Cox Elizabeth, Sanchez Magali, Taylor Katherine, Baxter Carly, Crary Isabelle, Every Emma, Futa Brianne, Adams Waldorf Kristina M
Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, USA.
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA.
Vaccines (Basel). 2023 Jul 17;11(7):1248. doi: 10.3390/vaccines11071248.
Pregnant women are a highly vaccine-resistant population and face unique circumstances that complicate vaccine decision-making. Pregnant women are also at increased risk of adverse maternal and neonatal outcomes to many vaccine-preventable diseases. Several models have been proposed to describe factors informing vaccine hesitancy and acceptance. However, none of these existing models are applicable to the complex decision-making involved with vaccine acceptance during pregnancy. We propose a model for vaccine decision-making in pregnancy that incorporates the following key factors: (1) perceived information sufficiency regarding vaccination risks during pregnancy, (2) harm avoidance to protect the fetus, (3) relationship with a healthcare provider, (4) perceived benefits of vaccination, and (5) perceived disease susceptibility and severity during pregnancy. In addition to these factors, the availability of research on vaccine safety during pregnancy, social determinants of health, structural barriers to vaccine access, prior vaccine acceptance, and trust in the healthcare system play roles in decision-making. As a final step, the pregnant individual must balance the risks and benefits of vaccination for themselves and their fetus, which adds greater complexity to the decision. Our model represents a first step in synthesizing factors informing vaccine decision-making by pregnant women, who represent a highly vaccine-resistant population and who are also at high risk for adverse outcomes for many infectious diseases.
孕妇是对疫苗高度抗拒的人群，面临着使疫苗决策复杂化的独特情况。孕妇感染许多可通过疫苗预防的疾病时，出现不良孕产妇和新生儿结局的风险也会增加。已经提出了几种模型来描述影响疫苗犹豫和接受度的因素。然而，这些现有模型都不适用于孕期疫苗接种所涉及的复杂决策。我们提出了一种孕期疫苗决策模型，该模型纳入了以下关键因素：（1）对孕期疫苗接种风险的感知信息充分性，（2）为保护胎儿而避免伤害，（3）与医疗保健提供者的关系，（4）对疫苗接种益处的感知，以及（5）孕期对疾病易感性和严重程度的感知。除了这些因素外，孕期疫苗安全性研究的可获得性、健康的社会决定因素、疫苗接种的结构性障碍、既往疫苗接种情况以及对医疗保健系统的信任在决策中也发挥作用。最后一步，孕妇必须权衡疫苗接种对自身和胎儿的风险与益处，这使得决策更加复杂。我们的模型是综合影响孕妇疫苗决策因素的第一步，孕妇是对疫苗高度抗拒的人群，并且在许多传染病中出现不良结局的风险也很高。
