---
title: "Safety and Uptake of COVID-19, Influenza, and Pertussis Vaccination in Pregnancy: Australian Cohor"
id: "pubmed-42667899"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42667899"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42667899/"
doi: "10.1016/j.vaccine.2026.129081"
published_at: "2026-10-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Safety and Uptake of COVID-19, Influenza, and Pertussis Vaccination in Pregnancy: Australian Cohor
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42667899
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42667899/)
- **DOI:** [10.1016/j.vaccine.2026.129081](https://doi.org/10.1016%2Fj.vaccine.2026.129081)
- **Published At:** 2026-10-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective cohort study assessed safety and coverage of **maternal influenza**, **pertussis**, and **COVID-19 vaccination** in 19,098 pregnant women who delivered at the Women’s and Children’s Hospital, South Australia, between 2020 and 2023. - Vaccine uptake during pregnancy was 64.1% for influenza, 74.1% for pertussis, and 29.5% for at least one dose of COVID-19 vaccine. - Statistical approaches included Cox proportional-hazards models for time-sensitive perinatal outcomes, log-binomial models for time-independent outcomes, and Poisson regression to identify determinants of vaccine uptake. - No increased risks were observed after maternal vaccination for hypertensive disorders, chorioamnionitis, premature rupture of membranes, antepartum or postpartum haemorrhage, small-for-gestational-age, or low birthweight. - Maternal vaccination was associated with reduced risk of preterm birth: influenza showed a 13% protective effect; pertussis and COVID-19 vaccination were also associated with reductions in preterm birth, and COVID-19 vaccination had an adjusted hazard ratio of 0.79 (95% CI 0.68–0.92) for preterm birth. - Pertussis vaccination was associated with a 17% reduction in preterm birth and nearly 50% fewer stillbirths; influenza and pertussis vaccination were associated with lower likelihood of at least one obstetric complication (influenza aRR 0.94, 95% CI 0.91–0.98; pertussis aRR 0.89, 95% CI 0.86–0.92). - A small increase in diagnosed gestational diabetes was observed among women who received influenza or pertussis vaccines during pregnancy. - Neonatal outcomes were favorable for infants of vaccinated mothers, including lower rates of resuscitation, early-onset sepsis, and low Apgar scores. - Sociodemographic determinants of lower vaccine uptake included being younger, multiparous, unmarried, First Nations identity, and discharge of the infant to non-parental care. - Authors conclude that maternal **influenza**, **pertussis**, and **COVID-19 immunisation** are safe and confer additional perinatal benefits, but persistent inequities in uptake require targeted, culturally safe strategies to ensure equitable protection. - Funding and COI: study supported by NHMRC Partnership grant APP2014684; institutions of some authors receive funding from Pfizer, Sanofi Pasteur and GSK. The funding bodies did not influence study design or manuscript writing.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 29. # A cohort study to assess the safety and coverage of COVID-19, influenza, and pertussis vaccine in Australian pregnant women [Hassen Mohammed](https://pubmed.ncbi.nlm.nih.gov/?term=Mohammed+H&cauthor_id=42667899)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42667899/#full-view-affiliation-1 "Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia."), [Prabha Andraweera](https://pubmed.ncbi.nlm.nih.gov/?term=Andraweera+P&cauthor_id=42667899)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42667899/#full-view-affiliation-1 "Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia."), [Helen S Marshall](https://pubmed.ncbi.nlm.nih.gov/?term=Marshall+HS&cauthor_id=42667899)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42667899/#full-view-affiliation-2 "Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia. Electronic address: helen.marshall@adelaide.edu.au.") Affiliations Expand ### Affiliations * 1 Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia. * 2 Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia. Electronic address: helen.marshall@adelaide.edu.au. * PMID: **42667899** * DOI: [ 10.1016/j.vaccine.2026.129081 ](https://doi.org/10.1016/j.vaccine.2026.129081) Item in Clipboard # A cohort study to assess the safety and coverage of COVID-19, influenza, and pertussis vaccine in Australian pregnant women Hassen Mohammed et al. Vaccine. 2026. Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42667899/) . 