How long should women avoid pregnancy after receiving the Measles, Mumps, and Rubella (MMR) vaccine?

MMR Vaccine and Pregnancy Avoidance

Women should be counseled to avoid pregnancy for 3 months after receiving the MMR vaccine or other rubella-containing vaccines. 1

Recommended Waiting Period After MMR Vaccination

• Women should avoid pregnancy for 30 days after receiving monovalent measles or mumps vaccines 1
• Women should avoid pregnancy for 3 months after receiving MMR or other rubella-containing vaccines 1
• The most recent guidance (2011) recommends avoiding pregnancy for 28 days after receipt of rubella-containing vaccine 1

Rationale for Pregnancy Avoidance

• The recommendation is based on theoretical concerns about potential risk to the fetus from live virus vaccines 1
• Although the risk is theoretical, it cannot be completely excluded, which is why pregnancy avoidance is recommended 1
• The rubella component of the vaccine is the primary concern driving the longer waiting period 1

Safety Data if Pregnancy Occurs

• If a woman becomes pregnant within 3 months after MMR vaccination, she should be counseled about the theoretical basis of concern, but this is not ordinarily a reason to consider pregnancy termination 1
• No cases of congenital rubella syndrome or abnormalities attributable to vaccine virus infection have been observed in infants born to susceptible mothers who received MMR during pregnancy 1
• Long-term follow-up of 321 rubella-susceptible women who were vaccinated within 3 months before or after conception showed:
  • None of the 324 infants had malformations compatible with congenital rubella syndrome 1
  • Five infants had evidence of subclinical infection 1
  • The estimated risk for serious malformations attributable to RA 27/3 rubella vaccine ranges from zero to 1.6% 1

Clinical Practice Recommendations

• Healthcare providers should:

  • Ask women if they are pregnant before administering MMR 1
  • Not vaccinate women who state they are pregnant 1
  • Explain the potential theoretical risk to women who state they are not pregnant 1
  • Counsel women who are vaccinated to avoid pregnancy for 3 months 1

• For postpartum women:

  • Non-immune women should receive MMR vaccine before discharge from the hospital or birthing center 2
  • Breastfeeding is not a contraindication to MMR vaccination 1
  • Although rubella vaccine virus can be excreted in breast milk, the infection remains asymptomatic in the infant 1

Special Considerations

• During pre-pregnancy counseling, MMR vaccination should be offered with advice to avoid pregnancy for the recommended period 3
• For women planning pregnancy, ensuring MMR immunity before conception is preferable to postpartum vaccination 2
• Women who are not vaccinated because they are pregnant should be counseled about the risk of congenital rubella syndrome and the importance of vaccination after pregnancy 1