Vaccination in Pregnancy: A Systematic Review of Maternal and Neonatal Outcomes

Abstract

Introduction. Vaccination during pregnancy is one of the most effective preventive interventions in maternal healthcare. 
Immunization protects pregnant individuals against vaccinepreventable infections while providing passive immunity to 
newborns. Current international guidelines recommend routine maternal vaccination against influenza, tetanus-diphtheria
pertussis (Tdap), COVID-19, and respiratory syncytial virus (RSV) in appropriate settings. Nevertheless, vaccine uptake remains suboptimal worldwide because of concerns regarding safety, limited awareness, and vaccine hesitancy. To systematically review the evidence regarding the effectiveness, safety, and clinical outcomes of vaccination during pregnancy.
Methods. Electronic databases including PubMed/MEDLINE, Scopus, WoS, Embase, and the Cochrane Library were searched for studies published from January 2015 to March 2026. Randomized controlled trials, cohort studies, systematic reviews, and meta analyses evaluating maternal vaccination during pregnancy were eligible. Outcomes included maternal infection, obstetric complications, neonatal infection, hospitalization, mortality, antibody transfer, and adverse events.
Results. Evidence consistently demonstrated that maternal vaccination significantly reduces maternal morbidity and 
severe infection while providing effective neonatal protection during the first months of life. Influenza vaccination reduced 
laboratory-confirmed influenza among mothers and infants. Tdap vaccination markedly reduced infant pertussis before primary immunization. COVID-19 vaccination lowered severe maternal disease and neonatal hospitalization without increasing adverse pregnancy outcomes. Recent evidence also supports maternal RSV vaccination for preventing severe lower respiratory tract infections in early infancy. Serious vaccine-related adverse 
events were rare.
Conclusions. Maternal vaccination is a safe and highly effective preventive strategy that improves both maternal and neonatal health. General practitioners play a pivotal role in counseling pregnant individuals, addressing vaccine hesitancy, and implementing evidence-based immunization recommendations.