Assessing vaccination intentions and perceptions among pregnant women in Italy: A multicenter cross-sectional study in the context of mandatory policies and the COVID-19 pandemic

Background/objectives: Vaccinations significantly reduce the incidence of preventable diseases. Despite their benefits, childhood vaccination rates have declined in Italy since the mid-2010s, prompting the government to mandate certain vaccinations. This cross-sectional study aims to assess the intention to vaccinate their children and the perception of mandatory vaccinations among pregnant women in Italy after the COVID-19 pandemic and post-mandatory vaccination policies. Methods: Participants over 18 years old recruited from 18 cities in Italy completed a questionnaire covering socio- demographic information, vaccination intentions, sources of information, and trust in vaccinations and the healthcare system. Descriptive analyses of the intention to vaccinate their children were carried out, and logistic regressions were performed to identify predictors of being in favor of mandatory vaccinations. Results: Out of 2472 women, 98.8 % intended to vaccinate their upcoming children. High intentions were re ported for rubella (91.7 %), measles (91.0 %), hepatitis B (90.4 %), and pertussis (90.4 %), while only 30.3 % intended to vaccinate against COVID-19. Healthcare professionals were the most trusted source of information. A total of 89.1 % of the women were in favor of mandatory vaccinations. Multivariable regression indicated that higher knowledge, risk perception, and trust scores were significant predictors of support for mandatory vaccinations. Conclusions: These findings highlight the crucial role of healthcare professionals in shaping positive vaccination intentions, providing valuable insights for policymakers seeking to enhance vaccination coverage in the post- pandemic era.