This qualitative systematic review identifies the facilitators and barriers to vaccination uptake among pregnant women in high-income countries. The study analyzed 28 studies involving 1,573 participants and identified five overarching themes: perception of disease severity and benefits of vaccination, knowledge and awareness, vaccine safety, efficacy, and trust, healthcare professional interactions, and access to vaccination and logistics. Barriers included low perception of disease severity, lack of knowledge about vaccines, concerns about vaccine safety and efficacy, and misinformation. Facilitators included recommendations from trusted healthcare professionals, clear communication about vaccine benefits and safety, and easy access to vaccination. Strategies to increase vaccination uptake included strong recommendations from healthcare professionals, provision of vaccines during routine antenatal care, and clear communication addressing pregnant women's concerns. The review highlights the importance of healthcare provider recommendations, clear communication about vaccine benefits and safety, and convenient access to vaccination in promoting vaccine uptake. It also emphasizes the need for interventions that address concerns about vaccine safety and provide accurate information about vaccines. The study concludes that addressing these barriers and leveraging facilitators can help increase vaccination rates among pregnant women. The findings are relevant to current efforts to encourage vaccination, including the administration of boosters and seasonal influenza and prenatal pertussis vaccinations. The study underscores the importance of tailored communication and public health campaigns delivered by trusted healthcare professionals to address the concerns of pregnant women.This qualitative systematic review identifies the facilitators and barriers to vaccination uptake among pregnant women in high-income countries. The study analyzed 28 studies involving 1,573 participants and identified five overarching themes: perception of disease severity and benefits of vaccination, knowledge and awareness, vaccine safety, efficacy, and trust, healthcare professional interactions, and access to vaccination and logistics. Barriers included low perception of disease severity, lack of knowledge about vaccines, concerns about vaccine safety and efficacy, and misinformation. Facilitators included recommendations from trusted healthcare professionals, clear communication about vaccine benefits and safety, and easy access to vaccination. Strategies to increase vaccination uptake included strong recommendations from healthcare professionals, provision of vaccines during routine antenatal care, and clear communication addressing pregnant women's concerns. The review highlights the importance of healthcare provider recommendations, clear communication about vaccine benefits and safety, and convenient access to vaccination in promoting vaccine uptake. It also emphasizes the need for interventions that address concerns about vaccine safety and provide accurate information about vaccines. The study concludes that addressing these barriers and leveraging facilitators can help increase vaccination rates among pregnant women. The findings are relevant to current efforts to encourage vaccination, including the administration of boosters and seasonal influenza and prenatal pertussis vaccinations. The study underscores the importance of tailored communication and public health campaigns delivered by trusted healthcare professionals to address the concerns of pregnant women.