Factors influencing influenza and pertussis vaccination coverage among pregnant women in Poland - a cross- sectional study

Factors influencing influenza and pertussis vaccination coverage among pregnant women in Poland - a cross- sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors influencing influenza and pertussis vaccination coverage among pregnant women in Poland - a cross- sectional study Monika Zasztowt-Sternicka, Hanna Laudy-Wiaderny, Anna Jagielska, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7905123/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background: Vaccination of pregnant women is an essential part of obstetric care, offering protection for both the mother and the neonate. Pregnant women and infants are at risk for a severe course of influenza and pertussis. This study aimed to investigate factors influencing influenza and pertussis vaccination coverage among pregnant women in Poland during the early COVID-19 pandemic. Methods: An anonymous, self-administered, cross-sectional online survey was conducted over 4 months in 2020/ 2021 among adult pregnant patients at any gestational stage. The analysis considered age, education, parity, and comorbidities. Results: 376 patients met the inclusion criteria. Most had higher education, a non-medical background, and were during uncomplicated first pregnancy. The majority believed that influenza (78%) and pertussis (58%) pose risk to pregnant and postpartum women, while 91% recognized pertussis as dangerous to newborns. However, nearly 20% were uncertain whether influenza poses neonatal risks, and fewer than half felt sufficiently informed about vaccination during pregnancy. Over 31% declared receiving the influenza vaccination in pre-pregnancy 2019/2020 season, but only 17% were vaccinated annually. 44% had never been vaccinated, and an additional 21% were unwilling to be vaccinated in the future. The most common reasons for vaccine refusal were doubts about effectiveness, fear of side effects for the mother and/or baby, and the perception of it as a rare disease. Older gravidas tended to view influenza vaccination as safe, effective, and necessary, though differences were not statistically significant. Obstetricians were indicated as sources of vaccine information by 27% of respondents for influenza and 29% for pertussis, while family doctors or other specialists were pointed by 46% and 28%, respectively. Nearly 68% indicated that receiving a free vaccine during routine gynecological or specialist visit would be the most convenient option. Conclusions: Vaccination coverage among pregnant women in Poland against influenza and pertussis remains suboptimal. Key factors that can enhance the immunization rate among pregnant women have been identified. Educating patients and the public about vaccine benefits, effectiveness and safety is essential. Additionally, medical personnel should be educated about effective methods to inform patients about vaccinations during pregnancy, including their safety and benefits. influenza vaccine IIV4 pertussis pregnancy vaccine maternal immunization transplacental antibody transfer Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. Background Infectious diseases are a significant threat to the health of vulnerable population groups, including pregnant women and newborns. One of many common infectious diseases, influenza, continues to be a major challenge for public health yearly (1). Based on years of observation, groups of people with a high risk of severe courses of influenza and its complications, as well as hospitalization due to influenza, have been identified. The high-risk groups included, among others, pregnant women, particularly in the second and third trimesters (2–6), women in the first 2 weeks of postpartum; children under 5 years of age, especially under 6 months, and chronically ill patients (7,8). It is well-documented that pregnant women with influenza face an elevated risk of both morbidity and mortality, with these parameters increasing with gestational age, as evidenced by data from the 2009 influenza A(H1N1) pandemic. Mortality and morbidity increase with the duration of pregnancy (9). Moreover, the risk of hospitalization is four times higher in pregnant women than in the general population (10). Pregnant women are also more prone to developing pulmonary complications, such as pneumonia or respiratory failure, and obstetric complications, including a four-fold increase in the risk of preterm labor (11). One of the best known forms of primary prevention is vaccination. It should be emphasized that vaccination of pregnant women allows for the passive transfer of maternal antibodies to the infant, providing protection during the infant's earliest stages of life. This is due to the fact that infants under six months of age are incapable of mounting an effective immune response to the influenza vaccination (12). Moreover, infants, especially those under 6 months of age, are particularly vulnerable to hospitalization and death due to influenza. Evidence suggests that influenza vaccination during pregnancy reduces the incidence of laboratory-confirmed influenza and reduces the risk of hospitalization in children (12,13). Importantly, many studies confirm the safety of inactivated influenza vaccination for both pregnant women and their children, without increasing the risk of preterm labor, low birth weight, or other adverse complications in pregnancy (13–22). In 2012, the World Health Organization (WHO) included pregnant women as a priority group in seasonal influenza vaccination (23). In addition, the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), and the American Academy of Family Physicians (AAFP) recommend that all women who may be pregnant during the influenza season receive the vaccine (2). In 2014, the Polish Immunization Program was expanded to include influenza vaccination for pregnant women. Furthermore, in August 2018, the Polish Minister of Health published a directive stipulating that perinatal education programs should implement the recommendation for prophylaxis against infectious diseases, including preventive vaccinations. Moreover, the Polish government has implemented a gradual reimbursement program for pregnant women, initially offering a 50% reimbursement (so was the case in the 2020/2021 season) and now providing the vaccine for this group free of charge (24,25). Another important infectious disease worth mentioning in the case of pregnant women is pertussis, the incidence of which has increased dramatically in recent years (26,27). The pertussis risk group primarily includes children aged 0–4 years, who demonstrate notably high hospitalization, morbidity, and mortality rates. Pertussis infection in infants can lead to several serious complications, including apnea, seizures, encephalopathy, pneumonia, and even death (28). Since 2015, the WHO has recommended vaccination against pertussis to all pregnant women (dTaP - vaccine against diphtheria, tetanus, and pertussis, with reduced amount of diphtheria toxoid, tetanus toxoid, and acellular pertussis component) (29). The pertussis vaccination of pregnant women provides approximately 90% protection to infants in their first two months of life, which coincides with the period when they may be vaccinated themselves (30,31). Vaccinating pregnant women against pertussis has been shown to be effective and safe in preventing pertussis in infants in a number of studies (30–38). As of April 2024, the pertussis vaccination program for pregnant women has been implemented in 22 countries, and as of October 2024, pregnant women can obtain the pertussis vaccination free of charge in primary health care in Poland – during the season 2020/2021, pregnant patients had to pay for the vaccine (24,39). RSV (respiratory syncytial virus) poses a severe threat to newborns and infants. In contrast, adults typically experience a milder form of the infection, characterized by symptoms resembling those of a cold, rather than a high fever. However, in more severe cases, shortness of breath, decreased oxygen saturation, and even apnea can manifest. This infection poses a heightened risk to the elderly and young children, with children accounting for up to 70% of all hospitalizations due to RSV-associated bronchiolitis (40). Currently, RSV vaccines (for selected adult groups) and monoclonal antibodies (for children under 8 months of age, with exceptions) are available to protect patient groups most at risk of severe infection. The CDC recommends vaccination against RSV at 32–36 weeks of gestation to allow the mother to pass protective antibodies to her offspring (offering protection for about 3–6 months) or infant immunization with the RSV monoclonal antibody (nirsevimab) (providing protection for at least 5 months), which is highly effective in preventing RSV-associated hospitalization (41). Another vaccination recommended for pregnant patients is that against Severe Acute Respiratory Syndrome caused by SARS-CoV-2 virus. Despite the shift in the epidemiological characteristics of the virus since the onset of the pandemic, the risk of severe infection or pregnancy complications, including premature labor, remains a concern for this demographic. Moreover, pregnant women with underlying health conditions, such as hypertension or diabetes, face an elevated risk of complications from SARS-CoV-2 infection (42). The protective benefits of vaccination during pregnancy extend to both the mother and child, with the option of individual vaccination for the child after the age of six months (43). Poland offers free vaccination against the SARS-CoV-2 virus (24). However, at the time of this study, the RSV vaccine was not yet available, and vaccination against COVID-19 was only just being introduced in Poland. As the pertussis vaccine is approved from the age of 6 weeks, the influenza and COVID-19 vaccine from the age of 6 months, and there is no RSV vaccine for children, only the vaccination of pregnant women can provide adequate protection for newborns and infants against the aforementioned diseases. A cocoon strategy entails the administration of vaccinations to individuals close to the infant, encompassing parents, other family members, and caregivers. However, a Cochrane Database Systematic Review notes that numerous studies have indicated the ineffectiveness of the cocoon strategy and post-partum vaccination in protecting children (28). Some researchers have reported that the cocoon strategy provides less effective protection for the infant than vaccinating pregnant women (44–46). Nevertheless, it is important to note that the vaccination coverage among pregnant women is lower compared to the general population, despite their inclusion as priority group (47,48). This phenomenon has been the subject of additional studies, which have identified potential causes (44,48–56). In Poland, there is no national registry of IV (influenza vaccination) in pregnant women, and small-scale studies report that the rate oscillates around 3–21% (53,57,58)- with a tendency for higher vaccination rates over time. The objective of our study was to assess the factors influencing influenza and pertussis vaccination coverage, as well as confidence, knowledge, attitudes, and concerns regarding vaccination uptake among pregnant women in Poland. In light of the prevailing epidemic conditions worldwide—including the escalating number of refusals of compulsory vaccinations, the spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and a surge in pertussis infections—the present work is particularly relevant. 2. Materials and Methods 2.1.Survey An anonymous, self-administered, cross-sectional survey was published online between December 2020 and March 2021. It examined the factors that influence influenza and pertussis vaccination rates among pregnant women in Poland, exploring their confidence, knowledge, attitudes, and concerns about vaccination. The invitation to participate in the study, in the form of stickers (with a link to an online survey, email contact to the researcher, and Medical University of Warsaw (MUW) logo) was given to patients of the Ist Department of Obstetrics and Gynecology, MUW by the obstetric providers. Additionally, the invitation to complete the questionnaire was distributed on the private internet forum dedicated to pregnancy and childbirth. In order to avoid multiple responses, the survey started with the creation of a verification code consisting of the first 2 letters of the first name, the last 2 letters of the surname, and the last 2 digits of the year of birth (ex. Katarzyna Kowalska, 1995: KA-KA95). The entire questionnaire was written in Polish and was divided into 4 sections - general information, questions about influenza, questions about pertussis, and questions about children’s vaccinations. The survey did not contain any questions enabling identification. The responses were safely stored - only the authors of the survey had access to the data. 2.2.Inclusion criteria The authors identified the following inclusion criteria: voluntary completion of the survey, age of consent, any stage of pregnancy and exclusion criteria: adolescent pregnancy, no will to participate in the study or no conscious volition. Authors applied double-checking of the completed questionnaires for correctness and to determine if all study participants met the required criteria using specific questions such as ,,What was the date of last menstrual period? What is your gestational age? What is your due date?”