Vaccinations during pregnancy in Germany between 2004 and 2022: a claims data analysis

Data on vaccinations during pregnancy are lacking in Germany. We aimed to assess the proportion of pregnancies with any vaccination over a 19-year period. Using health claims covering approximately 20% of the German population, we included pregnancies beginning between 2004 and 2022. We determined the proportion of pregnancies with at least one vaccination (any type and specific vaccines). Results were stratified by calendar year, maternal age, federal state of residence, and socioeconomic status. Of 2,801,552 pregnancies included overall, 423,567 (15.1%) were exposed to at least one vaccination. The proportion of pregnancies with influenza vaccination was 2% in 2004-2009 and increased after its recommendation (2010) from 7% in 2010-2014 to 19% in 2020-2022; the proportion of pregnancies with pertussis vaccination was 3% in 2015-2019 and increased after its recommendation (2020) to 37% in 2020-2022. In 2020-2022, about 0.3% of pregnancies were exposed to vaccines against mumps, rubella, and measles, which are contraindicated during pregnancy. Reasons why less than 50% of pregnancies receive recommended vaccinations should be explored, e.g., to what extent this is due to an informed decision or a lack of knowledge.