Recommended Vaccines for Pregnant Women
Pregnant women should receive the inactivated influenza vaccine during any trimester and the Tdap (tetanus, diphtheria, 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 2
- Pregnant women are at significantly higher risk for severe disease, hospitalization, and death from seasonal influenza compared to non-pregnant women 2
- Influenza infection during pregnancy is associated with adverse pregnancy outcomes, including late pregnancy loss (adjusted hazard ratio, 10.7) and reduced infant birthweight 2
- The live attenuated influenza vaccine (nasal spray) is contraindicated during pregnancy due to theoretical risk of placental transmission 2, 1
- Vaccination coverage rates for influenza among pregnant women in the US is approximately 61.2%, but worldwide rates vary from 1.7%-95% 2, 3
Tdap Vaccine
- One dose of Tdap vaccine is 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, Tdap should be given immediately postpartum 1
- For wound management during pregnancy, Tdap should replace Td if ≥5 years since previous booster 1
Contraindicated Vaccines During Pregnancy
- Live attenuated vaccines are generally contraindicated during pregnancy due to theoretical risk of placental transmission 2, 1
- These include:
Vaccines for High-Risk Situations
- Hepatitis B vaccine is recommended for pregnant women at risk for hepatitis B virus infection 2, 1
- Pneumococcal, meningococcal, and hepatitis A vaccines should be considered for pregnant women at increased risk 2, 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 2, 1
- Rabies vaccine (inactivated) is not contraindicated in pregnancy and should be administered for post-exposure prophylaxis 4
Important Clinical Considerations
- All pregnant women should be evaluated for immunity to rubella and tested for HBsAg in every pregnancy 2
- Women susceptible to rubella and varicella should be vaccinated immediately after delivery 2
- Inactivated, recombinant, subunit, polysaccharide, conjugate vaccines and toxoids pose no risk for mothers or their infants 2
- Provider recommendation significantly increases vaccination rates - women who received a provider offer or referral had much higher vaccination rates (influenza = 75.2%; Tdap = 72.7%) 3
Addressing Disparities and Barriers
- Racial/ethnic disparities exist in vaccination coverage, with Black and Hispanic women historically having lower rates 3
- Healthcare providers should provide culturally and linguistically tailored education about vaccine benefits and safety 2
- Addressing barriers to accessing healthcare is essential, particularly for marginalized communities 2
- Targeted messaging that specifically highlights the benefits of vaccination during pregnancy may help women feel more confident in their decision 2
Common Pitfalls to Avoid
- Delaying influenza vaccination until a specific trimester - it can be given at any time during pregnancy 2, 1
- Missing the optimal window (27-36 weeks) for Tdap administration 1
- Not addressing vaccine hesitancy through education about benefits to both mother and infant 2, 1
- Failing to provide a strong recommendation for vaccination, which is one of the strongest predictors of vaccine acceptance 5, 3