. 2.3. Ethical approval The study was conducted according to the guidelines of the Declaration of Helsinki and received a positive opinion from the MUW Bioethics Committee (KB/96/2020) as a part of clinical trial: Immunological and clinical efficacy and tolerability of tetravalent inactivated influenza vaccine (IV) in patients at risk of severe and complicated influenza disease. The first page of the questionnaire contained information on the voluntary and anonymous nature of the research as well as purposefulness of the study. 2.4. Sample size Out of 392 women, who took part in the study 376 met the inclusion criteria, including providing complete answers to all or nearly all questions in the questionnaire, and were taken into account in the statistical analysis. The results were analyzed in demographic subgroups of age, education, pregnancy period (1,2 or 3 trimester), the course of pregnancy (physiological vs. complicated) and accompanying chronic diseases. 2.5. Statistical analysis Statistical analyses were performed using the statistical program Statistica 13 - TIBCO Software Inc. (2017). The statistically significant results were at the p-value < 0.05. Mann-Whitney's U-test, Pearson chi-square and Spearman rank-order correlations analysis were used to develop the results. In the assessment of knowledge, the correct answers were marked in bold type (“definitely yes” and “rather yes” or “rather no” and “definitely no”) depending on a question type. Non-parametric (Mann–Whitney U) tests and Spearman rank-order correlations were used for ordinal, and Pearson's chi-squared test for nominal variables. Percentages were rounded to whole numbers; therefore, the sum of the percentages may differ slightly from 100%. 3. Results 3.1. Demographic data We received 392 questionnaires completed by pregnant women and excluded those with any essential missing data, as well as questionnaires received after the data collection deadline. The study included 376 pregnant women, half of them were up to 30 years of age and the other half - above 30 years of age. 90% of the respondents had a higher education (a master degree). Over 66% of women declared no medical education. For 60% of women it was the first pregnancy, also 61% of them were in the third trimester. 93% of pregnancies proceeded without complications. The most frequently mentioned health problem occurring during pregnancy was gestational diabetes mellitus (n=14; 50%). 25% of women were diagnosed with a chronic disease before pregnancy. The most common chronic diseases declared by respondents were hypothyroidism/ Hashimoto disease (n=56; 60%), bronchial asthma (n=9; 10%) and endometriosis (n=5; 5%). Only 2 women were expecting twins. Demographic characteristics of the sample, divided into 2 groups - under and over 30 years of age is presented in Table 1. Table 1. Sample characteristics, N=376. Characteristic Age groups P T A B N % N % N % Number of participants 376 100 188 50 188 50 0.9589 Education degree Primary 1 0 1 1 0 0 0.2687¹ Secondary 10 3 8 4 2 1 Bachelor degree 29 8 17 9 12 6 Master degree 336 90 162 86 174 93 Medical education No response 10 3 8 2 2 1 None 243 65 111 62 132 71 0.1128¹ Nurse/Midwife/Pharmacist/ Physiotherapist 62 17 34 19 28 15 Physician/Dentist 61 16 35 19 26 14 Gravidity 1 st pregnancy 226 60 128 68 98 52 0.0028¹ 2 nd pregnancy 109 29 48 26 61 32 >3 rd pregnancy 41 11 12 6 29 15 Trimester 1 st 24 6 14 7 10 5 0.3731¹ 2 nd 123 33 64 34 59 31 3 rd 229 61 110 59 119 63 The course of pregnancy Physiological/No 348 93 181 96 167 89 0.0060² Complicated/Yes 28 7 7 4 21 11 Presence of a chronic disease before pregnancy No 283 75 145 77 138 73 0.4028² Yes 93 25 43 23 50 27 Abbreviations: %- percentage, N – number; T- Total; A - Women aged 18-30 years; B - Women aged 31+ years; ¹ U Mann-Whitney test; ² chi² Pearson test 3.2. Statistical differences among age groups (18-30 years vs ≥31 years). As mentioned above the statistics were carried out based on the division into two age groups (up to 30 years of age and above 30 years of age) as statistical differences were shown in age groups. No statistical differences were found in the level of education, trimester of pregnancy or presence of chronic diseases. There was a statistically significant difference of gravidity between age groups: more primigravida were noticed among women under 30 years old (68%) than those above 30 years old (52%) (p=0.0028). Similarly, when it comes to complications occurring in pregnancy, older women were more likely to have complications (11%) vs. younger ones (4%) (p=0.0060) (Table 1). 3.3. Perception of influenza and pertussis as dangerous disease. We found a different perception of influenza and pertussis as dangerous diseases for a pregnant or postpartum woman and for a fetus or a newborn, although there was no statistically significant difference between age groups . The majority of respondents believe that influenza (78%) and pertussis (58%) pose a risk to pregnant and postpartum women. A significant majority (90%) of respondents are aware that pertussis is dangerous to newborns. However, nearly 20% of women do not know whether influenza poses a risk to newborns. There were no statistically significant differences between age groups in the declared knowledge about these diseases in age groups (Table 2). Table 2. Influenza and pertussis perception among pregnant women (correct answer in bold type) N=376. Question “Do you think…” Answer (%, N) Definitely yes Rather yes I don’t know Rather no Definitely no R P 1) this is a dangerous disease with the risk of complications for pregnant and postpartum women? Influenza (N=376) 48% (179) 30% (111) 14% (52) 7% (27) 2% (7) 0.3192 <0.0001 Pertussis (N=376) 28% (106) 30% (113) 32% (122) 8% (29) 2% (6) 2) this is a dangerous disease with the risk of complications for a fetus and a newborn? Influenza (N=376) 49% (184) 25% (94) 19% (73) 5% (20) 1% (5) 0.3777 <0.0001 Pertussis (N=376) 76% (285) 15% (55) 8% (29) 1% (5) 1% (2) Abbreviations : %- percentage, N – number; R- Spearman rank correlation ; Generally, the correct answer (definitely yes, yes) to the question “Do you believe that pregnancy and the postpartum period are a risk factor for a severe and complicated course of influenza?” was marked by 60% of respondents (Figure 1). There were no statistically significant differences in correct answers depending on age. 3.4. Perception of influenza and pertussis vaccines as safe, effective and needed for pregnant and postpartum women. About 66% of women believe the influenza vaccine is safe, 70% believe it is effective, and 59% believe it is necessary. In the case of the pertussis vaccine, just over 66% consider it safe, nearly 70% believe it is effective, and 63% believe it is necessary (Table 3.) Table 3. Attitudes towards influenza and pertussis vaccination among pregnant women (correct answer in bold type) N=376. Question “Do you think that a vaccine is…” Answer (%, N) Definitely yes Rather yes I don’t know Rather no Definitely no R P safe for pregnant and postpartum women? Influenza (N=376) 43% (161) 23% (86) 19% (71) 8% (30) 8% (28) 0.7220 <0.0001 Pertussis (N=376) 45% (170) 21% (79) 21% (79) 9% (33) 4% (15) 2) effective for pregnant and postpartum women? Influenza (N=376) 43% (161) 27% (101) 22% (82) 4% (16) 4% (16) 0.6352 <0.0001 Pertussis (N=376) 47% (177) 23% (86) 25% (94) 3% (11) 2% (8) 3) needed for pregnant and postpartum women? Influenza (N=376) 42% (156) 17% (62) 22% (82) 13% (50) 7% (26) 0.7443 <0.0001 Pertussis (N=376) 47% (177) 16% (60) 27% (101) 6% (23) 4% (15) Abbreviations: %- percentage, N – number; R- Spearman rank correlation ; Different proportions were observed in the perception of vaccines in terms of safety, effectiveness, and necessity in age groups above 30 versus below 30 years of age. In response to the question "Do you consider the IV during pregnancy and the postpartum period to be safe?", approximately 18% of patients under the age of 30 responded with a definitive "no" or "rather no". This proportion was lower among patients aged 31 and above, with only 13% responding in the same way. Among women up to 30 years of age, 10 % considered IV ineffective, and only 6% in the group over 30 years of age. A higher percentage of younger patients believed that IV during pregnancy and the postpartum period was unnecessary (26%) than older patients (15%). Furthermore, younger patients exhibited a higher proportion of respondents who perceived the vaccine to be dangerous (18% for influenza vaccine, 14% for pertussis vaccine) compared to patients over 30 years of age (13% for influenza vaccine, 11% for pertussis vaccine). Overall, older pregnant women are more likely to consider IV as safe, effective, and necessary, however, the differences are not statistically significant. The answers to the question: “Do you think that pertussis vaccination is needed during pregnancy and childbirth?” overall, 63% of respondents answered affirmatively. Among women under 30 years old 62% answered affirmatively, while above 30 years of age 65%. Nevertheless what is interesting, only 20% of all respondents answered affirmative to the question: “Due to your health condition or chronic diseases, would you qualify as a patient at risk of severe and complicated course of the influenza?”. 3.5. Vaccination coverage – influenza. Over 31% of responders declared receiving the influenza vaccination in pre-pregnancy 2019/2020 season. From among them less than 17% received IV annually - regularly, every season; 44% of women had never been vaccinated, and an additional 21% declared that they had never been vaccinated against influenza and were not willing to be vaccinated in the future (Figure 2). Almost 41% of responders planned to get vaccinated in the coming 2020/2021 season (Figure 3). 3.6. Knowledge and attitudes- IV 48% of pregnant women considered their level of knowledge about influenza vaccination as sufficient, 35% as insufficient, and 17% had no opinion (Figure 4). 3.7. Factors influencing vaccination refusal. The surveyed pregnant women cited the following as the primary reasons for refusing vaccination: the perception that influenza and pertussis are rare diseases (13%/14%); concerns regarding the safety of the vaccine for both the fetus and the pregnant woman (12%/9%); the belief that the vaccine is unnecessary (16%/9%); a professional recommendation from a midwife or gynecologist not to vaccinate (3%/6%); the lack of reimbursement for the vaccine (currently, all vaccines are reimbursed) (14%/5%); the belief that the vaccine is ineffective (13%/3%); a professional recommendation from a family doctor or other than a gynecologist specialist not to vaccinate (3%/2%) (Figure 5). 3.8. Source of information on influenza and pertussis . Unsurprisingly, the most common source of information used by patients was the Internet - 61% and 54% for influenza and pertussis respectively. Among the respondents, 27% indicated the obstetrician as the source of information about influenza, and 29% regarding pertussis. Family Doctor or other specialist as a source of information was pointed by 46% and 28% for influenza and pertussis respectively. Being a graduate in medical fields was an important source of knowledge about both diseases and vaccination against pertussis. While family and friends were important source of knowledge about vaccination against influenza – 26% (Figure 6). 3.9. The intention to vaccinate children. The respondents, when asked about their intention to vaccinate their children, answered as follows: 73% intend to vaccinate their children with the obligatory vaccines as well as with unrefunded but recommended vaccinations; 23% intend to vaccinate only with obligatory vaccinations, 5% intend to abandon some obligatory vaccinations, and 2% do not intend to vaccinate their children at all (Figure 7). 3.10. Preferred location to get vaccinated. It's worth noting that currently, pregnant women in Poland can get vaccinated by their family doctor, or, for COVID-19, at dedicated pharmacy locations. Most obstetrics outpatients clinics do not have vaccination points. For nearly 68% of pregnant women, the most convenient option would be to receive the free vaccine during a visit to the gynecologist or other specialist, 54% would like to be able to get vaccinated during a routine pregnancy visit, while 22% indicated their family doctor as their preferred vaccination location. 6% of patients could pay for the vaccination to be available immediately from the doctor providing obstetric care (Figure 8). 