Factors influencing vaccine uptake during pregnancy: A systematic literature review.

Clinical Snapshot

Key Findings

• P Value: Not reported — qualitative/mixed-methods synthesis

• Effect Size: No quantitative effect size reported; thematic synthesis identifies individual/group-level barriers (lack of knowledge, anti-vaccination beliefs, safety and efficacy concerns) as most prominent, and proactive HCP communication and trust as major enablers

• Primary Outcome: Barriers and enablers to maternal immunisation uptake, synthesised thematically across 184 qualitative and quantitative studies

• Nnt Or Sensitivity: Not applicable — descriptive systematic review; no NNT, sensitivity, specificity, or hazard ratio calculable from available data

• Confidence Interval: Not applicable — no meta-analysis performed

Clinical Application

Findings support feasible, low-cost interventions: enhanced HCP communication training, proactive vaccine counselling at antenatal visits, and targeted public health messaging. These are implementable within existing antenatal care frameworks without additional resource-intensive infrastructure Australia has a well-established maternal pertussis vaccination program. The TGA has approved dTpa (Boostrix, GSK) for use in pregnancy, and it is recommended by RANZCOG and RACGP during each pregnancy (ideally 20–32 weeks gestation). The National Immunisation Program (NIP) provides dTpa free of charge to pregnant women. ATAGI guidelines emphasise the importance of HCP recommendation as a key driver of uptake — consistent with this review's findings. The identified barriers (safety concerns, misinformation, low health literacy) are directly relevant to Australian antenatal practice, particularly in culturally and linguistically diverse (CALD) communities and rural/remote settings where access to antenatal care may be limited. The conflict of interest associated with GSK authorship is particularly salient in the Australian context given GSK's commercial interest in Boostrix uptake. Clinicians should interpret recommendations through independent sources such as ATAGI and RACGP guidelines. Pregnant individuals attending antenatal care in countries with national pertussis-containing maternal vaccine programs; findings are most directly applicable to high-income countries with established immunisation infrastructure

Abstract

A systematic literature review was conducted to build a comprehensive evidence base of qualitative/quantitative studies to identify barriers and enablers influencing maternal immunization (MI). Searches of seven databases on 20/10/2023 and 26/10/2023 yielded 87,367 records. Two reviewers performed full-text screening of 484 records. English-language articles from countries that had national recommendations for pertussis-containing maternal vaccines and reported on maternal vaccine acceptance, trust, and hesitancy were eligible. Overall, 184 studies were included. Barriers involving individual and group influences like lack of knowledge and reduced awareness of MI, pre-existing anti-vaccination beliefs and attitudes, and perceived concerns about vaccine safety and efficacy were the most prominent. Proactive communication and recommendations from healthcare professionals and public health authorities were major enablers, alongside trusting the information provided by healthcare professionals. Our results show that vaccine hesitancy is a complex phenomenon. Addressing both practical and perceptual barriers to MI might increase vaccination coverage among pregnant individuals. What is the context? Vaccines administered during pregnancy help protect both mother and newborn from serious infections. Yet, some expectant mothers hesitate to receive such vaccines.What is new? We systematically searched the available scientific literature to identify the factors that positively and negatively influence vaccine acceptance among expectant mothers.We analyzed data from 184 studies from countries across Europe, North America, Oceania, Asia, and South America that have national recommendations for vaccines against whooping cough.We found that vaccine refusal was mainly driven by personal perceptions of the vaccine or influences of the social environment.Convincing recommendations from healthcare professionals, fair access to prenatal care, increased trust in healthcare authorities and vaccines, and clear communication with the expectant mother were identified as promoters of vaccine acceptance.What is the impact? Addressing the identified issues might increase vaccine uptake among expectant mothers, which might have a serious impact on reducing infectious disease severity in newborns.

References

1. 1.Shamarina, D., Cortes Rueda, L. M., Alderson, D., & Collins, A. T. (2026). Factors influencing vaccine uptake during pregnancy: A systematic literature review. Human Vaccines & Immunotherapeutics. https://doi.org/10.1080/21645515.2026.2701546