In delicate condition: A scoping review on insights to promoting uptake of antenatal vaccination.

Problem

Pertussis and influenza infections can cause significant morbidity and mortality in pregnancy and the neonatal period. Maternal vaccination would substantially reduce this, but vaccine uptake rates show much variation across the United Kingdom and there is scope for improvement. This scoping review aimed to understand reasons for, and approaches to, non-uptake of pertussis and influenza vaccinations in pregnant women in the UK and Ireland.

Approach

The method of a scoping review to address the aims described was selected, as it provided a suitable approach to interpret the complex literature about maternal vaccination. MEDLINE, EMBASE, Web of Science and CINAHL databases were searched in June 2021. Searches were limited to articles published in the preceding 10 years from 2011 and in English language. Sources were selected in accordance with guidance from Joanna Briggs Institute on scoping reviews. Data extracted was charted in Microsoft Excel and results presented in descriptive form. The same search strategy was applied to update the review with records published from June 2021 to October 2022.

Findings

Five themes emerged from the review that included reasons for and approaches to non-uptake of pertussis and influenza vaccinations in pregnancy in the UK and Ireland. This included 1. acceptability; 2. organisational and awareness issues; 3. healthcare provider factors; 4. information interpretation and 5. pregnancy related factors. Acceptability as well as organisational and awareness issues were principal themes regarding reasons for and approaches to non-uptake of the vaccines respectively. Raising awareness and reflection on successful vaccination campaigns had potential to promote uptake, however information is lacking on the influence of social media on vaccine uptake. This may be more pertinent to women from ethnic minorities and with lower educational backgrounds, who may face greater challenges interpreting information. Pregnancy related factors associated with lower uptake included unplanned pregnancy; unscheduled antenatal care; women of younger age; nulliparous women and those that were not vaccinated in a previous pregnancy.

Consequences

The many reasons for, and approaches, to non-uptake of both pertussis and influenza vaccinations in pregnancy are complex and intertwined. Women who may feel hesitant towards vaccination need clear, comprehensible information, ideally provided their healthcare provider, in a way that is meaningful and addresses their circumstances and risk perceptions. Local and national public health awareness campaigns and interventions should particularly focus on the target groups identified in this review. Achieving this may facilitate uptake of maternal vaccination, thereby reducing morbidity and mortality associated with both diseases for pregnant women and their infants.