Background and objectives:
Infectious diseases contracted during pregnancy, such as influenza and Covid-19, are associated with a greater probability of developing adverse events (perinatal mortality, spontaneous abortions, etc). The Center for Disease Control and other international health authorities recommend co-administration of Influenza and SARS-CoV2 vaccines in pregnant women. In Italy, there is no systematic recording of data on vaccination status for pregnant women. The aim of this study is to assess the acceptance by pregnant women of Influenza and COVID-19 vaccines co-administration.

Methods:
A cross-sectional study was carried out on pregnant women at ARNAS Civico-Di Cristina-Benfratelli Hospital of Palermo, by administering a questionnaire based on the Health Action Process Approach model. It was detected difference among women who accept or not vaccine co-administration. Subsequently, it was performed a multivariable logistic analysis for women who accepted co-administration using Stata MP14.2 statistical software.

Results:
Overall 120 pregnant women were enrolled in the study. Of them 33.3% (n=40) would receive co-administration during pregnancy. The women predominantly are married and graduated. The main source of information on vaccinations is the gynecologist followed by the family doctor. The multivariable analysis shows the positive expectation on co-administration (reduction of complications for mother and newborn) was associated to a greater vaccine acceptance (aOR 2,07;IC% 1,15-3,73). The higher self-efficacy of women (influence of family context) appeared to be a further factor directly associated to co-administration adherence (aOR 2,63;IC% 1,15-4,56).

Conclusion:
The vaccination campaign could focus on the positive expectation of co-administration and on self-efficacy, also involving the people surrounding the pregnant woman. In places of prenatal visits, a figure is needed to improving access to vaccines for pregnant women and train healthcare workers in the mother-child area. Furthermore, a system that records specific data on vaccination coverage of pregnant women is needed to plan future interventions.