4. Discussion 4.1. Potential causes of vaccines refusal and acceptance. A review of recent literature reveals a consistent theme: many articles have highlighted the insufficient vaccination coverage and lack of knowledge about vaccinations among pregnant women. Therefore, it is necessary to investigate the causes of this phenomenon and the factors contributing to low vaccination rates in this patient group. The results of our study indicate that nearly 48% of the pregnant participants self-reported their knowledge of influenza vaccination as sufficient. In contrast, more than 35% of participants indicated their knowledge was insufficient, while nearly 17% expressed no opinion on the matter. As previously stated, it is unfortunate that there is no official vaccination registry for pregnant women in Poland. Consequently, the available evidence is derived from a limited number of studies conducted on small groups. In our study, over 31% of respondents declared receiving the influenza vaccination in pre-pregnancy 2019/2020 season. From among this group, less than 17% received IV annually—regularly, every season. Almost 41% of respondents still planned to get vaccinated in the 2020/2021 season. Nevertheless, the findings of our study must consider the elevated educational status of the respondents and the considerable proportion of individuals associated with healthcare/medical profession. Consequently, these vaccination rates may be overstated. Another Polish study, by Pisula et al., highlights that most participants rated their knowledge about influenza as sufficient to make an informed decision about vaccination (62%). However, despite this confidence, only 21% reported receiving the influenza vaccine during their current pregnancy, and only 18% expressed intention to get vaccinated. In this study, factors influencing the decision to get vaccinated include average household income and place of residence (53). A Greek study conducted in 2020-2022 (comparable to our own) reported that vaccination coverage among pregnant women against pertussis was 17%, and against influenza was 46%. Greece also lacks records regarding vaccinations for pregnant women. The study emphasizes that patients with higher education (MS and PhD) were more likely to be vaccinated. Factors influencing vaccine uptake included: information from a physician, lack of fear of vaccine side effects, recognition of influenza as a dangerous disease, and perception of the vaccine as safe. The researchers conclude that awareness and education of both physicians and patients influence vaccination coverage. In some studies, older age (supporting the results of our study), access to insurance, and at least college graduation were factors that contributed to influenza vaccination in pregnant women (44). A systematic review conducted by Ługowski et al. in 2024 (finally including 20 articles since 2015), assessing knowledge, attitudes, and practices regarding influenza vaccination among pregnant women, reported that, in many settings, general awareness of influenza was moderate to high, but detailed knowledge about transmission routes, complications during pregnancy, and vaccine safety was often poor. Safety concerns remain a major barrier to influenza vaccination during pregnancy. The most common misconception about vaccine safety, cited as a recurring reason for vaccine refusal, is the vaccine's impact on fetal health (as in our own study). Vaccination reluctance is influenced by many factors, such as the mandatory nature of vaccinations, their timing, with adverse health effects, lack of knowledge about vaccine-preventable diseases, as well as distrust of corporations and public health institutions, and cultural determinants (59,60). Several studies have shown that pregnant women who had greater knowledge about influenza and the vaccine were more likely to receive the vaccine. Individuals residing in rural areas or those with a lower socioeconomic status frequently encounter obstacles, including limited access to healthcare facilities, lack of insurance, and limited opportunities to participate in vaccination campaigns. (61) Nevertheless, our study revealed that the most common reasons for refusing vaccination included the belief that the vaccine is unsafe for pregnant women and for the baby, a lack of confidence in the vaccine's effectiveness, and the belief that the infectious disease in question is rare, but also lack of reimbursement or problems with the availability of vaccines. For comparison, another American study conducted in 2017 found that the vaccination coverage rate among 2,254 pregnant women in the United States was 36%. Fifty-eight percent of patients received a recommendation for influenza vaccination and were given the opportunity to be vaccinated on the spot. Of those, over 52% of pregnant women were vaccinated. Only 16% of those who received a recommendation to vaccinate themselves, without the option of being vaccinated on the spot, got vaccinated. Among them, approximately 26% were vaccinated. More than 25% of the women did not receive any of the aforementioned support, and only 6% of them were vaccinated. Overall, two-thirds of pregnant women were not vaccinated. Therefore, healthcare providers should be encouraged to educate patients and recommend immunizations to protect pregnant women and their children. Additionally, the study found that immunization coverage was the lowest among the least educated — some college (28%), high school or less (35%). Over 45% of the best educated women (above college degree) have been vaccinated. The type of insurance also mattered. The highest vaccination coverage was, as expected, among respondents with private and military insurance. What is also important, women with comorbidities were more likely to vaccinate (39% vs. 33%). Most pregnant women were vaccinated by the obstetrician doctor or midwife (50%), by the family doctor, or by other specialist (29%). It is worth emphasizing that a large percentage of pregnant women (10%) were vaccinated in a pharmacy, supermarket-pharmacy, drug store, supermarket, grocery store, superstore, which is not practiced in Poland in the light of the current legal regulations. The most common motivations for vaccination were protecting a baby from influenza (40%), self-protection (24%), and following a doctor's recommendation (15%). The most common reasons for refusing vaccination were inefficiency (22%), fear of side effects (21%), and concern about safety for the fetus (15%) [1]. 4.2. Factors improving vaccination rate in pregnant women. A comprehensive analysis was conducted to identify factors that could contribute to enhancing vaccination rates. The findings of our study highlighted the significance of vaccine accessibility, demonstrating that offering free vaccines at gynecological clinics and family doctor's offices could potentially enhance the existing statistics. A survey of patients revealed that more than half of them believe that vaccination during a routine obstetrician appointment would be the most convenient option. An additional 20% of respondents indicated that their primary care physician would be their preferred vaccination location. Currently, pregnant women in Poland can get vaccinated by their family doctor or, for COVID-19, at designated pharmacy locations. However, the majority of obstetrics outpatient clinics do not function as vaccination centers. In the present study, it was observed that a higher percentage of patients under the age of 30 expressed concerns regarding the influenza vaccination. A greater proportion of patients in this age group considered the IV to be unsafe, unnecessary, or ineffective. These differences are most likely due to the fact that the older the woman, the greater her chances of having more offspring, so patients over the age of 30 may have already been exposed more than once to information about vaccinations during pregnancy, their safety, and benefits for the child. Therefore, raising awareness about vaccinations for pregnant women and their newborns is crucial, as supported by numerous publications (13–16,23,25,28–31), but with particular focus on patients who are pregnant for the first time and/or are younger. However, all patients, regardless of age or parity, may benefit from education about vaccination. In order to adequately educate patients about the advantages of vaccination during pregnancy, it is essential to provide regular training to medical staff. This training should encompass both substantive knowledge about vaccinations and effective methods of discussing vaccinations with patients. According to a 2012 study by Shevell et al., recommendation of influenza vaccines in conjunction with the efficient communication between healthcare providers and pregnant patients lead to a substantial rise in IVC rates, even among patients who initially expressed reluctance to receive the influenza vaccination (59). As in many aspects of contemporary life, the internet constitutes a significant source of information, as confirmed by our study; consequently, public health vaccination campaigns should strategically utilize social media platforms that disseminate accurate and evidence-based content. 4.3. Healthcare professionals as a source of information. In our own study, among the respondents, significant proportion of respondents-over one-quarter indicated the obstetrician as the source of information about influenza, and pertussis. Family Doctor or a doctor of another specialty as a source of information was pointed by 46% and 28% for influenza and pertussis respectively. Similarly Maltezou et al. reports that in Greece physicians supervising the pregnancy recommended vaccination against pertussis to 27% of patients, and against influenza to 69% (60). What is important, a meta-analysis conducted by Regan et al. found that pregnant women are 12 times more likely to receive IV if recommended by their healthcare provider (61). Other study reports that patients who received a vaccination recommendation from Health Care Provider (HCP) were almost 19 times more likely to be vaccinated (OR: 18,86, p < 0,001) (60). Gorman et al. reported that those women who mentioned specific conversation with a doctor about influenza infection and the benefits of vaccination were much more likely to accept the vaccine (50). Other sources report that HCP play a crucial role in encouraging vaccination among pregnant women as it is estimated that their recommendation increases the chances of being vaccinated 3 times (three time the odds) (51,52). Systematic review by Eppes et al. on interventions to increase the uptake of seasonal influenza vaccination among pregnant woman, included 11 studies, from 2007-2014 from the USA, Canada and Australia. According to researchers conclusions, there are no universal methods of increasing vaccination coverage among pregnant women. One moderate quality randomized study argued that brochures increased vaccination coverage, and the dissemination of information brochures along with verbal messages about the benefits of influenza vaccination should be led by clinicians. The authors emphasized that further high-quality randomized trials are needed to improve pregnancy vaccination programs (49). Ługowski et al. emphasize the crucial impact of healthcare professional recommendations: In almost all studies, healthcare professional recommendations were a key factor in vaccine acceptance (62). It is disappointing that in our own study 3% of patients reported that their obstetrician had actually advised against the influenza vaccination. It is worth adding that there are also studies examining the knowledge among maternal care providers (MCPs). A survey conducted among MCPs - obstetricians and midwives in Catalonia, Spain, concerned questions about the current vaccination recommendations for both influenza and pertussis coverage. Interestingly, among the surveyed medical professionals, 31% were vaccinated annually (midwives - 27% less often than gynecologists - 45%). Of all respondents, 54% knew that influenza vaccination is recommended also in the first trimester of pregnancy, but only 43% prescribed it. But 99% of MCPs were aware of the pertussis vaccination recommendations and 97% recommended it. The most popular concern about vaccination of pregnant women were side effects, declared by 26% of MCPs (63). 4.4. Limitations. The main limitations of our study include participation and reporting bias. It's possible that respondents, patients in the country's capital and those with access to online forums, are more likely to be mothers with positive attitudes toward vaccinations, which also contributes to the inflated vaccination statistics. Furthermore, a significant portion of respondents are HCP (33%), and the majority (90%) have higher education (a master's degree). Moreover the data collected in the study were self-reported and not validated through an analysis of the patients' medical records. 