American Journal of Obstetrics and Gynecology
SupplementInfluenza immunization in pregnancy: overcoming patient and health care provider barriers
Section snippets
Patient barriers to vaccination
Patient uptake of preventive care measures like immunization likely is affected by demographics, beliefs, attitudes, perceptions, motivations, and expectations.24, 32 Reported patient barriers to maternal influenza vaccination are summarized in Table 1 and include safety concerns, lack of knowledge about influenza and its serious nature during pregnancy, fear of needles, vaccination history, general mistrust of the medical establishment, view of obstetrician-gynecologists as vaccinators, and
Health care provider barriers to vaccination
Perhaps the most important factor in a pregnant woman's decision to receive the influenza vaccine has been shown to be a compelling recommendation from her health care provider.35, 43 Based on 2006 Pregnancy Risk Assessment and Monitoring System data, “my physician did not mention anything about a flu vaccine during my pregnancy” was the second most cited reason for not receiving the influenza vaccine.44 Based on results from a CDC internet survey, 71% of women who were offered vaccination by
Final thoughts
Pregnant women are at increased risk for influenza-related morbidity and death. Immunization against influenza is the most effective intervention to mitigate the burden of influenza disease during pregnancy; nevertheless, immunization rates remain suboptimal in this patient population. To optimize influenza vaccination among pregnant women, it is critical that patient and health care provider barriers are recognized and addressed.
It is imperative that the health care provider learn the art of
References (66)
- et al.
Maternal mortality in the epidemic of Asian influenza, New York City, 1957
Am J Obstet Gynecol
(1958) - et al.
Deaths from Asian influenza associated with pregnancy
Am J Obstet Gynecol
(1959) - et al.
Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season
Am J Obstet Gynecol
(2003) - et al.
H1N1 2009 influenza virus infection during pregnancy in the USA
Lancet
(2009) - et al.
Influenza vaccination in pregnancy: current evidence and selected national policies
Lancet Infect Dis
(2008) - et al.
Safety of influenza vaccination during pregnancy
Am J Obstet Gynecol
(2005) - et al.
Safety of influenza vaccination during pregnancy
Am J Obstet Gynecol
(2009) - et al.
Influenza vaccination of recommended adult populations, US, 1989-2005
Vaccine
(2008) - et al.
Vaccines in pregnancy
Infect Dis Clin North Am
(2001) - et al.
Behaviors and perceptions regarding seasonal and H1N1 influenza vaccination during pregnancy
Am J Obstet Gynecol
(2011)
Pregnant women's knowledge of influenza and the use and safety of the influenza vaccine during pregnancy
J Obstet Gynaecol Can
Uptake of influenza vaccine in pregnant women during the 2009 H1N1 influenza pandemic
Am J Obstet Gynecol
Vaccine eligibility and acceptance among ambulatory obstetric and gynecology patients
Vaccine
A cross-sectional study of maternity care providers' and women's knowledge, attitudes, and behaviours towards influenza vaccination during pregnancy
J Obstet Gynaecol Can
Barriers to adult immunization
Am J Med
Obstetrician-gynecologists' practices and perceived knowledge regarding immunization
Am J Prev Med
Vaccination and perinatal infection prevention practices among obstetrician-gynecologists
Obstet Gynecol
The obstetrician-gynecologist's role in vaccine-preventable diseases and immunization
Obstet Gynecol
Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009
MMWR Recomm Rep
Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study
BJOG
The effects of the 1918-1919 influenza pandemic on infant and child health in Derbyshire
Med Hist
Epidemic pneumonia (Spanish Influenza) in pregnancy: effect in one hundred and one cases
JAMA
Influenza occurring in pregnant women: a statistical study of thirteen hundred and fifty cases
JAMA
Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women
Am J Epidemiol
Hospitalizations with respiratory illness among pregnant women during influenza season
Am J Obstet Gynecol
Influenza and pregnant women: hospitalization burden, United States, 1998-2002
J Womens Health
Influenza in the neonatal intensive care unit
J Perinatol
Novel influenza A (H1N1) virus among gravid admissions
Arch Int Med
Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study
BMJ
Severe 2009 H1N1 influenza in pregnant and postpartum women in California
N Engl J Med
Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States
JAMA
Maternal immunization with influenza or tetanus toxoid vaccine for passive antibody protection in young infants
J Infect Dis
Immunization of pregnant women with influenza A/New Jersey/76 virus vaccine: reactogenicity and immunogenicity in mother and infant
J Infect Dis
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2022, Gynecology and Obstetrics Clinical MedicineCitation Excerpt :Healthcare providers are long-standing essential partners in the recommendation and safe administration of vaccines.48,69 Positive attitudes toward immunization in pregnant women are reported with provider's recommendation for vaccination.49,50 They build confidence in patients who believe vaccinations are unsafe.51
Pregnant women & vaccines against emerging epidemic threats: Ethics guidance for preparedness, research, and response
2021, VaccineCitation Excerpt :In explaining why the vaccine is recommended for use in pregnancy, the communication plan should be sensitive to issues of low vaccine confidence among pregnant women and the communities in which they live, as well as public anxieties surrounding outbreaks and epidemics. The communication plan should also be sensitive to the critical role that health care providers can play in increasing the likelihood of vaccine acceptance [71,72]. Health care providers vary in knowledge and attitudes about vaccination in pregnancy.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Vaccine Program Office, the Centers for Disease Control and Prevention, or the Food and Drug Administration.
B.G. is a member of advisory committees for Merck Vaccines, Sanofi-Pasteur Vaccines, Novartis Vaccines, and GlaxoSmithKline Biologicals Vaccines, a speaker for Merck Vaccines, Sanofi-Pasteur Vaccines, and GlaxoSmithKline Biologicals Vaccines, and a member of the Michigan Advisory Committee on Immunization Practices and the ACOG Vaccine Expert Working Group. The remaining authors report no conflict of interest.
Reprints not available from the authors.