German health records covering millions of pregnancies between 2004 and 2022 reveal a substantial rise in maternal vaccinations, jumping from under 4% to nearly 44%. While pertussis and influenza uptake increased following national public health recommendations, coverage for influenza still falls far short of European Union targets.
Two Decades of Claims Data Reveal Changing Maternity Patterns
Nearly twenty years of health records from Germany illustrate a significant shift in how expectant mothers approach immunization. Researchers examining statutory insurance claims data tracked 2,801,552 pregnancies among women aged 13 to 49 years old between 2004 and 2022 (claims data analysis published in Scientific Reports). The study provides the first comprehensive overview of vaccinations during pregnancy across the country, capturing data from four statutory insurance providers that cover roughly 20 percent of the German population each year.
Overall vaccine exposure during pregnancy climbed substantially over the observed timeline. While only about 3.6 percent of pregnancies in cohorts beginning between 2004 and 2009 recorded at least one vaccine exposure, that proportion reached 43.6 percent in pregnancies starting between 2020 and 2022 (comprehensive overview of vaccinations during pregnancy in Germany). Across the entire multi-decade timeframe, approximately 15 percent of all pregnancies—and 17.4 percent of pregnancies ending in live births—involved at least one vaccination.
Uptake varied moderately according to patient demographics. Women aged 30 to 39 years recorded the highest exposure rate at about 17 percent, whereas women under 24 years old showed an exposure rate near 10 percent. Socioeconomic factors also played a role, with vaccine exposure rising to about 18 percent among those with higher educational status compared to roughly 11 percent among individuals with basic or secondary education.
The Impact of Official Recommendations for Influenza and Pertussis
The sharp upward trajectory in maternal vaccination directly reflects new public health guidance issued over the past two decades. German public health authorities formally recommended influenza vaccination in pregnancy in 2010, followed by pertussis vaccination recommendations in 2020.
Between 2020 and 2022, approximately 37 percent of pregnancies were exposed to combination vaccines protecting against diphtheria, pertussis, and tetanus, compared to just 3 percent between 2015 and 2019. Influenza uptake followed a similar upward curve, rising from a negligible 2 percent in the 2004–2009 window to 19.4 percent during the 2020–2022 period.
Researchers observed that the rise in pertussis immunization following its 2020 recommendation was much sharper than the multi-year climb for influenza shots. Tetanus and diphtheria exposure rates closely mirrored pertussis figures because these antigens are routinely administered as a combined formulation.
Persistent Gaps Compared to European Targets and Other Vulnerable Groups
Despite these notable gains, public health experts emphasize that immunization coverage among pregnant individuals remains suboptimal. Influenza uptake in particular falls well behind the European Union Council target of 75 percent coverage for pregnant women, who are classified as a high-risk group for severe influenza complications.
By comparison, influenza vaccination rates in Germany have historically been higher among other vulnerable populations. During the 2021–2022 influenza season, coverage reached 43.3 percent among adults aged 60 years or older and 35.4 percent among individuals managing relevant chronic medical conditions.
Countries with higher maternal influenza coverage—such as Spain, the United Kingdom, and the United States—have implemented proactive public health measures that extend far beyond simply recommending and reimbursing the shots. These strategies include active healthcare provider engagement, systematic reminder and recall systems, comprehensive public awareness campaigns, and rigorous uptake monitoring.
The study also tracked instances of contraindicated live-attenuated immunizations administered during gestation. Between 2004 and 2022, researchers identified 6,872 pregnancies exposed to at least one live vaccine, such as measles, mumps, rubella, or varicella. Because the dataset captures roughly 20 percent of the national population, the findings indicate that approximately 34,400 pregnancies nationwide may have been exposed to live vaccines during the broader study window, though investigators note some cases may stem from misestimated gestational timelines where vaccination occurred prior to conception.