5. Conclusions Although the influenza and pertussis vaccination coverage rate among pregnant women has been improving over the years, it remains unsatisfactory. Some modifiable factors have been identified as potentially enhancing the immunization process for pregnant women. A key component of this effort involves educating pregnant patients and the general public regarding the benefits of vaccination for both the mother and child, the effectiveness of vaccination, and its safety. Additionally, there should be an emphasis on educating the public about vaccine-preventable diseases, as a significant proportion of the population remains unaware of the severity of influenza and pertussis and the potential complications associated with these infections. Since only 20% of pregnant women who took part in our study believe that pregnancy itself increases the risk of complications from influenza, it is important to raise awareness of the significance of this risk factor. Family physicians and obstetricians have a crucial role in promoting vaccinations among pregnant women. Our results indicate not only barriers at the level of the individual patient, but also structural gaps in healthcare systems. Professional training for healthcare workers to effectively communicate information about vaccinating pregnant women should be considered. Abbreviations Abbreviations: The following abbreviations are used in this manuscript: AAFP American Academy of Family Physicians ACNM American College of Nurse- Midwives ACOG American College of Obstetricians and Gynecologists CDC The Centers for Disease Control and Prevention COVID-19 Coronavirus Disease 2019 dTaP Diphtheria, Tetanus, Pertussis vaccine HCP IIV4 Heathcare Proffesional/Provider Inactivated Influenza Vaccine Quadrivalent IV Influenza Vaccine MCP Maternal Care Provider MDPI Multidisciplinary Digital Publishing Institute MUW Medical University of Warsaw RSV Respiratory Syncytial Virus SARS-CoV-2 Severe Acute Respiratory Syndrome Coronavirus 2 WHO World Health Organization Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki, and approved by Bioethics Committee of the Medical University of Warsaw, Poland (KB/96/2020, 15.06.2020) for studies involving humans. Informed consent was obtained from all subjects involved in the study. Consent for publication: All authors reviewed and approved the final version of the manuscript and agreed to its publication. Availability of data and materials : The data presented in this study are available on request in the form of an Excel spreadsheet or a flat file from the corresponding author for any academic use upon citation of this article. Competing interests : The authors declare that they have no competing interests. Funding : Not applicable. This research received no external funding. Authors' contributions : Conceptualization and methodology, MZS, AJ, IS, and ANO; validation, MZS, AJ, HLW; formal analysis AJ, MZS, HLW; investigation, MZS; data curation MZS, IS; writing—original draft preparation, MZS, HLW, AJ.; writing—review and editing, HLW, ANO, IS.; visualization MZS, HLW, AJ.; project administration, AJ, ANO, MZS. All authors have read and agreed to the published version of the manuscript. 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07:02:28","extension":"xml","order_by":29,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127735,"visible":true,"origin":"","legend":"","description":"","filename":"14f4c3394a2f43f0b994d9a8e6eb79411structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/4dd07aef9a1fc98d710250fc.xml"},{"id":97115166,"identity":"a0c930e8-75f2-49f7-af0a-91ddc4cdba75","added_by":"auto","created_at":"2025-12-01 07:02:28","extension":"html","order_by":30,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":144822,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/698850bc6f83050d0eb39a49.html"},{"id":97140708,"identity":"9fcf0017-8536-4ce3-8be0-c192a3834f85","added_by":"auto","created_at":"2025-12-01 10:05:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36102,"visible":true,"origin":"","legend":"\u003cp\u003ePerception of pregnancy and postpartum period as a risk factor for a severe and complicated course of influenza in % (N=376).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/da275998489fe855ed1437b4.png"},{"id":97115149,"identity":"edc1e584-7c47-4943-97d7-64728d34f7df","added_by":"auto","created_at":"2025-12-01 07:02:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56815,"visible":true,"origin":"","legend":"\u003cp\u003eVaccination coverage in previous seasons in % (N = 376).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/2bdee04fbe9a86b284b86781.png"},{"id":97115152,"identity":"f08f44ec-66ac-4e3d-a7ee-737fc52a760f","added_by":"auto","created_at":"2025-12-01 07:02:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":27799,"visible":true,"origin":"","legend":"\u003cp\u003eWillingness to get vaccinated in coming 2020/2021 season in % (N = 376).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/5bf1555b8af60190673dda2f.png"},{"id":97115151,"identity":"fa499e21-1fb1-4c2a-a593-ea039f245dee","added_by":"auto","created_at":"2025-12-01 07:02:27","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":27514,"visible":true,"origin":"","legend":"\u003cp\u003eSelf-estimated level of knowledge about IV in % \u0026nbsp;(N = 376).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/029eb8e3e1299629867c2ed9.png"},{"id":97142532,"identity":"b3d8f746-3855-4d63-ad8f-c9391eed3615","added_by":"auto","created_at":"2025-12-01 10:07:42","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":71791,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of responses of patients in % to the question regarding the rationale for their decision to abstain from receiving the pertussis vs. influenza vaccination – a multiple choice question (N=376).\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/79d6de6e87f2c24ae8dbe831.png"},{"id":97141499,"identity":"6bb849ee-4d94-47a7-89f1-8e9d154358f0","added_by":"auto","created_at":"2025-12-01 10:06:45","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":55619,"visible":true,"origin":"","legend":"\u003cp\u003eSource of information on influenza vs. pertussis illness in % - a multiple-choice question (N=367).\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/f8d65f67dcf9dd89c381f8bd.png"},{"id":97115163,"identity":"f43f2234-5d61-4c67-b8cb-e311b8ccc746","added_by":"auto","created_at":"2025-12-01 07:02:28","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":72009,"visible":true,"origin":"","legend":"\u003cp\u003eThe intention to vaccinate children in % (N=376).\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/60b9ab3e758c26a8fe228b48.png"},{"id":97140741,"identity":"79cb6792-96e7-4395-a628-dd1fa17aa76e","added_by":"auto","created_at":"2025-12-01 10:05:41","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":74601,"visible":true,"origin":"","legend":"\u003cp\u003ePreferred location to get vaccinated – a multiple choice question in % (N=376).\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/2434fccd2d95fae748342924.png"},{"id":97145211,"identity":"7996e190-20e8-4a50-9e11-3d8356c9b105","added_by":"auto","created_at":"2025-12-01 10:13:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1579336,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7905123/v1/e4999745-6bc3-41bf-8bf9-05cae0d9d6fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors influencing influenza and pertussis vaccination coverage among pregnant women in Poland - a cross- sectional study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eInfectious diseases are a significant threat to the health of vulnerable population groups, including pregnant women and newborns. One of many common infectious diseases, influenza, continues to be a major challenge for public health yearly (1). Based on years of observation, groups of people with a high risk of severe courses of influenza and its complications, as well as hospitalization due to influenza, have been identified. The high-risk groups included, among others, pregnant women, particularly in the second and third trimesters (2\u0026ndash;6), women in the first 2 weeks of postpartum; children under 5 years of age, especially under 6 months, and chronically ill patients (7,8). It is well-documented that pregnant women with influenza face an elevated risk of both morbidity and mortality, with these parameters increasing with gestational age, as evidenced by data from the 2009 influenza A(H1N1) pandemic. Mortality and morbidity increase with the duration of pregnancy (9). Moreover, the risk of hospitalization is four times higher in pregnant women than in the general population (10). Pregnant women are also more prone to developing pulmonary complications, such as pneumonia or respiratory failure, and obstetric complications, including a four-fold increase in the risk of preterm labor (11).\u003c/p\u003e\u003cp\u003eOne of the best known forms of primary prevention is vaccination. It should be emphasized that vaccination of pregnant women allows for the passive transfer of maternal antibodies to the infant, providing protection during the infant's earliest stages of life. This is due to the fact that infants under six months of age are incapable of mounting an effective immune response to the influenza vaccination (12). Moreover, infants, especially those under 6 months of age, are particularly vulnerable to hospitalization and death due to influenza. Evidence suggests that influenza vaccination during pregnancy reduces the incidence of laboratory-confirmed influenza and reduces the risk of hospitalization in children (12,13). Importantly, many studies confirm the safety of inactivated influenza vaccination for both pregnant women and their children, without increasing the risk of preterm labor, low birth weight, or other adverse complications in pregnancy (13\u0026ndash;22). In 2012, the World Health Organization (WHO) included pregnant women as a priority group in seasonal influenza vaccination (23). In addition, the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), and the American Academy of Family Physicians (AAFP) recommend that all women who may be pregnant during the influenza season receive the vaccine (2). In 2014, the Polish Immunization Program was expanded to include influenza vaccination for pregnant women. Furthermore, in August 2018, the Polish Minister of Health published a directive stipulating that perinatal education programs should implement the recommendation for prophylaxis against infectious diseases, including preventive vaccinations. Moreover, the Polish government has implemented a gradual reimbursement program for pregnant women, initially offering a 50% reimbursement (so was the case in the 2020/2021 season) and now providing the vaccine for this group free of charge (24,25).\u003c/p\u003e\u003cp\u003eAnother important infectious disease worth mentioning in the case of pregnant women is pertussis, the incidence of which has increased dramatically in recent years (26,27). The pertussis risk group primarily includes children aged 0\u0026ndash;4 years, who demonstrate notably high hospitalization, morbidity, and mortality rates. Pertussis infection in infants can lead to several serious complications, including apnea, seizures, encephalopathy, pneumonia, and even death (28). Since 2015, the WHO has recommended vaccination against pertussis to all pregnant women (dTaP - vaccine against diphtheria, tetanus, and pertussis, with reduced amount of diphtheria toxoid, tetanus toxoid, and acellular pertussis component) (29). The pertussis vaccination of pregnant women provides approximately 90% protection to infants in their first two months of life, which coincides with the period when they may be vaccinated themselves (30,31). Vaccinating pregnant women against pertussis has been shown to be effective and safe in preventing pertussis in infants in a number of studies (30\u0026ndash;38). As of April 2024, the pertussis vaccination program for pregnant women has been implemented in 22 countries, and as of October 2024, pregnant women can obtain the pertussis vaccination free of charge in primary health care in Poland \u0026ndash; during the season 2020/2021, pregnant patients had to pay for the vaccine (24,39).\u003c/p\u003e\u003cp\u003eRSV (respiratory syncytial virus) poses a severe threat to newborns and infants. In contrast, adults typically experience a milder form of the infection, characterized by symptoms resembling those of a cold, rather than a high fever. However, in more severe cases, shortness of breath, decreased oxygen saturation, and even apnea can manifest. This infection poses a heightened risk to the elderly and young children, with children accounting for up to 70% of all hospitalizations due to RSV-associated bronchiolitis (40). Currently, RSV vaccines (for selected adult groups) and monoclonal antibodies (for children under 8 months of age, with exceptions) are available to protect patient groups most at risk of severe infection. The CDC recommends vaccination against RSV at 32\u0026ndash;36 weeks of gestation to allow the mother to pass protective antibodies to her offspring (offering protection for about 3\u0026ndash;6 months) or infant immunization with the RSV monoclonal antibody (nirsevimab) (providing protection for at least 5 months), which is highly effective in preventing RSV-associated hospitalization (41).