Receipt of and Barriers to Guideline Appropriate Influenza Vaccinations among Pregnant Women in the US

Experts recommend that all pregnant women get a flu shot, however the nasal spray flu vaccine is not approved for pregnant women. Getting the flu shot while a woman is pregnant has also been shown to prevent influenza and flu-related hospitalizations in their infants up to 6 months of age. We sought to determine the predictor of receipt of flu shot and spray among a nationally representative, population-based sample of pregnant women. We examined data on 4,310 women who were currently or recently pregnant (at the time of the survey) from the 2005-2010 National Health Interview Survey. Receipt of flu shot or spray was examined during a 12 month window. Although pregnant women's receipt of flu spray was generally low before the H1N1 outbreak (0.3%), it jumped to 2.7% during the outbreak. Multivariate logistic regression revealed that black (non-Hispanic) and Hispanic women are significantly less likely to receive a flu shot during pregnancy than white (non-Hispanic) women (OR 0.73, 95% CI 0.58-0.92; OR 0.81, 95% CI 0.66-0.99, respectively). Women with intermittent or no insurance were significantly less likely to receive a flu shot during their pregnancy. There were significant socioeconomic disparities in the receipt of the flu shot during pregnancy and the effect of public insurance varied by income. Despite recommendations, influenza shot levels among pregnant women are generally low and pregnant women are receiving the flu spray. Given the clear disparities, targeted public health efforts directed at priority populations should be made to improve influenza vaccination among pregnant women.