What are the recommendations for COVID-19 (Coronavirus Disease 2019) vaccine and flu (influenza) vaccine administration for a 12-week pregnant 26-year-old woman?

COVID-19 and Influenza Vaccination Recommendations for a 12-Week Pregnant Woman

Both COVID-19 and influenza vaccines are strongly recommended for pregnant women at 12 weeks gestation, as the benefits significantly outweigh potential risks for both mother and baby. 1, 2

COVID-19 Vaccination Recommendations

Safety and Benefits

• Pregnant women are at higher risk for severe COVID-19 illness, with increased risks of:
  • Premature labor
  • Myocardial injuries
  • Preeclampsia
  • Perinatal death
  • Vertical transmission to the fetus 1

Specific Recommendations

• mRNA vaccines (Pfizer-BioNTech or Moderna) are the preferred options for pregnant women 1
• Vaccination can be administered at any trimester, including at 12 weeks 1
• The American College of Obstetricians and Gynecologists (ACOG) explicitly recommends COVID-19 vaccination for all pregnant women 1

Benefits to Infant

• Vaccinated pregnant women can pass protective IgG antibodies to their offspring
• Transplacental transfer of vaccine-induced antibodies is more effective if vaccination occurs in the third trimester, but vaccination should not be delayed 1

Influenza Vaccination Recommendations

Safety and Benefits

• Women in second and third trimesters have increased risk for hospitalization from influenza
• The inactivated influenza vaccine is safe during any trimester of pregnancy 2, 3
• No studies have demonstrated increased risk of maternal complications or adverse fetal outcomes with influenza vaccination 3

Specific Recommendations

• The CDC and ACOG recommend influenza vaccination for all pregnant women during flu season, regardless of trimester 2, 3
• The live attenuated influenza vaccine (nasal spray) is contraindicated during pregnancy 2

Implementation Considerations

Timing and Administration

• Both vaccines can be administered simultaneously at the current 12-week gestational age 2
• No need to delay either vaccination

Factors That May Influence Acceptance

• Provider recommendation is the most influential factor in vaccination acceptance 2, 4
• Women offered vaccination by healthcare providers (62%) are significantly more likely to be vaccinated (71%) than those not offered (14%) 4

Common Concerns and Pitfalls

COVID-19 Vaccine Concerns

• Despite initial exclusion of pregnant women from vaccine trials, extensive post-authorization data supports safety 1
• No evidence of negative impacts on fertility or miscarriage rates in animal studies 1
• The theoretical risks of not vaccinating (severe COVID-19 illness) far outweigh any theoretical risks of vaccination

Influenza Vaccine Concerns

• No scientific evidence exists that thimerosal-containing vaccines cause adverse events among children born to women who received influenza vaccine during pregnancy 3
• Inactivated influenza vaccines have been safely administered during pregnancy for many years with extensive safety data 3, 5

Algorithm for Vaccination

1. Confirm no history of severe allergic reaction to any component of either vaccine
2. Administer both COVID-19 and influenza vaccines at the current visit (12 weeks)
3. Document vaccination in prenatal record
4. Schedule Tdap vaccination for between 27-36 weeks gestation (optimally at 27-28 weeks) 2

By following these evidence-based recommendations, both mother and baby will receive important protection against these potentially serious respiratory infections.