\u003c/p\u003e\u003cp\u003eAnother vaccination recommended for pregnant patients is that against Severe Acute Respiratory Syndrome caused by SARS-CoV-2 virus. Despite the shift in the epidemiological characteristics of the virus since the onset of the pandemic, the risk of severe infection or pregnancy complications, including premature labor, remains a concern for this demographic. Moreover, pregnant women with underlying health conditions, such as hypertension or diabetes, face an elevated risk of complications from SARS-CoV-2 infection (42). The protective benefits of vaccination during pregnancy extend to both the mother and child, with the option of individual vaccination for the child after the age of six months (43). Poland offers free vaccination against the SARS-CoV-2 virus (24). However, at the time of this study, the RSV vaccine was not yet available, and vaccination against COVID-19 was only just being introduced in Poland.\u003c/p\u003e\u003cp\u003eAs the pertussis vaccine is approved from the age of 6 weeks, the influenza and COVID-19 vaccine from the age of 6 months, and there is no RSV vaccine for children, only the vaccination of pregnant women can provide adequate protection for newborns and infants against the aforementioned diseases. A cocoon strategy entails the administration of vaccinations to individuals close to the infant, encompassing parents, other family members, and caregivers. However, a Cochrane Database Systematic Review notes that numerous studies have indicated the ineffectiveness of the cocoon strategy and post-partum vaccination in protecting children (28). Some researchers have reported that the cocoon strategy provides less effective protection for the infant than vaccinating pregnant women (44\u0026ndash;46). Nevertheless, it is important to note that the vaccination coverage among pregnant women is lower compared to the general population, despite their inclusion as priority group (47,48). This phenomenon has been the subject of additional studies, which have identified potential causes (44,48\u0026ndash;56). In Poland, there is no national registry of IV (influenza vaccination) in pregnant women, and small-scale studies report that the rate oscillates around 3\u0026ndash;21% (53,57,58)- with a tendency for higher vaccination rates over time.\u003c/p\u003e\u003cp\u003eThe objective of our study was to assess the factors influencing influenza and pertussis vaccination coverage, as well as confidence, knowledge, attitudes, and concerns regarding vaccination uptake among pregnant women in Poland. In light of the prevailing epidemic conditions worldwide\u0026mdash;including the escalating number of refusals of compulsory vaccinations, the spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and a surge in pertussis infections\u0026mdash;the present work is particularly relevant.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cem\u003e2.1.Survey\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAn anonymous, self-administered, cross-sectional survey was published online between December 2020 and March 2021. It examined the factors that influence influenza and pertussis vaccination rates among pregnant women in Poland, exploring their confidence, knowledge, attitudes, and concerns about vaccination. The invitation to participate in the study, in the form of stickers (with a link to an online survey, email contact to the researcher, and Medical University of Warsaw (MUW) logo) was given to patients of the Ist Department of Obstetrics and Gynecology, MUW by the obstetric providers. Additionally, the invitation to complete the questionnaire was distributed on the private internet forum dedicated to pregnancy and childbirth.\u003c/p\u003e\n\u003cp\u003eIn order to avoid multiple responses, the survey started with the creation of a verification code consisting of the first 2 letters of the first name, the last 2 letters of the surname, and the last 2 digits of the year of birth (ex. Katarzyna Kowalska, 1995: KA-KA95).\u003c/p\u003e\n\u003cp\u003eThe entire questionnaire was written in Polish and was divided into 4 sections - general information, questions about influenza, questions about pertussis, and questions about children\u0026rsquo;s vaccinations. The survey did not contain any questions enabling identification. The responses were safely stored - only the authors of the survey had access to the data.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2.Inclusion criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors identified the following inclusion criteria: voluntary completion of the survey, age of consent, any stage of pregnancy and exclusion criteria: adolescent pregnancy, no will to participate in the study or no conscious volition. Authors applied double-checking of the completed questionnaires for correctness and to determine if all study participants met the required criteria using specific questions such as ,,What was the date of last menstrual period? What is your gestational age? What is your due date?\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3. Ethical approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki and received a positive opinion from the MUW Bioethics Committee (KB/96/2020) as a part of clinical trial: Immunological and clinical efficacy and tolerability of tetravalent inactivated influenza vaccine (IV) in patients at risk of severe and complicated influenza disease. The first page of the questionnaire contained information on the voluntary and anonymous nature of the research as well as purposefulness of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.4. Sample size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOut of 392 women, who took part in the study 376 met the inclusion criteria, including providing complete answers to all or nearly all questions in the questionnaire, and were taken into account in the statistical analysis. The results were analyzed in demographic subgroups of age, education, pregnancy period (1,2 or 3 trimester), the course of pregnancy (physiological vs. complicated) and accompanying chronic diseases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.5. Statistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using the statistical program Statistica 13 - TIBCO Software Inc. (2017). The statistically significant results were at the p-value \u0026lt; 0.05. Mann-Whitney\u0026apos;s U-test, Pearson chi-square and Spearman rank-order correlations analysis were used to develop the results. In the assessment of knowledge, the correct answers were marked in bold type (\u0026ldquo;definitely yes\u0026rdquo; and \u0026ldquo;rather yes\u0026rdquo; or \u0026ldquo;rather no\u0026rdquo; and \u0026ldquo;definitely no\u0026rdquo;) depending on a question type. Non-parametric (Mann\u0026ndash;Whitney U) tests and Spearman rank-order correlations were used for ordinal, and Pearson\u0026apos;s chi-squared test for nominal variables. Percentages were rounded to whole numbers; therefore, the sum of the percentages may differ slightly from 100%.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cem\u003e3.1. Demographic data\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe received 392 questionnaires completed by pregnant women and excluded those with any essential missing data, as well as questionnaires received after the data collection deadline. The study included 376 pregnant women, half of them were up to 30 years of age and the other half - above 30 years of age. 90% of the respondents had a higher education (a master degree). Over 66% of women declared no medical education. For 60% of women it was the first pregnancy, also 61% of them were in the third trimester. 93% of pregnancies proceeded without complications. The most frequently mentioned health problem occurring during pregnancy was gestational diabetes mellitus (n=14; 50%). 25% of women were diagnosed with a chronic disease before pregnancy. The most common chronic diseases declared by respondents were hypothyroidism/ Hashimoto disease (n=56; 60%), bronchial asthma (n=9; 10%) and endometriosis (n=5; 5%). Only 2 women were expecting twins. Demographic characteristics of the sample, divided into 2 groups - under and over 30 years of age is presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eSample characteristics, N=376.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.9589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEducation degree\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.2687\u0026sup1;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBachelor degree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaster degree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMedical education\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo response\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.1128\u0026sup1;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNurse/Midwife/Pharmacist/\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePhysiotherapist\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysician/Dentist\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGravidity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.0028\u0026sup1;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003csup\u003end\u003c/sup\u003e pregnancy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;3\u003csup\u003erd\u003c/sup\u003e pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTrimester\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.3731\u0026sup1;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003csup\u003end\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003csup\u003erd\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe course of pregnancy\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysiological/No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.0060\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplicated/Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePresence of a chronic disease before pregnancy\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.4028\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 547px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations: %- percentage, N \u0026ndash; number; T- Total; A - Women aged 18-30 years; B - Women aged 31+ years; \u0026nbsp; \u0026nbsp; \u0026sup1; U Mann-Whitney test; \u0026nbsp;\u0026sup2; chi\u0026sup2; Pearson test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e3.2. Statistical differences among age groups (18-30 years vs \u0026ge;31 years).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs mentioned above the statistics were carried out based on the division into two age groups (up to 30 years of age and above 30 years of age) as statistical differences were shown in age groups. No statistical differences were found in the level of education, trimester of pregnancy or presence of chronic diseases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant difference of gravidity between age groups: more primigravida were noticed among women under 30 years old (68%) than those above 30 years old (52%) (p=0.0028). Similarly, when it comes to complications occurring in pregnancy, older women were more likely to have complications (11%) vs. younger ones (4%) (p=0.0060) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.3. Perception of influenza and pertussis as dangerous disease.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe found a different perception of influenza and pertussis as dangerous diseases for a pregnant or postpartum woman and for a fetus or a newborn, although there was no statistically significant difference between age groups . The majority of respondents believe that influenza (78%) and pertussis (58%) pose a risk to pregnant and postpartum women. A significant majority (90%) of respondents are aware that pertussis is dangerous to newborns. However, nearly 20% of women do not know whether influenza poses a risk to newborns. There were no statistically significant differences between age groups in the declared knowledge about these diseases in age groups (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Influenza and pertussis perception among pregnant women (correct answer in bold type) N=376.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"572\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion \u0026ldquo;Do you think\u0026hellip;\u0026rdquo;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 363px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnswer (%, N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Definitely yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRather \u0026nbsp;yes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eRather no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eDefinitely no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1) this is a dangerous disease with the risk of complications for pregnant and postpartum women?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eInfluenza (N=376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e48%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(179)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30% (111)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003cp\u003e(52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003cp\u003e(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003cp\u003e(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.3192\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003ePertussis \u0026nbsp; \u0026nbsp;(N=376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(106)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30% (113)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e32% (122)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003cp\u003e(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003cp\u003e(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2) this is a dangerous disease with the risk of complications for a fetus and a newborn?