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The World Health Organization prioritizes pregnant women for influenza vaccination; in China, flu vaccination during pregnancy has not been widely adopted. This gap is due to a lack of targeted policies and limited public health promotion. We aimed to describe knowledge and attitudes toward seasonal influenza vaccination among women of reproductive age (15-49 y old) (WRA), to inform evidence-based policy interventions. A cross-sectional survey assessed WRA's influenza and vaccine awareness, vaccination route preference, and influencing factors, analyzed via chi-square tests and multivariate logistic regression. The knowledge score among WRA in Shanghai Pudong was 3.77 ± 1.23, and the influenza vaccine knowledge score was 3.55 ± 1.66; the pass rates were 60.61% and 56.46%, respectively. Healthcare workers had the highest cognitive levels. Multivariate analysis indicated that education level and being a healthcare professional were predictors of the influenza vaccine pass rate. In particular, the preference for injection decreased sharply from 41.25% among non-pregnant women to 13.31% in the hypothetical pregnancy scenario. In comparison, nasal spray preference rose from 10.60% to 23.17%, and unwillingness increased from 10.19% to 35.58% (P < .05). Pregnant women preferred the nasal spray at 41.67%, a rate significantly higher than that of non-pregnant women (10.60%, P < .05). When receiving influenza vaccine recommendations, 87.63% of participants were more inclined to follow the advice of obstetricians and gynecologists. While WRA in Pudong New Area, Shanghai, demonstrates a relatively high level of attention to influenza and influenza vaccines, key gaps still exist. Strengthening obstetricians' guidance, promoting non-injectable influenza vaccines, and delivering targeted health education are important strategies to improve vaccination uptake in this population.