This qualitative systematic review examines the barriers and facilitators to vaccination uptake among pregnant women in high-income countries, focusing on influenza, pertussis, and COVID-19 vaccines. The review identified five overarching themes: personal factors (perception of disease severity, knowledge, and trust), provider factors (healthcare professional interactions), and systemic factors (access to vaccination and logistics). Key barriers included low perceptions of infection risk, lack of knowledge about vaccines, concerns about vaccine safety and efficacy, exposure to misinformation, and poor healthcare professional engagement. Facilitators included strong recommendations from trusted healthcare professionals, clear and accurate information, positive social influences, and convenient access to vaccines. The review highlights the need for interventions that address these barriers and emphasizes the importance of healthcare provider recommendations and addressing concerns about vaccine safety and effectiveness to increase vaccination rates during pregnancy.This qualitative systematic review examines the barriers and facilitators to vaccination uptake among pregnant women in high-income countries, focusing on influenza, pertussis, and COVID-19 vaccines. The review identified five overarching themes: personal factors (perception of disease severity, knowledge, and trust), provider factors (healthcare professional interactions), and systemic factors (access to vaccination and logistics). Key barriers included low perceptions of infection risk, lack of knowledge about vaccines, concerns about vaccine safety and efficacy, exposure to misinformation, and poor healthcare professional engagement. Facilitators included strong recommendations from trusted healthcare professionals, clear and accurate information, positive social influences, and convenient access to vaccines. The review highlights the need for interventions that address these barriers and emphasizes the importance of healthcare provider recommendations and addressing concerns about vaccine safety and effectiveness to increase vaccination rates during pregnancy.