Vaccines for Non-Immune Pregnant Women
If you are pregnant and not immune to rubella or varicella, you should NOT receive these vaccines during pregnancy—they are contraindicated and must be given immediately after delivery. 1, 2
Key Principle: Live vs. Inactivated Vaccines
The fundamental rule is straightforward: live attenuated vaccines are absolutely contraindicated during pregnancy, while inactivated vaccines are safe and should be given when indicated. 1, 2, 3
Live Vaccines - Contraindicated During Pregnancy
If you lack immunity to these diseases, you cannot receive vaccination until after delivery:
MMR (Measles, Mumps, Rubella): Absolutely contraindicated during pregnancy despite theoretical concerns only—no actual cases of congenital rubella syndrome have been documented in women inadvertently vaccinated during pregnancy. 1, 2
Varicella (Chickenpox): Contraindicated during pregnancy, though again no congenital varicella syndrome has been observed in inadvertently vaccinated pregnant women. 1, 2
Live Attenuated Influenza Vaccine (LAIV/nasal spray): Contraindicated—you must receive the inactivated injectable form instead. 2
Critical Action Point: All pregnant women should be evaluated for immunity to rubella and varicella at the first prenatal visit. 1 If non-immune, these vaccines should be administered immediately postpartum before hospital discharge. 1
Inactivated Vaccines - Safe and Recommended for Non-Immune Pregnant Women
If you lack immunity or adequate vaccination history for these diseases, you should receive them during pregnancy:
Routinely Recommended for ALL Pregnant Women
Tdap (Tetanus, Diphtheria, Pertussis): Recommended at 27-36 weeks gestation in every pregnancy, regardless of prior vaccination status. 4, 5, 6 If you have never completed a primary tetanus series (3 doses), you should complete it during pregnancy. 1
Inactivated Influenza Vaccine: Recommended in any trimester for all pregnant women during flu season. 1, 6
For Non-Immune Women at High Risk
If you lack immunity and have specific risk factors, these vaccines should be administered:
Hepatitis B: Recommended for pregnant women at high risk of HBV infection or who desire vaccination. 1 All pregnant women should be tested for HBsAg; if negative and at risk, vaccination is safe during pregnancy. 1
Hepatitis A: Can be given after consideration of exposure risks if you are non-immune and at increased risk. 1
Pneumococcal (polysaccharide): Should be considered for non-immune women at increased risk of pneumococcal infection. 1
Meningococcal (conjugate or polysaccharide): Should be considered for non-immune women at high risk or during outbreaks. 1
Inactivated Polio (IPV): Can be administered to pregnant women at risk for exposure to wild-type poliovirus. 1
Special Circumstances
Yellow Fever: Despite being a live vaccine, it should be given to pregnant women traveling to high-risk areas because the risk of yellow fever infection substantially outweighs the theoretical vaccine risk. 1
Rabies: Post-exposure prophylaxis with inactivated rabies vaccine is safe and should never be withheld during pregnancy given rabies' near-100% fatality rate. 1, 2
Common Pitfalls to Avoid
Do not confuse live attenuated influenza vaccine (nasal spray) with inactivated influenza vaccine (injection)—only the injectable form is safe during pregnancy. 2
Do not delay postpartum MMR/varicella vaccination—these should be given before hospital discharge if the woman is non-immune. 1, 2
Do not terminate pregnancy if live vaccines were inadvertently given—no documented cases of fetal harm from MMR or varicella vaccines have been reported despite theoretical concerns. 1, 2
Do not withhold Tdap waiting for "the right trimester"—while 27-36 weeks is optimal, if a woman has never received tetanus vaccination, the primary series should be started immediately. 1