mistrust of Vaccine Benefit, Concerns about Commercial Profiteering, and Preference for Natural Immunity (p < 0.001). The most frequently indicated reason for a woman's decision to be vaccinated was concern for the health and safety of the unborn child (n = 196, 94.23%). In contrast, women who were not vaccinated reported fear for the health and safety of the unborn child (n = 88, 52.69%).

CONCLUSIONS

A key point may be to contribute to the vaccinology education of healthcare professionals, who play an important role in pregnant women's decision to be vaccinated. However, our results may be disrupted because the majority of the women in our study had a university education.

Maternal Immunization Decision-Making Among Pregnant and Lactating People in Kenya: A Qualitative Exploration of Peer Influences on Vaccine Decision-Making for a Future RSV Vaccine

INTRODUCTION

Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in infants globally, with new maternal RSV vaccines on the horizon. Vaccine decision-making during pregnancy is shaped by individual, interpersonal, community, and societal factors. This study explored key interpersonal influences on maternal vaccine decision-making among pregnant and lactating people (PLP) and community members in Kenya.

METHODS

This qualitative study conducted in-depth interviews with six pregnant people, 18 lactating people, and 10 community members in one rural and one urban county in Kenya. Data were analyzed using a grounded theory approach.

RESULTS

Participants identified the pregnant person themself, male partners, other family members, peers, and healthcare providers (HCPs) as key influences on the maternal immunization decision-making process. The majority of interviewed PLP believed that decision-making during pregnancy should be left to themselves due to autonomy and their role as the primary caregiver. Community members, including male partners, also identified pregnant people as the key decision-maker. While some PLP said they deferred to male partners to make vaccine decisions, more felt that men were not as informed on maternal and child issues as themselves or other female peers and relatives. HCPs emerged as important influences and information sources for PLP during decision-making.

DISCUSSION

Understanding who influences vaccine-decision making during pregnancy will help inform demand generation strategies, and in turn, uptake of future maternal vaccines, including RSV vaccines. Given the strong role HCPs and peers have in the decision-making process, targeting key potential influences is essential to improve vaccine acceptance.

Pertussis Epidemiology in Children: The Role of Maternal Immunization

In the last twelve months, a significant global increase in pertussis cases has been observed, particularly among infants under three months of age. This age group is at the highest risk for severe disease, hospitalization, and death. Maternal immunization with the Tdap vaccine during pregnancy has been recommended to protect newborns by transferring maternal antibodies transplacentally. This review examines the current epidemiology of pertussis, the importance of preventing it in young children, and the effectiveness of maternal immunization. Despite the proven benefits of maternal vaccination, which has been found effective in pertussis prevention in up to 90% of cases, coverage remains suboptimal in many countries. Factors contributing to low vaccination rates include vaccine hesitancy due to low trust in health authority assessments, safety concerns, practical barriers to vaccine access, and the impact of the COVID-19 pandemic, which disrupted routine vaccination services. The recent increase in pertussis cases may also be influenced by the natural cyclic nature of the disease, increased Bordetella pertussis (Bp) activity in older children and adults, and the genetic divergence of circulating Bp strains from vaccine antigens. Given the high efficacy of maternal vaccination in preventing pertussis in infants, increasing coverage rates is crucial. Efforts to improve vaccine uptake should address barriers to access and vaccine hesitancy, ensuring consistent immune protection for the youngest and most vulnerable populations. Enhanced maternal vaccination could significantly reduce the incidence of whooping cough in infants, decreasing related hospitalizations and deaths.

