Vaccines Contraindicated in Pregnancy
Live attenuated vaccines are contraindicated during pregnancy due to the theoretical risk of placental transmission and fetal infection, while inactivated vaccines are generally safe and some are routinely recommended. 1
Live Attenuated Vaccines - Absolutely Contraindicated
The following live attenuated vaccines should never be administered during pregnancy:
- Measles, Mumps, Rubella (MMR) - contraindicated due to theoretical risk of fetal viremia 1, 2
- Varicella (chickenpox) - contraindicated due to theoretical risk of fetal infection 1, 2
- Live attenuated influenza vaccine (nasal spray/LAIV) - contraindicated, though the inactivated injectable form is strongly recommended 1, 3
- Live attenuated zoster vaccine (Zostavax) - absolutely contraindicated due to theoretical risk of placental viral transmission 1
- Smallpox (vaccinia) - contraindicated except in extraordinary circumstances 1
- Live attenuated cholera vaccine - contraindicated (inactivated form is safe) 4
- Oral polio vaccine (live attenuated) - contraindicated, though inactivated IPV is safe 4
- Live attenuated hepatitis A vaccine - contraindicated (inactivated form is safe) 4
- Live attenuated Japanese encephalitis vaccine - contraindicated (inactivated form may be considered for high-risk travel) 4
Important Clinical Caveats
Inadvertent Administration
- Women who inadvertently receive live vaccines during pregnancy should NOT be counseled to terminate the pregnancy based on teratogenic risk, as actual documented harm is rare 5
- For example, no adverse birth outcomes have been reported in women who received oral polio vaccine during pregnancy despite its contraindication 4
Pre-Pregnancy Planning
- Women of childbearing age who receive live vaccines (particularly MMR and varicella) should be counseled to delay pregnancy for at least 4 weeks after vaccination 5
- All pregnant women should be evaluated for immunity to rubella and those found susceptible should be vaccinated immediately after delivery 1
Vaccines to Delay (Not Absolute Contraindications)
- HPV vaccine - should be delayed until after pregnancy as a precautionary measure, though not an absolute contraindication 1
- Recombinant zoster vaccine (Shingrix) - should be delayed until after pregnancy if indicated, unlike the live vaccine which is absolutely contraindicated 1
Safe Vaccines During Pregnancy
For context, the following are safe and often recommended during pregnancy:
- Inactivated influenza vaccine - strongly recommended during any trimester 1, 2
- Tdap vaccine - strongly recommended between 27-36 weeks gestation in every pregnancy 1, 2
- Hepatitis B vaccine - safe for high-risk women 1, 2
- Pneumococcal vaccines - safe when clinically indicated 4
- Meningococcal vaccines - safe for high-risk women 1, 2
- Rabies vaccine (inactivated) - safe and recommended for post-exposure prophylaxis given the nearly 100% fatality rate of rabies 6
Common Pitfalls to Avoid
- Assuming all vaccines are contraindicated in pregnancy - only live attenuated vaccines are contraindicated; many inactivated vaccines are safe and beneficial 2, 7
- Recommending pregnancy termination after inadvertent live vaccine administration - the theoretical risk does not justify this recommendation 5
- Failing to vaccinate immediately postpartum - women who are susceptible to rubella or varicella should receive these vaccines before hospital discharge 1
- Confusing live attenuated influenza vaccine (contraindicated) with inactivated influenza vaccine (strongly recommended) - ensure the correct formulation is used 1, 3