Rabies Vaccine is Safe During Pregnancy
The rabies vaccine does NOT cause fetal abnormalities and should be administered to pregnant women whenever indicated—pregnancy is not a contraindication to either post-exposure or pre-exposure rabies prophylaxis. 1, 2
Evidence Against Fetal Abnormalities
The claim that rabies vaccination causes birth defects is definitively refuted by multiple authoritative sources:
The CDC explicitly states that "there is no indication that fetal abnormalities have been associated with rabies vaccination" and therefore pregnancy is not considered a contraindication to postexposure prophylaxis. 1
No increased incidence of abortion, premature births, or fetal abnormalities has been documented in association with rabies vaccination during pregnancy. 2
The largest prospective study of 202 pregnant Thai women who received postexposure rabies treatment found no congenital anomalies and confirmed that tissue culture-derived rabies vaccines and immune globulins are safe during pregnancy. 3
A study of 29 pregnant women vaccinated with purified vero cell rabies vaccine found normal intrauterine growth, satisfactory pregnancy outcomes, no congenital anomalies, and healthy infants with normal development during one-year follow-up. 4
Another study of 21 pregnant patients receiving postexposure vaccination reported no congenital malformations, with all infants well after one year (one spontaneous abortion occurred, which is within the baseline population rate). 5
Clinical Decision Algorithm
For Post-Exposure Situations:
- Always administer complete post-exposure prophylaxis (rabies vaccine + rabies immunoglobulin) immediately, regardless of pregnancy status. 2
- The consequences of inadequately treated rabies exposure (nearly 100% fatal) far outweigh any theoretical risks. 2
- Use standard dosing with no modifications needed for pregnancy. 2
For Pre-Exposure Prophylaxis:
- Administer pre-exposure vaccination if there is substantial risk of rabies exposure (veterinarians, animal handlers, laboratory workers, travelers to endemic areas). 2, 6
- The same safety profile demonstrated in post-exposure studies supports pre-exposure use. 2
- The inactivated virus platform used in rabies vaccines is inherently safer in pregnancy compared to live attenuated vaccines. 2
Important Caveats
Rabies immunoglobulin should never be administered intravenously—only intramuscularly—due to potential for serious reactions. 7
Once rabies develops clinically, mortality is virtually 100%, making prevention absolutely critical. 2, 8
The standard vaccination schedule should be followed without delay—treatment should never be withheld or postponed due to pregnancy. 3
Adverse reactions in pregnant women are mild, transient, and similar to those in non-pregnant patients (myalgia, malaise, injection site reactions). 5, 3