A systematic review and meta-analysis of strategies to promote vaccination uptake

Although immunization can dramatically curb the mortality and morbidity associated with vaccine-preventable diseases, vaccination uptake remains suboptimal in many areas of the world. Here, in this meta-analysis, we analysed the results from 88 eligible randomized controlled trials testing interventions to increase vaccination uptake with 1,628,768 participants from 17 countries with variable development levels (for example, Human Development Index ranging from 0.485 to 0.955). We estimated the efficacy of seven intervention strategies including increasing access to vaccination, sending vaccination reminders, providing incentives, supplying information, correcting misinformation, promoting both active and passive motivation and teaching behavioural skills. We showed that the odds of vaccination were 1.5 (95% confidence interval, 1.27 to 1.77) times higher for intervention than control conditions. Among the intervention strategies, using incentives and increasing access were most promising in improving vaccination uptake, with the access strategy being particularly effective in countries with lower incomes and less access to healthcare.

The nurse's role in a patient-centered approach for reducing COVID-19 vaccine hesitancy during pregnancy: An American Academy of Nursing consensus paper

The evidence shows that COVID-19 vaccines can reduce the risks of poor pregnancy outcomes. Yet, reluctance to vaccinate remains high in pregnant populations. In this paper, we take a precision health and patient-centered approach to vaccine hesitancy. We adopted the society-to-cells vaccine hesitancy framework to identify society, community, family, individual, and physiologic factors contributing to COVID-19 vaccine hesitancy in pregnancy. Nurses are particularly well-suited to impact the factors associated with vaccine hesitancy. Because of their proximity to the patient, nurses are positioned to provide individualized, timely health information, and clinical guidelines to assist patients with decision-making related to vaccinations. Recommendations are provided to bolster nurses' engagement in precision health and patient-centered models of care to mitigate COVID-19 vaccine hesitancy in pregnancy.

Opportunities and challenges to implementing mRNA-based vaccines and medicines: lessons from COVID-19

The messenger RNA (mRNA) platform emerged at the forefront of vaccine development during the COVID-19 pandemic, with two mRNA COVID-19 vaccines being among the first authorized globally. These vaccines were developed rapidly. Informed by decades of laboratory research, and proved to be safe and efficacious tools for mitigating the global impact of the COVID-19 pandemic. The mRNA platform holds promise for a broader medical application beyond COVID-19. Herein, we provide an overview of this platform and describe lessons learned from the COVID-19 pandemic to help formulate strategies toward enhancing uptake of future mRNA-based interventions. We identify several strategies as vital for acceptance of an expanding array of mRNA-based vaccines and therapeutics, including education, accurate and transparent information sharing, targeted engagement campaigns, continued investment in vaccine safety surveillance, inclusion of diverse participant pools in clinical trials, and addressing deep-rooted inequalities in access to healthcare. We present findings from the Global Listening Project (GLP) initiative, which draws on quantitative and qualitative approaches to capture perceptions and experiences during the COVID-19 pandemic to help design concrete action plans for improving societal preparedness for future emergencies. The GLP survey (>70,000 respondents in 70 countries) revealed tremendous disparities across countries and sociodemographic groups regarding willingness to accept novel mRNA vaccines and medicines. The comfort in innovations in mRNA medicines was generally low (35%) and was marginally lower among women (33%). The GLP survey and lessons learnt from the COVID-19 pandemic provide actionable insights into designing effective strategies to enhance uptake of future mRNA-based medicines.

COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study

OBJECTIVES

We investigated coronavirus disease 2019 (COVID-19) vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

METHODS

Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares and AID-related treatment modifications were analysed upon diagnosis of AID vs healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine.

RESULTS

Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, P = 0.01; minor AE 40% vs 25.9%, P = 0.03; major AE 17.5% vs 4.6%, P < 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a disease flare were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively.

CONCLUSION

This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and for the fetus by passive immunization appear to outweigh potential risks.

COVID-19 Vaccine Acceptance in Pregnancy

OBJECTIVE

The purpose of the study is to evaluate the acceptance rate of the coronavirus disease 2019 (COVID-19) vaccine among pregnant women at our institution prior to recommendations by national organizations (American College of Obstetricians and Gynecologists/The Society for Maternal-Fetal Medicine) in July 2021 and to determine whether factors including health disparities are associated with acceptance.

