Yes, pregnant women can and should receive both COVID-19 and influenza vaccines during pregnancy
Both the CDC and WHO explicitly recommend that pregnant women receive influenza vaccination during any trimester of pregnancy and COVID-19 vaccination is recommended for all pregnant individuals. These vaccines are routinely recommended during pregnancy by international and national health organizations 1, 2.
Key Recommendations
Influenza Vaccination
- Timing: One dose during any trimester of pregnancy 1, 2
- Type: Inactivated influenza vaccine (trivalent or quadrivalent) is recommended 1
- Important caveat: Live attenuated influenza vaccine (intranasal) is contraindicated during pregnancy 1
- Can be administered at any time during pregnancy, including early vaccination (July-August) for women in third trimester to provide protection for the infant after birth 2
COVID-19 Vaccination
- Timing: Recommended during any trimester of pregnancy 1
- Type: mRNA vaccines (Pfizer/BioNTech, Moderna) and other authorized formulations are supported 1
- Initial safety data supports safe use of mRNA vaccines in pregnant women 1
Co-administration
Both vaccines can be given during the same visit - the FDA drug label specifically states that if considering receiving COVID-19 vaccine with other vaccines, discuss options with your healthcare provider, indicating co-administration is acceptable 3.
Safety Evidence
The evidence strongly supports safety:
- Influenza vaccination during pregnancy is associated with reduced risk for respiratory illness in pregnant women and protection for infants in first months of life 2
- COVID-19 vaccination shows no increased risks of hypertensive disorders, chorioamnionitis, premature rupture of membranes, hemorrhage, small-for-gestational-age, or low birthweight 4
- Recent large cohort data (19,098 pregnant women) found protective effects: 13% reduction in preterm birth with influenza vaccine, 17% reduction with pertussis vaccine, and 21% reduction with COVID-19 vaccine 4
- Both influenza and pertussis vaccination associated with lower likelihood of obstetric complications 4
Critical Clinical Context
Why This Matters for Morbidity and Mortality
Pregnant women face substantially elevated risks from these infections:
- Influenza: Pregnant women are at greater risk of severe disease and death than non-pregnant women; during 2009 H1N1 pandemic, they were 7.2% more likely to be hospitalized and had disproportionally high mortality 1
- Influenza infection during pregnancy increases risk of late pregnancy loss (adjusted HR 10.7) and reduced infant birthweight 1
- COVID-19: Pregnant individuals infected with SARS-CoV-2 are at increased risk of severe COVID-19, with greater risk of preeclampsia/eclampsia (aOR 1.57), preterm delivery (aOR 2.17), and fetal death (aOR 2.21) 1, 3
Contraindications
The only absolute contraindications are:
- History of severe allergic reaction (anaphylaxis) to previous dose or vaccine component 1
- Live attenuated vaccines (intranasal flu vaccine) 1
Common Pitfalls to Avoid
- Don't delay vaccination waiting for a "better" trimester - any trimester is appropriate 1, 2
- Don't withhold both vaccines - they can be given simultaneously 3
- Don't assume pregnancy testing is needed before COVID-19 vaccination - WHO does not recommend pregnancy testing before vaccination 1
- Address vaccine hesitancy proactively - provider recommendation is strongly associated with uptake (65.6% vs 12.2% for influenza when recommended) 5
Practical Implementation
- Prioritize pregnant women for vaccination given their elevated risk 1, 2
- Provide clear counseling about safety data and benefits for both mother and infant
- Document vaccination in immunization registries 2
- For COVID-19 vaccination during pregnancy, encourage enrollment in pregnancy exposure registry (https://c-viper.pregistry.com/) 3
The evidence is unequivocal: both vaccines are safe, effective, and should be offered to all pregnant women to reduce maternal and neonatal morbidity and mortality from these preventable respiratory infections.