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eInfluenza (N=376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(184)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25% (94)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003cp\u003e(73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003cp\u003e(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003cp\u003e(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.3777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003ePertussis (N=376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e76%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(285)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15% (55)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e8% (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003cp\u003e(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003cp\u003e(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 556px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: %- percentage, N \u0026ndash; number; R- Spearman rank correlation ;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eGenerally, the correct answer (definitely yes, yes) to the question \u0026ldquo;Do you believe that pregnancy and the postpartum period are a risk factor for a severe and complicated course of influenza?\u0026rdquo; was marked by 60% of respondents (Figure 1). There were no statistically significant differences in correct answers depending on age.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.4. Perception of influenza and pertussis vaccines as safe, effective and needed for pregnant and postpartum women.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAbout 66% of women believe the influenza vaccine is safe, 70% believe it is effective, and 59% believe it is necessary. In the case of the pertussis vaccine, just over 66% consider it safe, nearly 70% believe it is effective, and 63% believe it is necessary (Table 3.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Attitudes towards influenza and pertussis vaccination among pregnant women (correct answer in bold type) N=376.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion \u0026ldquo;Do you think that a vaccine is\u0026hellip;\u0026rdquo;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"12\" style=\"width: 368px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnswer (%, N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinitely yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRather yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eRather no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003eDefinitely no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003col\u003e\n \u003cli\u003e\u003cstrong\u003esafe for pregnant and postpartum women?\u003c/strong\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eInfluenza (N=376)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e43%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(161)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e23%\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; (86)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003cp\u003e(71)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003cp\u003e(30)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003cp\u003e(28)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.7220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePertussis (N=376)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(170)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21%\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(79)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003e21%\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003cp\u003e(33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003cp\u003e(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2) effective for pregnant and postpartum women?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eInfluenza (N=376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(161)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27% (101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003cp\u003e(82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003cp\u003e(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003cp\u003e(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.6352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePertussis (N=376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e47%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(177)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23%\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(86)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003e25%\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003cp\u003e(11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003cp\u003e(8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3) needed for pregnant and postpartum women?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eInfluenza (N=376)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(156)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17%\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(62)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003cp\u003e(82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003cp\u003e(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003cp\u003e(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.7443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePertussis (N=376)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e47%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(177)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(60)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003e27%\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003cp\u003e(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003cp\u003e(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"17\" style=\"width: 99.8294%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations: %- percentage, N \u0026ndash; number; R- Spearman rank correlation ;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eDifferent proportions were observed in the perception of vaccines in terms of safety, effectiveness, and necessity in age groups above 30 versus below 30 years of age. In response to the question \u0026quot;Do you consider the IV during pregnancy and the postpartum period to be safe?\u0026quot;, approximately 18% of patients under the age of 30 responded with a definitive \u0026quot;no\u0026quot; or \u0026quot;rather no\u0026quot;. This proportion was lower among patients aged 31 and above, with only 13% responding in the same way. Among women up to 30 years of age, 10 % considered IV ineffective, and only 6% in the group over 30 years of age. A higher percentage of younger patients believed that IV during pregnancy and the postpartum period was unnecessary (26%) than older patients (15%). Furthermore, younger patients exhibited a higher proportion of respondents who perceived the vaccine to be dangerous (18% for influenza vaccine, 14% for pertussis vaccine) compared to patients over 30 years of age (13% for influenza vaccine, 11% for pertussis vaccine). Overall, older pregnant women are more likely to consider IV as safe, effective, and necessary, however, the differences are not statistically significant. The answers to the question: \u0026ldquo;Do you think that pertussis vaccination is needed during pregnancy and childbirth?\u0026rdquo; overall, 63% of respondents answered affirmatively. Among women under 30 years old 62% answered affirmatively, while above 30 years of age 65%. Nevertheless what is interesting, only 20% of all respondents answered affirmative to the question: \u0026ldquo;Due to your health condition or chronic diseases, would you qualify as a patient at risk of severe and complicated course of the influenza?\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.5. Vaccination coverage \u0026ndash; influenza.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOver 31% of responders declared receiving the influenza vaccination in pre-pregnancy 2019/2020 season. From among them less than 17% received IV annually - regularly, every season; 44% of women had never been vaccinated, and an additional 21% declared that they had never been vaccinated against influenza and were not willing to be vaccinated in the future (Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlmost 41% of responders planned to get vaccinated in the coming 2020/2021 season (Figure 3).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3.6. Knowledge and attitudes- IV\u003c/p\u003e\n\u003cp\u003e48% of pregnant women considered their level of knowledge about influenza vaccination as sufficient, 35% as insufficient, and 17% had no opinion (Figure 4).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.7. Factors influencing vaccination refusal.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe surveyed pregnant women cited the following as the primary reasons for refusing vaccination: the perception that influenza and pertussis are rare diseases (13%/14%); concerns regarding the safety of the vaccine for both the fetus and the pregnant woman (12%/9%); the belief that the vaccine is unnecessary (16%/9%); a professional recommendation from a midwife or gynecologist not to vaccinate (3%/6%); the lack of reimbursement for the vaccine (currently, all vaccines are reimbursed) (14%/5%); the belief that the vaccine is ineffective (13%/3%); a professional recommendation from a family doctor or other than a gynecologist specialist not to vaccinate (3%/2%) (Figure 5).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.8. Source of information on influenza and pertussis\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eUnsurprisingly, the most common source of information used by patients was the Internet - 61% and 54% for influenza and pertussis respectively. Among the respondents, 27% indicated the obstetrician as the source of information about influenza, and 29% regarding pertussis. Family Doctor or other specialist as a source of information was pointed by 46% and 28% for influenza and pertussis respectively. Being a graduate in medical fields was an important source of knowledge about both diseases and vaccination against pertussis. While family and friends were important source of knowledge about vaccination against influenza \u0026ndash; 26% (Figure 6).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.9. The intention to vaccinate children.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe respondents, when asked about their intention to vaccinate their children, answered as follows: 73% intend to vaccinate their children with the obligatory vaccines as well as with unrefunded but recommended vaccinations; 23% intend to vaccinate only with obligatory vaccinations, 5% intend to abandon some obligatory vaccinations, and 2% do not intend to vaccinate their children at all (Figure 7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.10. Preferred location to get vaccinated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt\u0026apos;s worth noting that currently, pregnant women in Poland can get vaccinated by their family doctor, or, for COVID-19, at dedicated pharmacy locations. Most obstetrics outpatients clinics do not have vaccination points. For nearly 68% of pregnant women, the most convenient option would be to receive the free vaccine during a visit to the gynecologist or other specialist, 54% would like to be able to get vaccinated during a routine pregnancy visit, while 22% indicated their family doctor as their preferred vaccination location. 6% of patients could pay for the vaccination to be available immediately from the doctor providing obstetric care (Figure 8).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003cem\u003e4.1. Potential causes of vaccines refusal and acceptance.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA review of recent literature reveals a consistent theme: many articles have highlighted the insufficient vaccination coverage and lack of knowledge about vaccinations among pregnant women. Therefore, it is necessary to investigate the causes of this phenomenon and the factors contributing to low vaccination rates in this patient group. The results of our study indicate that nearly 48% of the pregnant participants self-reported their knowledge of influenza vaccination as sufficient. In contrast, more than 35% of participants indicated their knowledge was insufficient, while nearly 17% expressed no opinion on the matter. As previously stated, it is unfortunate that there is no official vaccination registry for pregnant women in Poland. Consequently, the available evidence is derived from a limited number of studies conducted on small groups. In our study, over 31% of respondents declared receiving the influenza vaccination in pre-pregnancy 2019/2020 season. From among this group, less than 17% received IV annually\u0026mdash;regularly, every season. Almost 41% of respondents still planned to get vaccinated in the \u0026nbsp;2020/2021 season. Nevertheless, the findings of our study must consider the elevated educational status of the respondents and the considerable proportion of individuals associated with healthcare/medical profession. Consequently, these vaccination rates may be overstated.