STUDY DESIGN

This is an Institutional Review Board exempt descriptive study. Anonymous surveys were administered from February 2021 to May 2021 to pregnant patients at Mount Sinai South Nassau's affiliated Maternal Fetal Medicine office. The survey was completed by 701 pregnant women. Descriptive statistics were calculated for the overall sample, as well as separately by group (acceptance versus declining/undecided about getting the COVID-19 vaccine). The two groups were compared using the chi-square test or Fisher's exact test and the two-sample t-test. Analysis was compared between two groups (patients who accepted the COVID-19 vaccine and people who declined/undecided about the vaccine). A result was considered statistically significant at the p < 0.05 level of significance.

RESULTS

Of the 701 pregnant women who completed the survey, 96 patients accepted the vaccine. More pregnant women who were older accepted the COVID-19 vaccine compared with those who were younger (p = 0.0343). Pregnant women willing to get the flu vaccine and/or the Tdap vaccine in pregnancy were more likely to obtain the COVID-19 vaccine (p < 0.05). Pregnant patients who had household members willing to receive the COVID-19 vaccine sought to obtain the vaccine for themselves (p < 0.0001). Interestingly, pregnant women who had an underlying respiratory illness in the pregnancy were less likely to accept the COVID-19 vaccine than those who had either other or no medical problems (p < 0.05).

CONCLUSION

There is a low rate of COVID-19 vaccine acceptance among pregnant women (13.69%). Efforts should be made to encourage the vaccine in this vulnerable population to protect them from the health risks of the COVID-19 virus.

KEY POINTS

· COVID-19 vaccine acceptance rates in our population were 13.6%.. · Accepting Tdap and influenza vaccines increased the likelihood of accepting the COVID vaccine.. · Pregnant patients with respiratory illnesses were more likely to decline the COVID vaccine..

Assessing the Impact of the COVID-19 Pandemic on Pregnant Women's Attitudes towards Childhood Vaccinations: A Cross-Sectional Study

The COVID-19 pandemic has globally disrupted immunisation practices, impacting vulnerable populations such as pregnant women (PW), who harbour concerns about future children's immunisations. This study aimed to assess the pandemic's impact on PW's attitudes towards childhood vaccinations. During three consecutive flu seasons from October 2019 to January 2022, a cross-sectional study was conducted in a large Italian teaching hospital using a questionnaire. The chi-square test was performed to compare each season. Across the 2019-2020 to 2021-2022 seasons, course attendance by PW surged from 105 to 340. Significant shifts in vaccination intentions were noted, including a 7.5% decrease in measles vaccination intent (p = 0.02) and a 10% decrease in that of pertussis (p = 0.004) from 2019-2020 to 2020-2021. While perceived contagion risk decreased, disease severity perceptions increased, with few significant differences. A statistically significant reduction was noted in the proportion of participants suspecting economic motives behind NHS workers' promotion of childhood vaccinations. Furthermore, the pandemic period saw an increase in the perceived utility of non-institutional websites and the advice of physicians outside the NHS. These findings will help develop evidence-based, tailored interventions and communication strategies to address vaccine hesitancy and ensure optimal vaccination coverage among children born during and after the pandemic.

Facilitators and barriers to vaccination uptake in pregnancy: A qualitative systematic review

INTRODUCTION

Vaccination during pregnancy protects both the mother and the foetus from vaccine-preventable diseases. However, uptake of the recommended vaccines (influenza, pertussis, COVID-19) by pregnant women remains low in Europe and the USA. Understanding the reasons for this is crucial to inform strategies to increase vaccination rates in pregnant women. This qualitative systematic review aimed to identify the barriers and facilitators to vaccination against influenza, pertussis/whooping cough and COVID-19 during pregnancy and identify possible strategies to increase vaccination rates.

