Research Article: Influenza vaccination of pregnant women in Paris, France: Knowledge, attitudes and practices among midwives

Date Published: April 25, 2019

Publisher: Public Library of Science

Author(s): Paul Loubet, Catherine Nguyen, Espérie Burnet, Odile Launay, Italo Francesco Angelillo.


In France, midwives have been authorized to prescribe vaccines since 2016. Yet vaccination coverage among pregnant women remains low. Understanding the knowledge, attitudes and practices of midwives regarding influenza vaccination could help improve coverage.

A cross-sectional survey was conducted in 2017 among midwives practicing in the public and private sectors in Paris using an online questionnaire. Multivariate logistic regression analysis of the data was conducted.

The response rate was 31% (n = 208/669). Overall, knowledge of influenza vaccine recommendations and of vaccine safety and effectiveness was high except regarding new-born immunity and influenza vaccine characteristics. Only 10% of midwives systematically prescribed the vaccine. Reported influenza vaccine uptake among midwives was 39%.

Efforts to improve the knowledge of midwives regarding the safety and effectiveness of vaccinating pregnant women in order to prevent influenza infection in newborns are necessary. Increasing vaccine uptake in both midwives and pregnant women will require adjusting education strategies.

Partial Text

Pregnant women and infants younger than 6 months are at high risk of developing severe influenza, which can cause cardiopulmonary complications and death [1,2]. Immunization against influenza during pregnancy has proven its effectiveness not only in mothers but in newborns as well, thanks to the passive transplacental transfer of antibodies [3–7]. However, although the WHO and French national guidelines recommend seasonal influenza vaccination in pregnant women at any trimester [8], coverage remains low [9,10]. Indeed, only 7,4% (95% Confidence Interval (CI): 6,9–7,9) of pregnant women were vaccinated in 2016, and only 24,9% (24,2–25,7) of them reported having been offered the vaccine by a health care provider [11].

The results of the cross-sectional survey conducted among midwives practicing in Paris, France, showed that most midwives had a good understanding of influenza and related risks during pregnancy and of vaccine safety and effectiveness in pregnant women. Knowledge was more limited regarding the composition of the influenza vaccine itself and its ability to protect infants. Results also showed low rates of influenza vaccine proposition and prescription to pregnant women and low vaccine coverage among midwives.

The inclusion of midwives among health-care professionals authorized to prescribe vaccines was thought to lead to an increase in the influenza vaccination rate in pregnant women in France. Yet this study shows that, although the midwives surveyed were aware of vaccination recommendations and of their ability to prescribe, they did not seem to have made the leap of systematically recommending and prescribing the vaccine to their patients. Midwife training and education should emphasize the effectiveness of the influenza vaccine in infants and the safety of the vaccine’s components. Systematic vaccination protocols and information campaigns explaining the benefits of vaccinating health-care workers who care for pregnant women should be generalized.