\u003c/p\u003e\n\u003cp\u003eAnother Polish study, by Pisula et al., highlights that most participants rated their knowledge about influenza as sufficient to make an informed decision about vaccination (62%). However, despite this confidence, only 21% reported receiving the influenza vaccine during their current pregnancy, and only 18% expressed intention to get vaccinated. In this study, factors influencing the decision to get vaccinated include average household income and place of residence (53). A Greek study conducted in 2020-2022 (comparable to our own) reported that vaccination coverage among pregnant women against pertussis was 17%, and against influenza was 46%. Greece also lacks records regarding vaccinations for pregnant women. The study emphasizes that patients with higher education (MS and PhD) were more likely to be vaccinated. Factors influencing vaccine uptake included: information from a physician, lack of fear of vaccine side effects, recognition of influenza as a dangerous disease, and perception of the vaccine as safe. The researchers conclude that awareness and education of both physicians and patients influence vaccination coverage. In some studies, older age (supporting the results of our study), access to insurance, and at least college graduation were factors that contributed to influenza vaccination in pregnant women (44). A systematic review conducted by Ługowski et al. in 2024 (finally including 20 articles since 2015), assessing knowledge, attitudes, and practices regarding influenza vaccination among pregnant women, reported that, in many settings, general awareness of influenza was moderate to high, but detailed knowledge about transmission routes, complications during pregnancy, and vaccine safety was often poor. Safety concerns remain a major barrier to influenza vaccination during pregnancy. The most common misconception about vaccine safety, cited as a recurring reason for vaccine refusal, is the vaccine\u0026apos;s impact on fetal health (as in our own study). Vaccination reluctance is influenced by many factors, such as the mandatory nature of vaccinations, their timing, with adverse health effects, lack of knowledge about vaccine-preventable diseases, as well as distrust of corporations and public health institutions, and cultural determinants (59,60). Several studies have shown that pregnant women who had greater knowledge about influenza and the vaccine were more likely to receive the vaccine. Individuals residing in rural areas or those with a lower socioeconomic status frequently encounter obstacles, including limited access to healthcare facilities, lack of insurance, and limited opportunities to participate in vaccination campaigns. (61) Nevertheless, our study revealed that the most common reasons for refusing vaccination included the belief that the vaccine is unsafe for pregnant women and for the baby, a lack of confidence in the vaccine\u0026apos;s effectiveness, and the belief that the infectious disease in question is rare, but also lack of reimbursement or problems with the availability of vaccines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor comparison, another American study conducted in 2017 found that the vaccination coverage rate among 2,254 pregnant women in the United States was 36%. Fifty-eight percent of patients received a recommendation for influenza vaccination and were given the opportunity to be vaccinated on the spot. Of those, over 52% of pregnant women were vaccinated. Only 16% of those who received a recommendation to vaccinate themselves, without the option of being vaccinated on the spot, got vaccinated. Among them, approximately 26% were vaccinated. More than 25% of the women did not receive any of the aforementioned support, and only 6% of them were vaccinated. Overall, two-thirds of pregnant women were not vaccinated. Therefore, healthcare providers should be encouraged to educate patients and recommend immunizations to protect pregnant women and their children. Additionally, the study found that immunization coverage was the lowest among the least educated \u0026mdash; some college (28%), high school or less (35%). Over 45% of the best educated women (above college degree) have been vaccinated. The type of insurance also mattered. The highest vaccination coverage was, as expected, among respondents with private and military insurance. What is also important, women with comorbidities were more likely to vaccinate (39% vs. 33%). Most pregnant women were vaccinated by the obstetrician doctor or midwife (50%), by the family doctor, or by other specialist (29%). It is worth emphasizing that a large percentage of pregnant women (10%) were vaccinated in a pharmacy, supermarket-pharmacy, drug store, supermarket, grocery store, superstore, which is not practiced in Poland in the light of the current legal regulations. The most common motivations for vaccination were protecting a baby from influenza (40%), self-protection (24%), and following a doctor\u0026apos;s recommendation (15%). The most common reasons for refusing vaccination were inefficiency (22%), fear of side effects (21%), and concern about safety for the fetus (15%) [1].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.2. Factors improving vaccination rate in pregnant women.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive analysis was conducted to identify factors that could contribute to enhancing vaccination rates. The findings of our study highlighted the significance of vaccine accessibility, demonstrating that offering free vaccines at gynecological clinics and family doctor\u0026apos;s offices could potentially enhance the existing statistics. A survey of patients revealed that more than half of them believe that vaccination during a routine obstetrician appointment would be the most convenient option. An additional 20% of respondents indicated that their primary care physician would be their preferred vaccination location. Currently, pregnant women in Poland can get vaccinated by their family doctor or, for COVID-19, at designated pharmacy locations. However, the majority of obstetrics outpatient clinics do not function as vaccination centers.\u003c/p\u003e\n\u003cp\u003eIn the present study, it was observed that a higher percentage of patients under the age of 30 expressed concerns regarding the influenza vaccination. A greater proportion of patients in this age group considered the IV to be unsafe, unnecessary, or ineffective. These differences are most likely due to the fact that the older the woman, the greater her chances of having more offspring, so patients over the age of 30 may have already been exposed more than once to information about vaccinations during pregnancy, their safety, and benefits for the child. Therefore, raising awareness about vaccinations for pregnant women and their newborns is crucial, as supported by numerous publications (13\u0026ndash;16,23,25,28\u0026ndash;31), but with particular focus on\u0026nbsp;patients who are pregnant for the first time and/or are younger. However, all patients, regardless of age or parity, may benefit from education about vaccination.\u003c/p\u003e\n\u003cp\u003eIn order to adequately educate patients about the advantages of vaccination during pregnancy, it is essential to provide regular training to medical staff. This training should encompass both substantive knowledge about vaccinations and effective methods of discussing vaccinations with patients. According to a 2012 study by Shevell et al., recommendation of influenza vaccines in conjunction with the efficient communication between healthcare providers and pregnant patients lead to a substantial rise in IVC rates, even among patients who initially expressed reluctance to receive the influenza vaccination (59).\u003c/p\u003e\n\u003cp\u003eAs in many aspects of contemporary life, the internet constitutes a significant source of information, as confirmed by our study; consequently, public health vaccination campaigns should strategically utilize social media platforms that disseminate accurate and evidence-based content.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.3. Healthcare professionals as a source of information.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn our own study, among the respondents, significant proportion of respondents-over one-quarter\u0026nbsp;indicated the obstetrician as the source of information about influenza, and pertussis. Family Doctor or a doctor of another specialty as a source of information was pointed by 46% and 28% for influenza and pertussis respectively. Similarly Maltezou et al. reports that in Greece physicians supervising the pregnancy recommended vaccination against pertussis to 27% of patients, and against influenza to 69%\u0026nbsp;(60). What is important, a meta-analysis conducted by Regan et al. found that pregnant women are 12 times more likely to receive IV if recommended by their healthcare provider\u0026nbsp;(61). Other study reports that patients who received a vaccination recommendation from Health Care Provider (HCP) were almost 19 times more likely to be vaccinated (OR: 18,86, p \u0026lt; 0,001)\u0026nbsp;(60). Gorman et al. reported that those women who mentioned specific conversation with a doctor about influenza infection and the benefits of vaccination were much more likely to accept the vaccine\u0026nbsp;(50). Other sources report that HCP play a crucial role in encouraging vaccination among pregnant women as it is estimated that their recommendation increases the chances of being vaccinated 3 times (three time the odds)\u0026nbsp;(51,52). Systematic review by Eppes et al. on interventions to increase the uptake of seasonal influenza vaccination among pregnant woman, included 11 studies, from 2007-2014 from the USA, Canada and Australia. According to researchers conclusions, there are no universal methods of increasing vaccination coverage among pregnant women. One moderate quality randomized study argued that brochures increased vaccination coverage, and the dissemination of information brochures along with verbal messages about the benefits of influenza vaccination should be led by clinicians. The authors emphasized that further high-quality randomized trials are needed to improve pregnancy vaccination programs\u0026nbsp;(49). Ługowski et al. emphasize the crucial impact of healthcare professional recommendations: In almost all studies, healthcare professional recommendations were a key factor in vaccine acceptance\u0026nbsp;(62). It is disappointing that in our own study 3% of patients reported that their obstetrician had actually advised against the influenza vaccination.\u003c/p\u003e\n\u003cp\u003eIt is worth adding that there are also studies examining the knowledge among maternal care providers (MCPs). A survey conducted among MCPs - obstetricians and midwives in Catalonia, Spain, concerned questions about the current vaccination recommendations for both influenza and pertussis coverage. Interestingly, among the surveyed medical professionals, 31% were vaccinated annually (midwives - 27% less often than gynecologists - 45%). Of all respondents, 54% knew that influenza vaccination is recommended also in the first trimester of pregnancy, but only 43% prescribed it. But 99% of MCPs were aware of the pertussis vaccination recommendations and 97% recommended it. The most popular concern about vaccination of pregnant women were side effects, declared by 26% of MCPs (63).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.4. Limitations.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe main limitations of our study include participation and reporting bias. It\u0026apos;s possible that respondents, patients in the country\u0026apos;s capital and those with access to online forums, are more likely to be mothers with positive attitudes toward vaccinations, which also contributes to the inflated vaccination statistics. Furthermore, a significant portion of respondents are HCP (33%), and the majority (90%) have higher education (a master\u0026apos;s degree). Moreover the data collected in the study were self-reported and not validated through an analysis of the patients\u0026apos; medical records.