METHODS

We conducted a comprehensive search of electronic databases, including Medline, PsycINFO, CINAHL, Web of Science, WHO database, Embase and grey literature to identify qualitative studies that explored barriers and facilitators to vaccine uptake among pregnant women (PROSPERO CRD42023399488). The search was limited to studies published between 2012 and 2022 conducted in high-income countries with established vaccination programmes during pregnancy. Studies were thematically analysed and underwent quality assessment using the Joanna Briggs Institute validated critical appraisal tool for qualitative research.

RESULTS

Out of 2681 articles screened, 28 studies (n = 1573 participants) were eligible for inclusion. Five overarching themes emerged relating to personal, provider and systemic factors. Barriers to vaccine uptake included concerns about vaccine safety and efficacy, lack of knowledge about vaccines' benefits and necessity, fear of adverse effects on the foetus or mother and low perception of disease severity. Facilitators included recommendations from trusted healthcare providers, easy access to vaccination, clear communication on the benefits and safety of vaccination, and positive social influences from family and friends. Strategies for increasing vaccination uptake included strong and proactive vaccine recommendations by trusted healthcare professionals, provision of vaccines during routine antenatal care, and clear and consistent communication about vaccines addressing pregnant women's concerns.

CONCLUSION

This review highlights the need for interventions that address the identified barriers to vaccine uptake among pregnant women. Recommendation from a healthcare provider can play a significant role in promoting vaccine uptake, as can clear risk/benefit communication and convenient access to vaccination. Addressing concerns about vaccine safety and providing accurate information about vaccines is also important.

Estimating COVID-19 vaccine acceptance in pregnant and lactating women: a cross-sectional study in Lebanon

BACKGROUND

The COVID-19 pandemic highlights vaccination's critical role in reducing morbidity and mortality, depending on public attitude. This study aims to identify the estimates of COVID-19 vaccine acceptance in pregnant and lactating women, as well as associated potential factors.

METHODS

A cross-sectional study was conducted between August and September 2021, through an online survey and with a paper survey distributed in gynecology and pediatric clinics. Pregnant and breastfeeding women aged 18 years and above were recruited. The attitude scale was created specifically for evaluating attitudes towards the COVID-19 vaccine.

RESULTS

In total, 207 women participated, with 132 breastfeeding, 74 pregnant and 1 experiencing both conditions. Of these, one hundred and twenty women (58%) considered themselves at risk for COVID-19 infection. In addition, 51.7% (n = 107) of women expressed the intent to receive the vaccine once available. A multivariable linear regression was conducted taking the COVID-19 vaccination attitude scale as a dependent variable. The results revealed an R-squared value of 0.558, indicating that approximately 55.8% of the variance in the attitude scale was accounted for by the included predictors. The results showed that preventive measures (ß=2.25, 95% Confidence Interval (CI) [1.02; 3.48], p < 0.001), preference for vaccines made in Europe and America (ß=1.23; 95% CI [0.69-1.77], p < 0.001), protect yourself for getting sick (ß=4.22, 95% Confidence Interval (CI) [2.83; 5.61], p < 0.001) and belief in the importance of vaccination for themselves and their baby (ß=3.49; 95% CI [2.01; 4.98], p < 0.001) were associated with a positive attitude towards vaccination. Conversely, experiencing a previous bad reaction to a vaccine (ß= -1.35; 95% CI [0.85-1.85], p < 0.001) and concerns regarding COVID-19 vaccine safety (ß= -4.09; 95% CI [-5.98; -2.21], p < 0.001) were associated with a negative attitude towards vaccination.

CONCLUSION

Our findings reveal that COVID-19 vaccine acceptability among pregnant and breastfeeding women, amidst the pandemic was insufficient to meet community immunity. The identified reasons for vaccine reluctance, notably concerns about safety for both personal health and the health of their pregnancy or newborns, along with insufficient information about the vaccine, underscore the pressing need to address these factors to improve immunization rates.

