Rabies Vaccine Safety in Pregnancy
The rabies vaccine has no known adverse effects on the unborn child and should be administered without hesitation during pregnancy for both post-exposure and pre-exposure prophylaxis when indicated, as pregnancy is explicitly not a contraindication. 1, 2, 3
Evidence of Safety
No evidence exists linking rabies vaccination during pregnancy to fetal abnormalities, adverse birth outcomes, or congenital malformations. 1, 3
The most recent comprehensive guideline review (2022) from the American Journal of Obstetrics and Gynecology confirms there is no evidence of increased risk of adverse pregnancy outcomes following postexposure administration of the rabies vaccine when compared with background outcomes. 1
The CDC has consistently stated since at least 1991 that there is no indication that fetal abnormalities have been associated with rabies vaccination, a position maintained through their most recent recommendations. 1, 3
Real-world clinical data from 21 pregnant women who received postexposure rabies vaccination showed no congenital malformations, with all infants healthy after one year of follow-up (one spontaneous abortion occurred, but this is within the background rate). 4
An additional study of 14 pregnant women receiving rabies PEP found all had safe vaginal deliveries with both mothers and children healthy and normal. 5
Critical Clinical Context
Rabies has a nearly 100% case fatality rate once clinical symptoms develop, making the decision to vaccinate straightforward—the risk of withholding vaccination vastly exceeds any theoretical vaccine risk. 1, 2
Tragically, documented deaths have occurred in pregnant and breastfeeding women in Vietnam who refused PEP due to unfounded fears about fetal safety, highlighting the deadly consequences of vaccine hesitancy in this population. 6
The rabies vaccine uses an inactivated virus platform, which is inherently safer in pregnancy compared to live attenuated vaccines. 1
Clinical Recommendations by Scenario
Post-Exposure Prophylaxis (After Bite/Exposure)
Always administer complete post-exposure prophylaxis immediately, regardless of pregnancy status or trimester. 1, 2, 3
- Use the standard vaccination schedule without any dose modifications. 2, 3
- Administer rabies immune globulin at the standard weight-based dose of 20 IU/kg. 2
- No special monitoring beyond routine post-vaccination care is required. 2
Pre-Exposure Prophylaxis (Before Potential Exposure)
Pre-exposure prophylaxis may be indicated during pregnancy if there is substantial risk of exposure to rabies. 1, 2, 3
- Consider for pregnant women with high-risk occupational exposures (veterinarians, animal handlers, laboratory workers in endemic areas). 1, 2
- The safety demonstrated in post-exposure studies supports its use before exposure for pregnant women at high risk. 1
- Use standard dosing without modifications. 2
Important Caveats
- Rabies prophylaxis should never be interrupted or discontinued due to local or mild systemic reactions during pregnancy. 1, 7
- Common side effects (myalgia, malaise, injection site reactions) occur at similar rates as in non-pregnant individuals and are mild and transient. 4
- The FDA label explicitly states that pregnancy is not considered a contraindication to post-exposure prophylaxis, and pre-exposure prophylaxis may also be indicated if there is substantial risk of exposure. 3
Addressing Patient Concerns
Counsel pregnant women that refusing rabies vaccination poses a far greater risk to both mother and fetus than receiving the vaccine. 6
- Emphasize that decades of use have shown no association with birth defects or pregnancy complications. 1, 4, 5
- Explain that rabies is uniformly fatal once symptoms develop, with essentially no survivors. 2, 7
- Reassure that the vaccine should not be a reason to consider termination of pregnancy if inadvertently given. 8