What vaccines are safe to receive during pregnancy?

Vaccines Safe During Pregnancy

Inactivated vaccines are generally safe during pregnancy, while live attenuated vaccines are contraindicated due to theoretical risks to the fetus. 1, 2 The benefits of vaccination during pregnancy typically outweigh potential risks when disease exposure risk is high, infection would pose risk to mother or fetus, and the vaccine is unlikely to cause harm 1.

Routinely Recommended Vaccines for All Pregnant Women

Tetanus, Diphtheria, and Acellular Pertussis (Tdap)

• Recommended between 27-36 weeks gestation (optimally at 27-28 weeks) in every pregnancy regardless of prior vaccination history 2
• Provides passive antibody transfer to protect newborns against pertussis before they can receive their own vaccinations
• Earlier vaccination within the recommended window provides higher antibody concentrations in cord blood 2

Influenza (Inactivated)

• Recommended for all pregnant women during influenza season
• Women in second and third trimesters have increased risk for hospitalization from influenza 1
• Only the inactivated influenza vaccine should be used; live attenuated influenza vaccine (nasal spray) is contraindicated 2
• Can be administered simultaneously with Tdap 2
• Reduces risk of maternal complications, late pregnancy loss, and provides passive immunity to infants 2

Vaccines Recommended in Special Circumstances

Hepatitis B Vaccine

• Recommended for pregnant women at risk for hepatitis B infection 1
• Not associated with increased adverse pregnancy outcomes 2

Meningococcal Vaccines

• Safe and immunogenic during pregnancy 1
• Recommended if a woman is at high risk of meningococcal disease or during outbreaks 1, 2
• No safety concerns reported in pregnancy 2

Pneumococcal Vaccine

• Recommended for pregnant women with increased risk of infection 2
• Polysaccharide vaccines are safe during pregnancy 1, 2

Hepatitis A Vaccine

• Inactivated virus vaccine can be used after considering exposure risks 1
• No evidence of increased adverse pregnancy outcomes 1

Polio Vaccine

• Only inactivated poliovirus vaccine (IPV) should be used if indicated 1
• Oral poliovirus vaccine (live attenuated) is contraindicated 2
• IPV is routinely offered to pregnant women in some countries (UK, New Zealand) 1

Other Vaccines for Special Circumstances

• Cholera (inactivated): Can be used for women at high risk; WHO recommends inclusion in vaccination campaigns 1
• Rabies: Pregnancy not a contraindication for post-exposure prophylaxis due to high fatality rate 1
• Yellow fever: Can be administered when travel to high-risk areas is necessary; benefits outweigh theoretical risks 1

Contraindicated Vaccines During Pregnancy

Live Attenuated Vaccines

• Measles, Mumps, Rubella (MMR) 1, 2
• Varicella (chickenpox) 1, 3
• Live attenuated influenza (nasal spray) 2
• Oral polio vaccine 1, 2
• Live attenuated cholera vaccine 1

Important Considerations and Caveats

Timing of Vaccination

• Many women receive vaccines during second or third trimester to avoid theoretical concerns during first trimester organogenesis 1
• For Tdap, timing within 27-36 weeks optimizes antibody transfer to infant 2

Post-Exposure Scenarios

• In some high-risk exposure situations, benefits of vaccination may outweigh theoretical risks
• Rabies post-exposure prophylaxis should not be withheld during pregnancy 1

Post-Delivery Vaccination

• Women susceptible to rubella should be vaccinated immediately after delivery 1
• Other live vaccines contraindicated during pregnancy can be administered postpartum 1

Provider Recommendation Impact

• Healthcare provider recommendation is the most influential factor in vaccination acceptance (75.2% for influenza and 72.7% for Tdap) 2
• Document vaccination status at first prenatal visit and emphasize protection for both mother and infant 2

Common Pitfalls to Avoid

1. Withholding indicated inactivated vaccines due to unfounded safety concerns
2. Administering live attenuated vaccines during pregnancy
3. Missing the optimal window for Tdap administration (27-36 weeks)
4. Failing to recognize special circumstances that warrant additional vaccinations
5. Not documenting vaccination history at first prenatal visit
6. Overlooking the opportunity to vaccinate postpartum for vaccines contraindicated during pregnancy

By following these evidence-based recommendations, providers can help protect both pregnant women and their infants from vaccine-preventable diseases while minimizing risks.