Are there any complications in pregnancy for pregnant women who receive the rabies (Rabies Immunoglobulin) vaccine during pregnancy?

Rabies Vaccination in Pregnancy: Safety Profile

Rabies vaccine is safe during pregnancy with no evidence of increased complications, and pregnancy should never be considered a contraindication to either post-exposure or pre-exposure prophylaxis given rabies' nearly 100% fatality rate. 1, 2

Post-Exposure Prophylaxis: Always Administer

• The rabies vaccine and rabies immunoglobulin should be administered immediately to all pregnant women following potential rabies exposure, regardless of trimester. 1, 2
• No increased incidence of abortion, premature births, or fetal abnormalities has been documented following rabies vaccination during pregnancy. 1, 2
• The consequences of inadequately treated rabies exposure (nearly 100% mortality once symptomatic) far outweigh any theoretical vaccine risks. 1, 2

Pre-Exposure Prophylaxis: Consider for High-Risk Women

• Pre-exposure prophylaxis may be indicated during pregnancy when there is substantial risk of exposure (e.g., veterinarians, animal handlers, travelers to endemic areas, laboratory workers). 1, 2
• The safety profile demonstrated in post-exposure studies supports pre-exposure use in pregnant women at high risk. 1, 2
• The inactivated virus platform used in rabies vaccines is inherently safer than live attenuated vaccines, which are contraindicated in pregnancy. 1

Evidence from Clinical Experience

• A study of 21 pregnant women who received post-exposure rabies vaccination (12 also received equine rabies immunoglobulin) showed only mild, transient side effects (15% reported myalgia, malaise, erythema, swelling, urticarial rashes, or mild lymphadenopathy). 3
• All vaccine series were completed, no mothers or infants developed rabies after one year, no congenital malformations were detected, and only one spontaneous abortion occurred (within expected background rates). 3
• A separate follow-up study of 14 pregnant women receiving rabies PEP found no adverse events to either vaccine or equine rabies immunoglobulin, with all having safe deliveries and healthy infants. 4

Practical Administration Guidelines

• No special dosing adjustments or modifications to the standard vaccination schedule are needed for pregnant women. 2
• The standard regimen consists of vaccine doses on days 0,7, and 21 or 28, with rabies immunoglobulin administered for post-exposure prophylaxis. 5
• Previously vaccinated pregnant women exposed to rabies require only 2 vaccine doses (day 0 and day 3) without rabies immunoglobulin. 5

Critical Clinical Pitfalls to Avoid

• Never delay or withhold rabies post-exposure prophylaxis due to pregnancy status—this is the most dangerous error given rabies' near-certain fatality. 1, 2
• Do not confuse rabies vaccine (inactivated, safe in pregnancy) with live attenuated vaccines that are contraindicated in pregnancy. 1
• Ensure complete vaccination series is administered; incomplete prophylaxis provides inadequate protection. 3

Algorithm for Decision-Making

Post-Exposure Situation:

• Administer complete post-exposure prophylaxis immediately (vaccine + rabies immunoglobulin if not previously vaccinated) regardless of pregnancy status or trimester. 1, 2

Pre-Exposure Situation:

• Assess occupational or travel-related rabies exposure risk. 5
• If substantial risk exists (veterinarian, animal handler, endemic area traveler, laboratory worker), administer pre-exposure vaccination series despite pregnancy. 1, 2
• If minimal risk, vaccination can be deferred until after pregnancy. 1