Attitudes and behaviors of maternal Tdap vaccination in Panama, Peru, and Colombia: An international cross-sectional study

INTRODUCTION

Despite a recommendation by PAHO for Tdap vaccination in pregnant women since 2019, uptake remains suboptimal across Latin America. This study evaluated the knowledge and attitudes of women towards maternal Tdap vaccination in Colombia, Peru, and Panama to identify the critical behavioral and social drivers of Tdap vaccine uptake during pregnancy.

METHODS

A cross-sectional online survey was undertaken between December 8, 2022, and January 11, 2023, targeting women in Colombia, Peru, or Panama with a child 12 months or under. We collected data on respondents' demographics, social and behavioral determinants of vaccine acceptance, determinants of vaccine uptake (using the validated 5As taxonomy), and previous vaccination experience.

RESULTS

In the 938 respondents who completed the survey (Panama, n = 325; Peru, n = 305; Colombia, n = 308), 73-80 % had received the influenza vaccine, whereas only 30-39 % had received a Tdap vaccine. Significant correlates of Tdap vaccine uptake common to all three countries included a health professional recommendation, knowledge of the vaccine and location of vaccination, perceived vulnerability to pertussis infection, perceived importance of immunization, and receipt of a reminder. In specific countries, nonvaccinated women were more likely to cite issues with ease of access (Panama, Colombia), affordability (opportunity costs; Peru, Colombia), and understanding the rationale for vaccination in pregnancy (Panama, Colombia).

CONCLUSION

To increase maternal Tdap vaccine uptake, health professionals should be encouraged to recommend vaccination consistently, and pregnant women should receive reminders explaining why and where to be vaccinated.

Promoting informed decision making about maternal pertussis vaccination: the systematic development of an online tailored decision aid and a centering-based group antenatal care intervention

Introduction

Maintaining and enhancing vaccine confidence continues to be a challenge. Making an informed decision not only helps to avoid potential future regret but also reduces susceptibility to misinformation. There is an urgent need for interventions that facilitate informed decision-making about vaccines. This paper describes the systematic development of two interventions designed to promote informed decision making and indirectly, acceptance of maternal pertussis vaccination (MPV) in the Netherlands.

Materials and methods

The 6-step Intervention Mapping (IM) protocol was used for the development of an online tailored decision aid and Centering Pregnancy-based Group Antenatal Care (CP) intervention. A needs assessment was done using empirical literature and conducting a survey and focus groups (1), intervention objectives were formulated at the behavior and determinants levels (2), theoretical methods of behavior change were selected and translated into practical applications (3), which were further developed into the two interventions using user-centered design (4). Finally, plans were developed for implementation (5), and evaluation (6) of the interventions.

Results

The needs assessment showed that pregnant women often based their decision about MPV on information sourced online and conversations with their partners, obstetric care providers, and peers. Responding to these findings, we systematically developed two interactive, theory-based interventions. We created an online tailored decision aid, subjecting it to four iterations of testing among pregnant women, including those with low literacy levels. Participants evaluated prototypes of the intervention positively on relevance and usability. In addition, a CP intervention was developed with midwives.

Conclusion

Using IM resulted in the creation of an online decision aid and CP intervention to promote informed decision making regarding MPV. This description of the systematic development of the interventions not only serves to illustrate design rationales, it will also aid the interpretation of the evaluation of the interventions, the development of future interventions promoting informed decision and acceptance of vaccines, and comparisons with other interventions.

Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis

BACKGROUND

Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low.

METHODS

We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics.

RESULTS

From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations.

CONCLUSIONS

Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.

