Systematic review and meta-analysis of interventions to increase the uptake of vaccines recommended during pregnancy

Abstract

Although immunization during pregnancy can protect mothers and their infants from vaccine-preventable morbidity and mortality, vaccination rates are often poor. We systematically reviewed the literature from inception to July 4, 2023, for randomized and non-randomized quasi-experimental studies estimating the effects of interventions to increase vaccination during pregnancy. Of 9331 studies screened, 36 met inclusion criteria, including 18 demand-side interventions, 11 supply-side interventions, and seven multi-level (demand and supply-side) interventions. Demand-side interventions commonly addressed patient education, showing modest improvement (pooled RR 1.18; 95% CI: 1.04, 1.33; I² = 63.1%, low certainty). Supply-side interventions commonly implemented Assessment-Feedback-Incentive-eXchange interventions with little improvement (pooled RR 1.13; 95% CI: 0.96, 1.33; I² = 94.0%, low certainty). Multi-level interventions were modestly effective in increasing vaccination (pooled RR 1.62; 95% CI: 1.09, 2.42; I² = 97%, very low certainty). Interventions identified in the literature mostly resulted in low to moderate increases in vaccination with likely high heterogeneity and low to very low certainty in the findings.

Fig. 1. Selection of studies.

PRISMA diagram for selection of studies evaluating the effect of interventions to increase the uptake of vaccines recommended during pregnancy.

Fig. 2. Effect of patient-level (demand-side) interventions.

Individual and pooled effect estimates for interventions that target patient-level demand-side interventions to increase the uptake of recommended vaccines during pregnancy. Pooled effect estimates were estimated by random effects meta-analysis overall and by intervention. CI indicates 95% confidence intervals, and RR indicates relative risk estimates.

Fig. 3. Effect of supply-side interventions targeting health systems and/or healthcare providers.

Individual and pooled effect estimates for interventions that target health systems and/or healthcare providers to increase the uptake of recommended vaccines during pregnancy. Pooled effect estimates were estimated by random effects meta-analysis overall and by intervention. AFIX indicates Assessment, Feedback, Incentive, eXchange programs, CI indicates 95% confidence intervals, and RR indicates relative risk estimates.

Fig. 4. Effect of demand and supply-side interventions.

Individual and pooled effect estimates for demand and supply-side interventions to increase the uptake of recommended vaccines during pregnancy. Pooled effect estimates were estimated by random effects meta-analysis. CI indicates 95% confidence intervals, and RR indicates relative risk estimates.

Fig. 5. Community preventive services task force framework for increasing vaccination.

The Community Preventive Services Task Force framework for increasing vaccination rates recommends using a combination of community-based and healthcare system-based interventions to increase demand and supply of vaccines (SOURCE: https://www.thecommunityguide.org/topics/vaccination.html).