Abstract
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Résumé
Objectif
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.
Méthodologie
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.
Résultats
Au total, 17 études répondaient aux critères d'inclusion, la plupart portant sur les
vaccins contre la grippe saisonnière et pandémique. Les facteurs favorables et défavorables
étaient examinés à l'échelle du patient et du fournisseur de soins. Dans les deux
cas, les connaissances constituaient un facteur important dans l'acceptation de la
vaccination durant la grossesse et celles-ci se sont améliorées de façon notable dans
les études réalisées après l'éclosion de la grippe pandémique H1N1 en 2009, par rapport
aux études réalisées avant cette période. La recommandation du vaccin par un fournisseur
de soins prénataux et des messages clairs sur l'innocuité pour le fœtus étaient les
principaux facteurs de motivation. Par ailleurs, peu d'études ont été menées à l'échelle
du système de santé sur les facteurs défavorables ou sur les interventions visant
à augmenter la vaccination durant la grossesse en contexte canadien.
Conclusion
Des thèmes récurrents sont ressortis des études canadiennes sur les facteurs favorables
et défavorables à la vaccination durant la grossesse. Toutefois, il manque de données
pour proposer des stratégies visant à augmenter la vaccination des femmes enceintes
au Canada. Il faudrait mener d'urgence d'autres études examinant le rôle croissant
de la vaccination dans les soins prénataux habituels.
Key Words
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Article info
Publication history
Published online: October 22, 2018
Accepted:
May 24,
2018
Received:
March 27,
2018
Footnotes
Competing interests: The authors declare that they have no competing interests.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