Impact of Actively Offering Influenza Vaccination to Frail People during Hospitalisation: A Pilot Study in Italy

Despite the worldwide recommendations for influenza immunisation, vaccination coverage for patients exposed to the highest risk of severe complications is still far from the optimal target. The need to take advantage of alternative methods to provide vaccination is essential. This study presents a hospital-based strategy which offers influenza vaccination to inpatients at discharge. This study was conducted during the 2022-2023 influenza season at the University Hospital of Palermo. A questionnaire was administered to identify the determinants for the acceptance of influenza vaccination in the frail population. Overall, 248 hospitalised patients were enrolled, of which 56.1% were female and 52.0% were over 65 years of age. The proportion of patients vaccinated against influenza during hospitalisation was 62.5%, an increase of 16% in influenza vaccination uptake among frail people in comparison with the previous influenza season (46.8% vaccinated during the 2021-22 influenza season). Factors significantly associated with vaccination acceptance were the following: to have received influenza vaccine advice from hospital healthcare workers (OR = 3.57, p = 0.001), to have been previously vaccinated for influenza (OR = 3.16 p = 0.005), and to have had a low level of education (OR = 3.56, p = 0.014). This study showed that offering influenza vaccination to hospitalised patients could be an effective strategy to increase vaccination coverage in the most vulnerable population, and these findings could be useful for planning and improving future influenza vaccination campaigns.

Pertussis Non-Vaccination During Pregnancy Despite Advice From Prenatal Care Providers

OBJECTIVE

The purpose of this study was to measure the proportion of non-vaccination for pertussis in mothers in Canada who had been advised by their prenatal care provider to get vaccinated, and to identify sociodemographic factors and beliefs associated with non-vaccination.

METHODS

The Survey on Vaccination during Pregnancy (part of childhood National Immunization Coverage Survey) included biological mothers of children born from September 2018 to March 2019. This analysis was restricted to 2657 mothers who had been advised by their prenatal care provider to get vaccinated against pertussis during pregnancy and knew whether or not they had been vaccinated.

RESULTS

Of those who had been advised to get vaccinated against pertussis, 21% were not. This rate varied across provinces and territories, ranging from 9% in Prince Edward Island to 32% in Newfoundland and Labrador. Factors independently associated with pertussis non-vaccination included lower household income, having had past live births, and having received prenatal care from an obstetrician-gynecologist or a midwife compared to a family doctor. The risk of pertussis non-vaccination despite prenatal care advice was higher for those who disagreed that the baby would be at greater risk of pertussis if the mother did not get vaccinated. It was also higher for those who disagreed with statements regarding perceived benefits of vaccination. Conversely, disagreement with statements on perceived barriers was negatively associated with pertussis non-vaccination.

CONCLUSION

These findings highlight the underlying factors associated with non-vaccination against pertussis despite prenatal care provider recommendation. Some inaccurate beliefs about pertussis and vaccination during pregnancy persist, leading to non-vaccination.

The protective role of maternal genetic immunization on maternal-fetal health and welfare

Pregnancy is a critical period associated with alterations in physiologic, biologic, and immunologic processes, which can affect maternal-fetal health through development of several infectious diseases. At birth, neonates have an immature immune system that makes them more susceptible to severe viral infections and diseases. For this reason, different maternal nutritional and immunization interventions have been used to improve the immune and health status of the mother and her neonate through passive immunity. Here, we reviewed the protective role of maternal immunization with different types of vaccines, especially genetic vaccines, during pregnancy in maternal-fetal health, immune response, colostrum quality, immune response, and anti-oxidative status. For this purpose, we have used different scientific databases (PubMed and Google Scholar) and other official web pages. We customized the search period range from the year 2000 to 2023 using the key words "maternal immunization" OR "gestation period/pregnancy" OR "genetic vaccination" OR "maternal-fetal health" OR "micronutrients" OR "neonatal immunity" "oxidative stress" OR "colostrum quality". The evidence demonstrated that inactivated or killed vaccines produced significant immune protection in the mother and fetus. Furthermore, most recent studies have suggested that the use of genetic vaccines (mRNA and DNA) during pregnancy is efficient at triggering the immune response in mother and neonate without the risk of undesired pregnancy outcomes. However, factors such as maternal redox balance, nutritional status, and the timing of immunization play essential roles in regulating immune response inflammatory status, antioxidant capacity, and the welfare of both the pregnant mother and her newborn.

