Vaccination choices among pregnant women: findings from the MAMI-MED cohort

BACKGROUND: According to the Italian National Immunization Plan 2023-2025, vaccinations against Measles, Mumps, Rubella (MMR), Varicella and Human Papillomavirus (HPV) are indicated for women of childbearing age. During pregnancy, vaccination against Diphtheria, Tetanus, and Pertussis (DTaP), and Seasonal Influenza are recommended. The present analysis aimed to estimate vaccination choice and its main determinants among pregnant women. METHODS: We used data from the “MAMI-MED” cohort, an ongoing prospective study on mother-child dyads established in December 2020. Socio-demographic information (i.e., age, educational level and employment) were assessed at enrollment, during the first trimester visit at the Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima (Catania, Italy). Self-reported maternal vaccination status was collected at delivery. RESULTS: Among 1004 women with a complete vaccination assessment, 83.5% were vaccinated against MMR, 87.4% against DTaP, 68.3% against Varicella, while only 23.7% and 9.4% against HPV and Seasonal Influenza, respectively. During pregnancy, only 8.7% and 21.1% of women were vaccinated against DTaP and Seasonal Influenza, respectively. The lack of information was the main ground for refusal, accounting for 93.7% for HPV, 82.5% for Influenza, 64.7% for DTaP, 31.8% for MPR, and 18.9% for Varicella. Women vaccinated against HPV and MMR were younger than their unvaccinated counterpart (p < 0.001 and p = 0.023, respectively). The logistic regression showed that the odds of being vaccinated against HPV increased with increasing age, adjusting for education and employment (OR = 1.12; 95% CI = 1.09-1.16; p < 0.001). CONCLUSIONS: The analysis showed modest vaccination coverages, mainly depending on the lack of information about vaccination programs. Moreover, we observed that younger women were more aware of HPV vaccination, which probably reflects improvements in the national vaccination program over the years. KEY MESSAGES: • It is necessary to increase knowledge about vaccination among women in the reproductive age. • Social determinants should be assessed to understand the barriers that might affect vaccination choice.