Recommended Vaccines During Pregnancy
The CDC and WHO strongly recommend that all pregnant women receive the inactivated influenza vaccine during any trimester and the Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine between 27-36 weeks of gestation in every pregnancy to protect both mother and infant from severe disease and mortality. 1
Routinely Recommended Vaccines
Influenza Vaccine
- One dose of inactivated influenza vaccine is recommended during any trimester of pregnancy, ideally before flu season begins 1
- Pregnant women are at significantly higher risk for severe disease, hospitalization, and death from influenza compared to non-pregnant women 1
- Influenza infection during pregnancy is associated with adverse pregnancy outcomes including late pregnancy loss and reduced infant birthweight 1
- The live attenuated influenza vaccine (nasal spray) is contraindicated during pregnancy 1
- Contraindicated in individuals with history of severe allergic reaction to previous doses 1
Tdap Vaccine (Tetanus, Diphtheria, Pertussis)
- One dose recommended between 27 and 36 weeks of gestation in every pregnancy 1
- Optimal timing is 27-28 weeks to maximize maternal antibody response and passive antibody transfer to the infant 1
- If not previously vaccinated and dose not administered during pregnancy, give immediately postpartum 1
- For wound management during pregnancy, Tdap should replace Td if ≥5 years since previous booster 1
- Contraindicated in individuals with severe allergic reaction to previous doses 1
Special Circumstances
COVID-19 Vaccine
- Recommended during any trimester of pregnancy based on recent safety data 2
- Pregnant women with COVID-19 are at increased risk for severe disease compared to non-pregnant individuals 3
- Initial safety data supports the use of mRNA vaccines in pregnant women 1
Rabies Vaccine
- Not contraindicated during pregnancy for both post-exposure and pre-exposure prophylaxis 4
- Post-exposure prophylaxis should always be administered following potential rabies exposure regardless of pregnancy status 4
- No increased incidence of adverse pregnancy outcomes has been associated with rabies vaccination during pregnancy 4
Contraindicated Vaccines During Pregnancy
- Live attenuated vaccines are generally contraindicated during pregnancy due to theoretical risk of placental transmission 1
- These include:
Vaccines for High-Risk Situations
- Hepatitis B vaccine is recommended for pregnant women at risk for hepatitis B virus infection 1
- Pneumococcal, meningococcal, and hepatitis A vaccines should be considered for pregnant women at increased risk 1
- Yellow fever vaccine should be administered to pregnant women who must travel to high-risk areas, as the risk of infection outweighs theoretical vaccination risks 1
Important Clinical Considerations
- All pregnant women should be evaluated for immunity to rubella and tested for HBsAg in every pregnancy 1
- Women susceptible to rubella and varicella should be vaccinated immediately after delivery 1
- Inactivated vaccines are generally considered safe during pregnancy 5
- Vaccination coverage rates among pregnant women remain suboptimal, with influenza vaccination rates in the US at only 61.2% 1
- Healthcare providers should proactively recommend and administer needed vaccines to pregnant patients 6
- The International Federation of Gynecology and Obstetrics (FIGO) endorses recommendations to vaccinate all pregnant women against influenza and Tdap 7
Common Pitfalls to Avoid
- Delaying influenza vaccination until a specific trimester - it can be given at any time during pregnancy 1
- Missing the optimal window (27-36 weeks) for Tdap administration 1
- Failing to administer Tdap during each pregnancy, regardless of prior vaccination history 6
- Unnecessarily avoiding inactivated vaccines in pregnant women due to unfounded safety concerns 6
- Not addressing vaccine hesitancy through education about benefits to both mother and infant 1