Effects of an online tailored decision aid to promote informed decision making about maternal pertussis vaccination in the Netherlands: A randomized controlled trial

INTRODUCTION

In 2019, maternal pertussis vaccination (MPV) during pregnancy was introduced in the Netherlands. New interventions to promote informed decision making (IDM) about vaccinations are highly needed, especially for new vaccinations. Decision aids (DAs) have the potential to support IDM. This study evaluates the effects of an online DA on IDM and MPV uptake.

METHODS

Pregnant individuals, recruited for the randomized controlled trial (RCT), who gave informed consent (N = 1,236) were randomly assigned to the control (N = 650; no information) or intervention condition (N = 586; DA at 18 weeks pregnancy). MPV uptake and IDM were primary outcomes, decisional certainty and psychological determinants of MPV uptake were secondary outcomes. Measures were taken at 18 weeks of pregnancy (baseline) and at 20 weeks of pregnancy (post-test); intervention use was logged. Data were analysed using intention-to-treat analyses, logistic regression, and linear mixed regression models.

RESULTS

Uptake of MPV was high in our sample (92.3 %). No significant effect of the DA condition on MPV uptake was found compared to the control condition. We found that the DA increased IDM (β = 0.24, p < .004) and one of its components level of knowledge about MPV (β = 0.31, p < .004). We also found an increase in decisional certainty (β = 0.24, p < .004), perceived susceptibility (β = 0.24, p < .004), severity of pertussis (β = 0.41, p < .004), and positive affect about MPV (β = 0.15, p < .004). There was a positive association between dose of the intervention and MPV uptake (β = 0.05, p < .004).

DISCUSSION

The DA seemed effective in promoting IDM about and determinants of MPV uptake. No main effect was found on MPV uptake, but MPV uptake was related to the level of exposure to the DA. People with high intentions towards MPV were overrepresented in the sample. However, effects on IDM were consistent among participants with different levels of MPV intention at baseline.

Maternal pertussis vaccination behavior: Psychosocial, attitudinal and organizational factors

BACKGROUND

In December 2019, the maternal pertussis vaccination (MPV) became part of the Dutch National Immunization Program. This study aims to study MPV behavior and associated psychosocial, attitudinal and organizational factors of pertussis vaccination behavior during pregnancy in the Netherlands.

METHODS

We conducted a cross-sectional survey among pregnant women and recent mothers, up to six months post-partum. The primary outcome measure of this study was MPV behavior. Associations between psychosocial, attitudinal and organizational factors and MPV behavior were assessed using univariate and multivariate binary logistic regression analysis.

RESULTS

In total 1348 participants filled out the questionnaire, including 1282 (95.1%) MPV acceptors and 66 (4.9%) MPV refusers. The most important factors associated with MPV behavior were: attitude (aOR: 10.19; 95%CI: 4.30-24.16), outcome expectations (aOR: 8.94; 95%CI: 3.60-22.21), omission bias (aOR: 0.11; 95%CI: 0.02-0.59) and physical accessibility (aOR: 7.44; 95%CI: 3.37-16.46).

CONCLUSION

Pregnant women make their decision about the MPV primarily based on attitudinal and psychosocial factors, such as outcome expectations and attitude. A combination and variation of different messages, about the advantages (effectiveness) and disadvantages (side effects) of maternal vaccination, can be used in reaching pregnant women with a positive and negative attitude about the MPV. In addition, strategies to increase MPV uptake should not only focus on providing information, but also decrease experienced practical barriers, such as poor physical accessibility, in people that are intended to receive the MPV but are not getting vaccinated.

