Rates and determinants of seasonal influenza vaccination in pregnancy and association with neonatal outcomes

Background: There is growing evidence that seasonal influenza vaccination in pregnancy has benefits for mother and baby. We de - termined influenza vaccination rates among pregnant women during the 2 nonpandemic influenza seasons following the 2009 H1N1 pandemic, explored maternal factors as predictors of influenza vaccination status and evaluated the association between maternal influenza vaccination and neonatal outcomes. Methods:We used a population-based peri natal database in the province of Nova Scotia, Canada, to examine maternal vaccination rates, determinants of vaccination status and neonatal outcomes. Our cohort included wo men who gave birth between Nov. 1, 2010, and Mar. 31, 2012. We compared neonatal outcomes be - tween vaccinated and unvaccinated women using logistic regression analysis. Results: Overall, 1958 (16.0%) of 12 223 wo men in our cohort received the influenza vaccine during their pregnancy. Marital status, parity, location of residence (rural v. urban), smoking during pregnancy and maternal influenza risk status were determinants of maternal vaccine receipt. The odds of preterm birth was lower among infants of vaccinated women than among those of nonvaccinated women (adjusted odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.94). The rate of lowbirth- weight infants was also lower among vaccinated women (adjusted OR 0.73, 95% CI 0.56-0.95). Interpretation: Despite current guidelines advising all pregnant women to receive the seasonal influenza vaccine, influenza vaccination rates among pregnant women in our cohort were low in the aftermath of the 2009 H1N1 pandemic. This study and others have shown an association between maternal influenza vaccination and improved neonatal outcomes, which supports stronger initiatives to promote vaccination during pregnancy.