Despite awareness of recommendations, why do health care workers not immunize pregnant women?

•Uncertainty about vaccination safety and efficacy for pregnant women is a health issue.•Gap between physicians' knowledge about recommendations and implementation.•Some health care workers have fears and concerns about vaccine efficacy and safety.

Studies indicate uncertainty surrounding vaccination safety and efficacy for pregnant women, causing a central problem for health authorities. In this study, approximately 26% of participants do not recommend the tetanus, diphtheria, and acellular pertussis and influenza vaccines to their patients, although being aware of the health ministry recommendations. We found significant statistical discrepancies between the knowledge about the recommendations and their actual implementation, revealing the concerns of health care workers regarding vaccine safety.