Maternal Anxiety and its Association with COVID-19 Vaccination Acceptance among Pregnant Women: A Narrative Review

Abstract

Pregnant women represent a vulnerable population during infectious disease outbreaks, including the COVID-19 pandemic. Although vaccination is a key strategy to prevent severe maternal and neonatal outcomes, vaccine acceptance among pregnant women remains inconsistent. Psychological factors, particularly maternal anxiety, play an important role in shaping vaccination decisions. This study aimed to examine the association between anxiety levels among pregnant women and their acceptance of COVID-19 vaccination. A narrative literature review was conducted using the PICOS framework. Scientific articles were retrieved from PubMed, ScienceDirect, and Google Scholar, limited to publications from 2022 to 2025. A total of 18 peer-reviewed articles were analyzed. The findings indicate that moderate to high levels of anxiety are significantly associated with vaccine hesitancy among pregnant women, particularly when anxiety is driven by misinformation, fear of adverse fetal outcomes, and lack of social support. Conversely, adequate antenatal counseling, family support, and trust in healthcare providers were found to reduce anxiety and improve vaccine acceptance. These results highlight the importance of integrating mental health screening and evidence-based education into antenatal care services to improve COVID-19 vaccination uptake among pregnant women.