Women's Health
Vaccination Against Influenza in Pregnancy: A Survey of Canadian Maternity Care Providers

https://doi.org/10.1016/j.jogc.2018.09.007Get rights and content

Abstract

Objective

Influenza vaccine uptake among Canadian pregnant individuals is suboptimal. Failure to incorporate vaccination into routine prenatal care and a lack of recommendations from healthcare providers are recognized as barriers to vaccination. The aim of this study was to assess Canadian maternity care providers’ knowledge, attitudes, and practices regarding influenza vaccination in pregnancy.

Methods

A cross-sectional Web-based questionnaire was sent during July and August 2017 to family physicians, obstetricians-gynaecologists, midwives, pharmacists, and nurses who care for pregnant individuals. A multivariable logistic regression model was used to determine variables independently associated with providers’ recommendation of the influenza vaccine in pregnancy.

Results

The analysis included 1061 providers. Most participants (85%) reported being vaccinated against influenza themselves, and 72% reported recommending the influenza vaccine to all of their pregnant patients during the previous influenza season. Participants’ attitudes regarding influenza vaccination during pregnancy were generally positive: 64% strongly agreed that pregnant individuals are at an increased risk of complications from influenza, and 69% strongly agreed that it is safe to vaccinate pregnant individuals against influenza. The main determinants of participants’ recommendations for influenza vaccination to all pregnant patients were following official recommendations on influenza vaccination, discussing vaccines with most or all pregnant individuals seen in their practice, and being vaccinated themselves during the previous influenza season.

Conclusion

Enhancing influenza vaccine uptake in pregnancy is largely dependent on maternity care providers’ recommendations. This study provides valuable insight on providers’ knowledge, attitudes, and practices.

Résumé

Objectif

Le taux de vaccination contre la grippe des femmes enceintes canadiennes est sous optimal. La non-intégration de la vaccination aux soins prénataux de base et l'absence de recommandations des fournisseurs de soins de santé sont des obstacles connus à la vaccination. Cette étude visait à évaluer les connaissances, les attitudes et les pratiques des fournisseurs canadiens de soins de maternité à l'égard de la vaccination contre la grippe durant la grossesse.

Méthodologie

Un questionnaire transversal en ligne a été envoyé en juillet et août 2017 à des médecins de famille, obstétriciens, gynécologues, sages-femmes, pharmaciens et infirmiéres qui prennent soin de femmes enceintes. Un modéle de régression logistique multivariée a été utilisé pour mettre en évidence des variables indépendamment associées à la recommandation du vaccin antigrippal durant la grossesse par les fournisseurs.

Résultats

L'analyse comprenait 1 061 fournisseurs. La plupart des participants (85 %) ont indiqué être eux-mêmes vaccinés contre la grippe, et 72 % ont dit avoir recommandé le vaccin antigrippal à toutes leurs patientes enceintes durant la saison de la grippe précédente. Les attitudes des participants à l'égard de la vaccination contre la grippe durant la grossesse étaient généralement positives : 64 % étaient tout à fait d'accord pour dire que les femmes enceintes présentent un risque accru de complications grippales, et 69 % étaient tout à fait d'accord pour dire qu'il est sécuritaire de vacciner les femmes enceintes contre la grippe. Les principaux critéres déterminant si le participant recommandait la vaccination contre la grippe à toutes ses patientes enceintes étaient le respect des recommandations officielles à ce sujet, les discussions sur les vaccins avec la plupart ou la totalité des femmes enceintes qui les consultaient et le fait d'avoir été eux-mêmes vaccinés durant la saison de la grippe précédente.

Conclusions

L'augmentation du taux de vaccination contre la grippe durant la grossesse repose largement sur les recommandations des fournisseurs de soins de maternité. Cette étude fournit des renseignements précieux sur les connaissances, les attitudes et les pratiques des fournisseurs.

Section snippets

INTRODUCTION

Pregnancy increases the risk of serious complications and hospitalization from seasonal influenza.1, 2, 3 Influenza vaccine administered during pregnancy is effective and can reduce influenza-like illness.4, 5, 6 It can additionally protect infants from influenza infection during their first months of life.6 In Canada, the National Advisory Committee on Immunization has recommended universal vaccination against influenza in pregnancy since 2007.1 However, influenza vaccine uptake in pregnancy

Data Collection

In Canada, no official list of maternity care providers is available. In July and August 2017, a Web-based survey was distributed using Survey Monkey to maternity care providers practicing in Canada. The survey was developed by an interdisciplinary group of maternity care providers and expert researchers and used the results of a previous qualitative study with maternity care providers.34 Data collection was led by the SOGC in partnership with several professional organizations across Canada,

Participants’ Characteristics

A total of 1542 participants completed the questionnaire, and 129 (8.4%) of these participants were excluded because they did not provide pregnancy care. An additional 278 participants were excluded from analysis because either they did not answer the sociodemographic section (n = 271) or did not complete any question (n = 7). Of the remaining 1135 participants, 1061 completed the items on influenza vaccine recommendations and were included in this analysis.

The characteristics of the

DISCUSSION

To the best of our knowledge, this study is the first that has investigated the opinions and behaviours associated with seasonal influenza vaccination during pregnancy in a large and diverse group of maternity care providers in Canada. In our study, almost three fourths of the surveyed maternity care providers reported having recommended influenza vaccine to all pregnant patients during the influenza season before the study. This finding is congruent with the results of other studies that have

CONCLUSION

Health care providers play an important role in social acceptance of vaccination in general and in pregnancy. Despite years of research and innovative interventions to increase maternal vaccination rates, rates of influenza vaccination in pregnant individuals are still alarmingly low (<30%) in Canada. Increasing the uptake of recommended vaccines in pregnancy is largely dependent on maternity care providers’ recommendations. Despite strong recommendations by North American medical and public

Acknowledgements

This study received funds from the Canadian Immunization Research Network and from the Public Health Agency of Canada. Dr. Dubé is supported by a Fonds de recherche du Québec - Santé (FRQS) Research Scholar Junior 1 award. Dr. Witteman is supported by an FRQS Research Scholar Junior 2 award. Dr. Bettinger is supported by a Career Investigator Award from the Michael Smith Foundation for Health Research. Dr. Greyson is supported by a Trainee Award from the Michael Smith Foundation for Health

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      Provider type was cited as a determinant in studies from Canada, Europe, and Thailand [33,46,51,52], with more frequent recommendations coming from ObGyns, gynecologists or nurses [37] than midwives, except in one study where it was the opposite [50]. Several other studies found that recommendation rates did not vary by provider type [26,38]. Data for determinants in MICs was limited to 4 countries - Thailand, Georgia, China and India; however, consistent determinants from those countries were higher awareness of the vaccination policy, and perceived safety [18,33,34].

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    Competing interests: See Acknowledgements.

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