Four hundred 16 pregnant women participated in this study. Their mean of age was 27.06 ± 5.27 y (median 26, range 16 to 42). Of 397 pregnant women whose gestational age was determined, 178 (44.83%) were in the third trimester, 180 (45.34%) in the 2nd and 39 (9.82%) in the 1st trimester of their pregnancy. Seventeen (4.08%) were illiterate, 33 (7.93%) had graduated from university and 366 (87.98%) had attended primary school or high school. Two hundred nine women (69.47%) resided in urban areas and 118 (28.36%) in rural areas. Only 22 (5.28%) were employed outside the home ().
Table 1. Univariate analysis of factors associated with influenza vaccination in pregnant women referred to obstetrics and maternity hospitals affiliated with Shiraz University of Medical Sciences, 2010−2011*
Eighty six (20.67%) of pregnant women had history of at least one chronic disease, including 7 (28%) of vaccinated and 79 (20.62%) of non-vaccinated groups. Thirty two (7.69%) of pregnant women had Diabetes mellitus and 28 (6.73%) had neurological diseases.
Twenty one (5%) were hypertensive, excluding 18(4.32%) that had other cardiovascular diseases. Twelve (2.88%), 7 (1.68%), 3 (0.72%) and 2 (0.48%) had hypothyroidism, Asthma, hyperthyroidism and HIV/AIDS respectively. Five (1.2%) were on chronic corticosteroid treatment.
Three hundreds 80 three (92.06%) of pregnant women had not been vaccinated against flu, including pandemic H1N1 influenza and/or seasonal influenza, since 2 y before conducting this study. And 25 (6%) had history of flu vaccination. In 8 (1.92%), status of influenza vaccination could not be defined. In 19 (4.56%) of the 416 pregnant women initially included, both gestational age and history of influenza vaccination were unknown. Two hundred two (48.55%) of the women were able to describe at least two influenza symptoms. Thirty seven (8.89%) reported at least one complication from influenza during pregnancy, and 146 (35.09%) identified at least one difference between influenza and the common cold. Their total mean score for knowledge on influenza-related items and methods of prevention was 2.05 ± 1.63 (out of 10). Mean score for preventive measures against influenza was 1.11 ± 1.01 (out of 7). Less than 30% (1.44–28.12%) of the women were able to correctly explain how to prevent influenza (). Of 383 (92.06%) pregnant women who had refused influenza vaccination, 116 (30.28%) declared that the main reason was lack of information and 44 (11.48%) stated that they did not need vaccination. Thirty seven (9.66%) reported that they did not get influenza and 30 (7.83%) stated that influenza vaccination did not matter to them. Concerns about the side effects of the influenza vaccine for pregnant women, the fetus or the newborn were reported by 2 women (0.52%). One woman (0.26%) expressed uncertainties about the efficacy of flu vaccination. More than one reason for declining vaccination was mentioned by 147 (38.38%) women, but none of them said that lack of access was the cause of non-vaccination ().
Table 2. Knowledge of influenza and methods to prevent it, reported by pregnant women seen in obstetrics and maternity hospitals affiliated with Shiraz University of Medical Sciences, 2010−2011
Table 3. Reasons for declining or accepting the influenza vaccination reported by pregnant women referred to obstetrics and maternity hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, 2010–2011
Of the 25 (6%) pregnant women who had been vaccinated against influenza, 15 (60%) reported being vaccinated on the advice of someone other than a physician. None of the women reported being vaccinated as a result of advice from a physician. Five (20%) believed that influenza vaccination was necessary for everyone. Three (12%) reported getting influenza several times each year, and 1 (4%) believed that vaccination was an effective method of prevention ().
Non Parametric tests showed that among demographic, obstetrics and influenza related characteristics and also history of chronic diseases, influenza vaccination in pregnant women only correlated significantly with the number of fetuses in the current pregnancy (single vs. multiple gestation). (p = 0.01, ). However, forward logistic regression analysis including factors with a P value up to 0.30 (number of fetuses in the current pregnancy, BMI before pregnancy and BMI in the 1st trimester of pregnancy, current gravidity, years since the previous pregnancy, history of hyperthyroidism, knowledge of the difference between influenza and the common cold, and using a mask or tissue during coughing or sneezing, and ) showed that none of these factors was an independent predictor of influenza vaccination in pregnant women.