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eAlthough the influenza and pertussis vaccination coverage rate among pregnant women has been improving over the years, it remains unsatisfactory. Some modifiable factors have been identified as potentially enhancing the immunization process for pregnant women. A key component of this effort involves educating pregnant patients and the general public regarding the benefits of vaccination for both the mother and child, the effectiveness of vaccination, and its safety. Additionally, there should be an emphasis on educating the public about vaccine-preventable diseases, as a significant proportion of the population remains unaware of the severity of influenza and pertussis and the potential complications associated with these infections. Since only 20% of pregnant women who took part in our study believe that pregnancy itself increases the risk of complications from influenza, it is important to raise awareness of the significance of this risk factor. Family physicians and obstetricians have a crucial role in promoting vaccinations among pregnant women. Our results indicate not only barriers at the level of the individual patient, but also structural gaps in healthcare systems. Professional training for healthcare workers to effectively communicate information about vaccinating pregnant women should be considered.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAbbreviations:\u0026nbsp;The following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"533\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eAAFP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eAmerican Academy of Family Physicians\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eACNM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eAmerican College of Nurse- Midwives\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eACOG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eAmerican College of Obstetricians and Gynecologists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eThe Centers for Disease Control and Prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eCOVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eCoronavirus Disease 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003edTaP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eDiphtheria, Tetanus, Pertussis vaccine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eHCP\u003c/p\u003e\n \u003cp\u003eIIV4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eHeathcare Proffesional/Provider\u003c/p\u003e\n \u003cp\u003eInactivated Influenza Vaccine Quadrivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eInfluenza Vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eMCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eMaternal Care Provider\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eMDPI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eMultidisciplinary Digital Publishing Institute\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eMUW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eMedical University of Warsaw\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eRSV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eRespiratory Syncytial Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eSARS-CoV-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eSevere Acute Respiratory Syndrome Coronavirus 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 448px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by Bioethics Committee of the Medical University of Warsaw, Poland (KB/96/2020, 15.06.2020) for studies involving humans.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll authors reviewed and approved the final version of the manuscript and agreed to its publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: The data presented in this study are available on request in the form of an Excel spreadsheet or a flat file from the corresponding author for any academic use upon citation of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e:\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Not applicable. This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: Conceptualization and methodology, MZS, AJ, IS, and ANO; validation, MZS, AJ, HLW; formal analysis AJ, MZS, HLW; investigation, MZS; data curation MZS, IS; writing\u0026mdash;original draft preparation, MZS, HLW, AJ.; writing\u0026mdash;review and editing, HLW, ANO, IS.; visualization MZS, HLW, AJ.; project administration, AJ, ANO, MZS. All authors have read and agreed to the published version of the manuscript. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe would like to express our gratitude to Aleksandra Saletra-Bielińska, MD, Bartosz Godek, MD and Izabela Dembińska for their assistance with study organization\u003cstrong\u003e,\u003c/strong\u003e as well as to pregnant women who voluntarily completed the questionnaire.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u0026Aacute;lvarez F, Froes F, Rojas AG, Moreno-Perez D, Martin\u0026oacute;n-Torres F. The challenges of influenza for public health. Future Microbiol. listopada 2019;14:1429\u0026ndash;36. \u003c/li\u003e\n\u003cli\u003ePregnant Women and Flu Vaccination, Internet Panel Survey, United States, November 2017 | FluVaxView | Seasonal Influenza (Flu) | CDC [Internet]. 2023 [cytowane 26 lutego 2024]. 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Vaccine. 12 czerwca 2013;31(27):2874\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eGorman JR, Brewer NT, Wang JB, Chambers CD. Theory-based predictors of influenza vaccination among pregnant women. Vaccine. 17 grudnia 2012;31(1):213\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAhluwalia IB, Jamieson DJ, Rasmussen SA, D\u0026rsquo;Angelo D, Goodman D, Kim H. Correlates of seasonal influenza vaccine coverage among pregnant women in Georgia and Rhode Island. Obstet Gynecol. października 2010;116(4):949\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eFisher BM, Scott J, Hart J, Winn VD, Gibbs RS, Lynch AM. Behaviors and perceptions regarding seasonal and H1N1 influenza vaccination during pregnancy. Am J Obstet Gynecol. czerwca 2011;204(6 Suppl 1):S107-111. \u003c/li\u003e\n\u003cli\u003ePisula A, Sienicka A, Pawlik KK, Dobrowolska-Redo A, Kacperczyk-Bartnik J, Romejko-Wolniewicz E. Pregnant Women\u0026rsquo;s Knowledge of and Attitudes towards Influenza Vaccination during the COVID-19 Pandemic in Poland. Int J Environ Res Public Health. stycznia 2022;19(8):4504. \u003c/li\u003e\n\u003cli\u003eDonaldson B, Jain P, Holder BS, Lindsey B, Regan L, Kampmann B. What determines uptake of pertussis vaccine in pregnancy? A cross sectional survey in an ethnically diverse population of pregnant women in London. Vaccine. 26 października 2015;33(43):5822\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eBarrett T, McEntee E, Drew R, O\u0026rsquo;Reilly F, O\u0026rsquo;Carroll A, O\u0026rsquo;Shea A, et al. Influenza vaccination in pregnancy: vaccine uptake, maternal and healthcare providers\u0026rsquo; knowledge and attitudes. A quantitative study. BJGP Open. 8 sierpnia 2018;2(3):bjgpopen18X101599. \u003c/li\u003e\n\u003cli\u003eHill L, Burrell B, Walls T. Factors influencing women\u0026rsquo;s decisions about having the pertussis-containing vaccine during pregnancy. J Prim Health Care. marca 2018;10(1):62\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eŁukowska P, Biesiada D, Molas-Biesiada A, Dubiel P, Leonczuk D, Gańczak M. Influenza vaccination coverage among Polish pregnant women. Eur J Public Health. 1 września 2020;30(Supplement_5):ckaa166.1454. \u003c/li\u003e\n\u003cli\u003eJagielska AM, Jasik M, Nitsch-Osuch A. Determinants and coverage of seasonal influenza vaccination among women of childbearing age in Poland. Ginekol Pol. 2021;92(1):35\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eShavell VI, Moniz MH, Gonik B, Beigi RH. Influenza immunization in pregnancy: overcoming patient and health care provider barriers. Am J Obstet Gynecol. września 2012;207(3 Suppl):S67-74. \u003c/li\u003e\n\u003cli\u003eMaltezou PG, Kourkouni E, Kousi D, Hadjichristodoulou C, Dadouli A, Briana D, et al. Knowledge, Attitudes, and Practices Regarding Influenza and Pertussis Immunization During Pregnancy in Greece. Vaccines. kwietnia 2025;13(4):347. \u003c/li\u003e\n\u003cli\u003eRegan AK, Fiddian-Green A. Protecting pregnant people \u0026amp; infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion. Hum Vaccines Immunother. 18(7):2156229. \u003c/li\u003e\n\u003cli\u003eŁugowski F, Babińska J, Kwiatkowski J, Akpang N, Urban A, Kacperczyk-Bartnik J, et al. Knowledge, Attitudes, and Practices Towards the Influenza Vaccine Among Pregnant Women: A Systematic Review of Cross-Sectional Studies. Healthcare. 29 maja 2025;13(11):1290. \u003c/li\u003e\n\u003cli\u003eVilca LM, Mart\u0026iacute;nez C, Burballa M, Campins M. Maternal Care Providers\u0026rsquo; Barriers Regarding Influenza and Pertussis Vaccination During Pregnancy in Catalonia, Spain. Matern Child Health J. lipca 2018;22(7):1016\u0026ndash;24. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"influenza vaccine, IIV4, pertussis, pregnancy, vaccine, maternal immunization, transplacental antibody transfer","lastPublishedDoi":"10.21203/rs.3.rs-7905123/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7905123/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eVaccination of pregnant women is an essential part of obstetric care, offering protection for both the mother and the neonate. Pregnant women and infants are at risk for a severe course of influenza and pertussis. This study aimed to investigate factors influencing influenza and pertussis vaccination coverage among pregnant women in Poland during the early COVID-19 pandemic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An anonymous, self-administered, cross-sectional online survey was conducted over 4 months in 2020/ 2021 among adult pregnant patients at any gestational stage. The analysis considered age, education, parity, and comorbidities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 376 patients met the inclusion criteria. Most had higher education, a non-medical background, and were during uncomplicated first pregnancy. The majority believed that influenza (78%) and pertussis (58%) pose risk to pregnant and postpartum women, while 91% recognized pertussis as dangerous to newborns. However, nearly 20% were uncertain whether influenza poses neonatal risks, and fewer than half felt sufficiently informed about vaccination during pregnancy. Over 31% declared receiving the influenza vaccination in pre-pregnancy 2019/2020 season, but only 17% were vaccinated annually. 44% had never been vaccinated, and an additional 21% were unwilling to be vaccinated in the future. The most common reasons for vaccine refusal were doubts about effectiveness, fear of side effects for the mother and/or baby, and the perception of it as a rare disease. Older gravidas tended to view influenza vaccination as safe, effective, and necessary, though differences were not statistically significant. Obstetricians were indicated as sources of vaccine information by 27% of respondents for influenza and 29% for pertussis, while family doctors or other specialists were pointed by 46% and 28%, respectively. Nearly 68% indicated that receiving a free vaccine during routine gynecological or specialist visit would be the most convenient option.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Vaccination coverage among pregnant women in Poland against influenza and pertussis remains suboptimal. Key factors that can enhance the immunization rate among pregnant women have been identified. Educating patients and the public about vaccine benefits, effectiveness and safety is essential. Additionally, medical personnel should be educated about effective methods to inform patients about vaccinations during pregnancy, including their safety and benefits.\u003c/p\u003e","manuscriptTitle":"Factors influencing influenza and pertussis vaccination coverage among pregnant women in Poland - a cross- sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 07:02:22","doi":"10.21203/rs.3.rs-7905123/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-31T17:05:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T14:20:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-02T09:39:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193982782634636287932946692051606948632","date":"2025-12-02T06:44:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T12:05:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61101164717744512225105311513226163419","date":"2025-11-23T09:46:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116165181983688599814725025268971034372","date":"2025-11-22T18:53:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253417697074732409990524213028159674866","date":"2025-11-22T17:59:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-20T17:45:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-25T15:29:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-21T23:37:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-21T23:37:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-10-20T11:15:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3323e37d-c66f-4f13-8c1a-811c40ec7149","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-31T17:09:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 07:02:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7905123","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7905123","identity":"rs-7905123","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}