Cent Eur J Public Health. X:X
Physician’s recommendation as a key determinant of influenza vaccination uptake during pregnancy: a prospective observational study
- 1 Department of Obstetrics and Gynaecology, Istanbul Medipol University, Bahcelievler Medipol University Hospital, Istanbul, Türkiye
- 2 Department of Family Medicine, Health Sciences University Şişli 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: April 7, 2026; Accepted: September 11, 2026; Prepublished online: September 11, 2026
