Cent Eur J Public Health 2026, 34(3):160-166 | DOI: 10.21101/cejph.a9024

Physician's recommendation as a key determinant of influenza vaccination uptake during pregnancy: a prospective observational study

Asiye Uzun1, Saliha Büºra Aksu2, Güneº Topçu1, Seda Özmen Sever3, Güzin Zeren Öztürk2
1 Department of Obstetrics and Gynaecology, Istanbul Medipol University, Bahcelievler Medipol University Hospital, Istanbul, Türkiye
2 Department of Family Medicine, Health Sciences University ªiºli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
3 Department of Family Medicine, Taksim Training and Research Hospital, Istanbul, Türkiye

Objectives: Influenza infection is associated with substantial maternal morbidity and mortality during pregnancy; however, influenza vaccination uptake remains low. Physician's recommendations have been identified as one of the key determinants of vaccination rates. This study was conducted to evaluate the effect of physician's recommendation on influenza vaccination rates among pregnant women and to examine factors associated with vaccination behaviour.

Methods: This prospective observational study included 356 pregnant women aged 18-50 years with a gestational age of ≥12 weeks who were receiving prenatal care at a tertiary-care hospital in Istanbul, Türkiye. Participants completed a structured questionnaire assessing their knowledge and attitudes toward the influenza vaccine. Standard information about the influenza vaccine was provided as part of routine prenatal care. Vaccination status was confirmed via telephone follow-up at the end of the influenza season.

Results: The overall influenza vaccination rate during pregnancy was 7.6%. A prior 's recommendation was strongly associated with higher vaccination uptake (15.2% vs. 1.5%, RR = 10.0, 95% CI: 3.07-32.69, p < 0.001). In multivariable analysis, physician's recommendation remained an independent predictor of vaccination (aOR = 10.39, 95% CI: 3.00-35.97, p < 0.001). The most common reasons for vaccine refusal were a lack of trust (42.2%) and perceived lack of necessity (36.2%).

Conclusion: Influenza vaccination uptake during pregnancy remains low in this Turkish cohort. Physician's recommendation is a strong independent determinant of vaccination behaviour. Strengthening physician-led counselling and improving patient awareness may play a critical role in increasing vaccination rates and reducing preventable maternal and neonatal complications.

Keywords: pregnancy, influenza vaccination, vaccination during pregnancy, vaccine hesitancy, physician's recommendation, maternal immunization

Received: April 7, 2026; Revised: June 17, 2026; Accepted: June 17, 2026; Prepublished online: September 11, 2026; Published: September 30, 2026  Show citation

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Uzun A, Aksu SB, Topçu G, Özmen Sever S, Zeren Öztürk G. Physician's recommendation as a key determinant of influenza vaccination uptake during pregnancy: a prospective observational study. Cent Eur J Public Health. 2026;34(3):160-166. doi: 10.21101/cejph.a9024.
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