2026 Oct 3:91:129081. doi: 10.1016/j.vaccine.2026.129081. Epub 2026 Aug 29. ### Authors [Hassen Mohammed](https://pubmed.ncbi.nlm.nih.gov/?term=Mohammed+H&cauthor_id=42667899)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42667899/#short-view-affiliation-1 "Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia."), [Prabha Andraweera](https://pubmed.ncbi.nlm.nih.gov/?term=Andraweera+P&cauthor_id=42667899)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42667899/#short-view-affiliation-1 "Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia."), [Helen S Marshall](https://pubmed.ncbi.nlm.nih.gov/?term=Marshall+HS&cauthor_id=42667899)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42667899/#short-view-affiliation-2 "Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia. Electronic address: helen.marshall@adelaide.edu.au.") ### Affiliations * 1 Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia. * 2 Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; School of Medicine, College of Health, Adelaide University, Adelaide, South Australia, Australia. Electronic address: helen.marshall@adelaide.edu.au. * PMID: **42667899** * DOI: [ 10.1016/j.vaccine.2026.129081 ](https://doi.org/10.1016/j.vaccine.2026.129081) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** The study aimed to evaluate the safety and impact of maternal influenza, pertussis, COVID-19 vaccine on perinatal outcomes and identify determinants of uptake among pregnant women in South Australia. **Methods:** This retrospective cohort study included 19,098 pregnant women who delivered at the Women's and Children's Hospital in South Australia between 2020 to 2023. Cox proportional-hazards models estimated hazard ratios (HRs) for time-sensitive perinatal outcomes, and log-binomial models were used for time-independent outcomes. Poisson regression models were used to estimate adjusted prevalence ratios (aPRs) to identify factors influencing maternal vaccine uptake. **Results:** Overall, 64.1% received influenza, 74.1% pertussis, and 29.5% received ≥1 COVID-19 dose during pregnancy. Maternal influenza, pertussis, and COVID-19 vaccination were not associated with increased risks of hypertensive disorders, chorioamnionitis, premature rupture of membranes, antepartum or postpartum haemorrhage, small-for-gestational-age, or low birthweight. Following maternal influenza vaccination, a 13% protective effect against preterm birth was observed, with similar reductions after pertussis (17% and nearly 50% fewer stillbirths) and COVID-19 vaccination (aHR 0.79, 95% CI 0.68-0.92). Both maternal influenza (aRR 0.94, 95% CI 0.91-0.98) and pertussis vaccination (aRR 0.89, 95% CI 0.86-0.92) were associated with a lower likelihood of experiencing at least one obstetric complication. A small increase in diagnosed gestational diabetes was observed among women vaccinated against influenza or pertussis. Neonatal outcomes were favourable, with lower rates of resuscitation, early-onset sepsis, and low Apgar scores among infants of vaccinated mothers. Younger, multiparous, unmarried, and First Nations women were less likely to be vaccinated, with lower uptake also observed among mothers whose infants were discharged to non-parental care. **Conclusions:** Findings reaffirm the safety and added benefits of maternal influenza, pertussis, and COVID-19 immunisation, and highlight persistent inequities in uptake that require targeted, culturally safe strategies to ensure equitable protection for all pregnant women and their infants. **Keywords:** COVID-19; Influenza; Maternal Vaccine; Perinatal; Pertussis; Pregnant. Crown Copyright © 2026. Published by Elsevier Ltd. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This work is supported by the National Health and medical Research Council of Australia [NHMRC Partnership grant APP2014684]. The funding bodies had no role in the study design or writing the manuscript. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prof Helen Marshall acknowledges support from the National Health and Medical Research Council of Australia: Investigator Fellowship (APP APP2034644). Prof Helen Marshall’s, Dr. Prabha Andraweera’s and Dr. Hassen Mohammed’s institution receives funding for investigator-led studies from Pfizer, Sanofi Pasteur and GSK. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ The Risk of Adverse Birth Outcomes Among Twin Pregnancies After Influenza and Pertussis Vaccinations During Pregnancy: A Data Linkage Study. ](https://pubmed.ncbi.nlm.nih.gov/41549545/) Boyle K, Graham S, Binks M, McHugh L.Boyle K, et al.BJOG. 2026 Apr;133(5):1083-1092. doi: 10.1111/1471-0528.70156. Epub 2026 Jan 18.BJOG. 2026.PMID: 41549545Free PMC article. * [ Antenatal influenza and pertussis vaccination in Western Australia: a cross-sectional survey of vaccine uptake and influencing factors. ](https://pubmed.ncbi.nlm.nih.gov/30355329/) Mak DB, Regan AK, Vo DT, Effler PV.Mak DB, et al.BMC Pregnancy Childbirth. 2018 Oct 24;18(1):416. doi: 10.1186/s12884-018-2051-3.BMC Pregnancy Childbirth. 2018.PMID: 30355329Free PMC article. * [ The Safety of Influenza and Pertussis Vaccination in Pregnancy in a Cohort of Australian Mother-Infant Pairs, 2012-2015: The FluMum Study. ](https://pubmed.ncbi.nlm.nih.gov/30475988/) McHugh L, Marshall HS, Perrett KP, Nolan T, Wood N, Lambert SB, Richmond P, Ware RS, Binks P, Binks MJ, Andrews RM.McHugh L, et al.Clin Infect Dis. 2019 Jan 18;68(3):402-408. doi: 10.1093/cid/ciy517.Clin Infect Dis. 2019.PMID: 30475988 * [ Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016-2021. ](https://pubmed.ncbi.nlm.nih.gov/37248802/) McRae JE, McHugh L, King C, Beard FH, Blyth CC, Danchin MH, Giles ML, Mohammed H, Wood N, Macartney K.McRae JE, et al.Med J Aust. 2023 Jun 19;218(11):528-541. doi: 10.5694/mja2.51989. Epub 2023 May 29.Med J Aust. 2023.PMID: 37248802Review. * [ Experience and challenges on influenza and pertussis vaccination in pregnant women. ](https://pubmed.ncbi.nlm.nih.gov/30024822/) Madhi SA, Nunes MC.Madhi SA, et al.Hum Vaccin Immunother. 2018;14(9):2183-2188. doi: 10.1080/21645515.2018.1483810. Epub 2018 Jul 24.Hum Vaccin Immunother. 2018.PMID: 30024822Free PMC article.Review. 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