A Systematic Review of Barriers to Vaccination During Pregnancy in the Canadian Context

Although vaccination in pregnancy has the potential to affect maternal and infant morbidity and mortality dramatically, uptake of recommended vaccinations in pregnancy remains low. The objective of this study was to identify barriers and facilitators of vaccination during pregnancy in Canada. The Medline database and the tables of contents of four relevant Canadian journals were screened to identify all studies that considered barriers and/or facilitators to vaccination during pregnancy, specifically in Canadian settings. Citations were screened, and a narrative synthesis of findings was undertaken given the heterogeneity of study design. In total, 17 studies met inclusion criteria, most with a focus on the seasonal and pandemic influenza vaccines. Facilitators and barriers were identified at the level of the patient and the provider. At both levels, knowledge was an important facilitator of vaccine acceptance during pregnancy and was notably improved in studies following the 2009 pandemic H1N1 influenza outbreak compared with earlier studies. Vaccine endorsement by a prenatal care provider and clear messages of safety for the fetus emerged as key motivators. Few studies addressed system-level barriers or interventions for improving vaccine uptake during pregnancy in the Canadian setting. Common themes have emerged from the Canadian literature addressing barriers and facilitators of vaccination during pregnancy. However, there is a paucity of literature to suggest strategies to improve the uptake of vaccination during pregnancy in Canadian settings. Further research is urgently needed given the expanding role of vaccination during routine prenatal care. Bien que la vaccination durant la grossesse puisse considérablement diminuer la morbidité et la mortalité maternelles et infantiles, le suivi des recommandations en la matière demeure faible. L'objectif de cette étude était de déterminer les facteurs favorables et défavorables à la vaccination des femmes enceintes au Canada. Nous avons consulté la base de données Medline et les tables des matières de quatre revues canadiennes pertinentes pour trouver toutes les études examinant les facteurs favorables ou défavorables à la vaccination durant la grossesse, en contexte canadien. Nous avons analysé les références des articles, et effectué une synthèse narrative des résultats étant donné l'hétérogénéité de la conception des études. Au total, 17 études répondaient aux critères d'inclusion, la plupart portant sur