Reactogenicity, pregnancy outcomes, and SARS-CoV-2 infection following COVID-19 vaccination during pregnancy in Canada: A national prospective cohort study

OBJECTIVE

To describe self-reported reactogenicity, pregnancy outcomes, and SARS-CoV-2 infection following COVID-19 vaccination during pregnancy.

DESIGN

National, prospective cohort study.

SETTING

Participants across Canada were enrolled from July 2021 until June 2022.

POPULATION

Individuals pregnant during the COVID-19 pandemic, regardless of vaccination status, were included.

METHODS

The Canadian COVID-19 Vaccine Registry for Pregnant and Lactating Individuals (COVERED) was advertised through traditional and social media. Surveys were administered at baseline, following each vaccine dose if vaccinated, pregnancy conclusion, and every two months for 14 months. Changes to pregnancy or vaccination status, SARS-CoV-2 infections, or significant health events were recorded.

MAIN OUTCOME MEASURES

Reactogenicity (local and systemic adverse events, and serious adverse events) within 1 week post-vaccination, pregnancy and neonatal outcomes, and subsequent SARS-CoV-2 infection.

RESULTS

Among 2868 participants who received 1-2 doses of a COVID-19 vaccine during pregnancy, adverse events described included: headache (19.5-33.9%), nausea (4.8-13.8%), fever (2.7-10.2%), and myalgia (33.4-42.2%). Reactogenicity was highest after the 2nd dose of vaccine in pregnancy. Compared to 1660 unvaccinated participants, there were no statistically significant differences in adverse pregnancy or infant outcomes, aside from an increased risk of NICU admission ≥ 24 h among the unvaccinated group. During follow-up, there was a higher rate of participant-reported SARS-CoV-2 infection in the unvaccinated compared to the vaccinated group (18[47.4%] vs. 786[27.3%]).

CONCLUSIONS

Participant-reported reactogenicity was similar to reports from non-pregnant adults. There was no increase in adverse pregnancy and birth outcomes among vaccinated vs. unvaccinated participants and lower rates of SARS-CoV-2 infection were reported in vaccinated participants.

TWEETABLE ABSTRACT

No significant increase in adverse pregnancy or infant outcomes among vaccinated versus unvaccinated pregnant women in Canada.

Review of short-term and long-term adverse effects of covid-19 vaccination during pregnancy

BACKGROUND

The covid-19 pandemic sparked a debate about the safety of vaccines during pregnancy. However, pregnant women were excluded from the Pfizer-BioNTech vaccine phase 3 trials. As two years have passed since the first Covid-19 vaccine and more studies have been conducted, we want to evaluate the scientific literature to determine any actual risks in taking the vaccine during pregnancy.

METHODS

We conducted literature research using PubMed and Google Scholar databases from January to April 2023. As the review considers short- and long-term adverse effects it was divided into two parts. The first part was conducted as a systematic review. The second concerning long-term negative effects due to lack of research is a literature review. The inclusion criteria for the systematic review part were singleton pregnancies, women vaccinated during pregnancy, and studies from 2020 and later. The most common short-term pregnancy adverse effects were included in the search: preterm delivery, small gestation age, intrauterine death, congenital defects, stillborn, fetal growth retardation, spontaneous abortion. Maternal immune activation was the primary concern for the long-term adverse effects and whether vaccination could cause it. The search terms included maternal immune activation, fetal neurodevelopment, neuropsychiatric disorders and the studies used were from 2019.

RESULTS

Most studies showed no significant difference in short-term adverse effects between vaccinated and non-vaccinated women and their fetuses. However, the literature is insufficient to evaluate possible long-term adverse effects.

CONCLUSION

Available evidence supports the safety of administering SARS-CoV-2 vaccines to pregnant women, but further systematic reviews and meta-analyses are essential. Maternal immune activation caused by vaccination may impact a child's neurodevelopment and should be a concern for future studies.