What vaccines are recommended and which live‑attenuated vaccines should be avoided in pregnant women?

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Last updated: February 12, 2026 • View editorial policy

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Vaccination During Pregnancy

Direct Answer

All pregnant women should receive inactivated influenza vaccine during any trimester and Tdap vaccine between 27-36 weeks of gestation in every pregnancy, while live attenuated vaccines (MMR, varicella, live influenza nasal spray, and zoster) are absolutely contraindicated due to theoretical risk of placental viral transmission. 1, 2

Routinely Recommended Vaccines for All Pregnant Women

Inactivated Influenza Vaccine

  • Administer during any trimester of pregnancy, ideally before flu season begins 1
  • Pregnant women face significantly higher risk for severe disease, hospitalization, and death from influenza compared to non-pregnant women 1
  • Influenza infection during pregnancy is associated with late pregnancy loss and reduced infant birthweight 1
  • The live attenuated influenza vaccine (nasal spray/LAIV) is absolutely contraindicated during pregnancy 1, 2

Tdap Vaccine (Tetanus, Diphtheria, Pertussis)

  • Administer between 27-36 weeks of gestation in every pregnancy, with optimal timing at 27-28 weeks to maximize maternal antibody response and passive antibody transfer to the infant 1, 3
  • This recommendation applies to every pregnancy regardless of prior vaccination history 1
  • If not administered during pregnancy, give immediately postpartum 1
  • For wound management during pregnancy, Tdap should replace Td if ≥5 years since previous booster 1

RSV Vaccine (Newer Recommendation)

  • Administer RSVPreF between weeks 24-36 of gestation, preferably between weeks 32-36 3

COVID-19 Vaccine

  • Recommended during any trimester of pregnancy and up to 6 months postpartum in women not vaccinated during pregnancy 3

Absolutely Contraindicated Vaccines (Live Attenuated)

Live attenuated vaccines pose theoretical risk of placental transmission and fetal infection and should never be administered during pregnancy. 1, 2

These include:

  • Measles, Mumps, Rubella (MMR) 1, 2
  • Varicella (chickenpox) 1, 2
  • Live attenuated influenza vaccine (nasal spray/LAIV) 1, 2
  • Live attenuated zoster vaccine (Zostavax) 1, 2
  • Oral polio vaccine (OPV) 2
  • Live attenuated cholera vaccine 2
  • Smallpox (vaccinia) 1

Critical Caveat

  • 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 2, 4
  • Women who receive live vaccines should be counseled to delay pregnancy for at least 4 weeks (one month) 5, 4

Vaccines to Delay Until After Pregnancy (Precautionary, Not Absolute Contraindications)

  • HPV vaccine should be delayed until after pregnancy 1, 2
  • Recombinant zoster vaccine (Shingrix) should be delayed until after pregnancy 1, 2

Vaccines Recommended for High-Risk Situations

Hepatitis B Vaccine

  • Recommended for pregnant women at risk for hepatitis B virus infection (multiple sexual partners, partner with hepatitis B, injection drug use, household contact with chronically infected person) 5, 1, 2
  • Safe throughout all trimesters; contains non-infectious hepatitis B surface antigen particles 1
  • Standard three-dose series (0,1,6 months) may be initiated and completed during pregnancy 1
  • Must be administered intramuscularly in the deltoid muscle; buttock administration markedly reduces immunogenicity 1

Hepatitis A Vaccine

  • Should be considered for pregnant women at increased risk 5, 1

Pneumococcal Vaccines

  • Should be considered for pregnant women at increased risk 5, 1, 2

Meningococcal Vaccines (Conjugate and Polysaccharide)

  • Recommended for pregnant women with additional risk factors; pregnancy should not preclude their use when otherwise indicated 5, 1, 2

Yellow Fever Vaccine

  • Should be administered to pregnant women who must travel to high-risk areas, as the risk of infection outweighs theoretical vaccination risks 1

Inactivated Polio Vaccine (IPV)

  • Can be administered to pregnant women at risk for exposure to wild-type poliovirus infection 5

Rabies Vaccine (Inactivated)

  • Safe and recommended for post-exposure prophylaxis given the nearly 100% fatality rate of rabies 2

Post-Exposure Prophylaxis During Pregnancy

Hepatitis B Exposure

  • Sexual contacts of individuals with acute hepatitis B should receive hepatitis B immune globulin (HBIG) and begin the vaccine series within 14 days, irrespective of pregnancy status 1
  • Combined HBIG + vaccine PEP is more effective than vaccine alone 1
  • Pregnancy does not modify the standard PEP protocol 1

Postpartum Vaccination Recommendations

Women susceptible to rubella and varicella should be vaccinated immediately after delivery. 1, 2

Additional postpartum vaccines if not given during pregnancy:

  • Influenza vaccine 1
  • Tdap vaccine 1
  • HPV vaccine 6

Vaccination of Close Contacts and Household Members

Safe for Contacts

  • MMR and varicella vaccines should be administered when indicated to children and other household contacts of pregnant women 7
  • MMR vaccines do not transmit vaccine viruses to contacts 7
  • Varicella vaccine has an extremely rare transmission rate 7

Special Consideration for Varicella

  • If a varicella-like rash with vesicles develops at the injection site in a contact, isolation is recommended and varicella-zoster immune globulin (VZIG) may be administered prophylactically to the pregnant woman 7

Exception

  • Oral poliovirus vaccine (OPV) should not be given to close contacts of pregnant women, as live poliovirus is shed by vaccinees 7

Breastfeeding and Vaccination

  • Neither inactivated nor live vaccines administered to a lactating woman affect the safety of breastfeeding 5, 1
  • Breastfeeding does not adversely affect immunization and is not a contraindication for any vaccine, with the exception of smallpox vaccine 5
  • Hepatitis B vaccination is not contraindicated for breastfeeding individuals 1

Common Pitfalls to Avoid

  • Do not delay influenza vaccination until a specific trimester - it can be given at any time during pregnancy 1
  • Do not miss the optimal window (27-36 weeks) for Tdap administration 1
  • Do not confuse live attenuated influenza vaccine (contraindicated) with inactivated influenza vaccine (strongly recommended) 2
  • Do not postpone hepatitis B vaccination in pregnant individuals at risk due to unfounded safety concerns 1
  • Do not administer hepatitis B vaccine in the buttock, as this significantly lowers immunogenicity 1
  • Do not restart the hepatitis B vaccination series if a dose is missed; simply administer the missed dose promptly 1
  • Do not delay vaccination of children or household contacts due to the presence of a pregnant woman, as this exposes the woman to greater risk of natural infection 7
  • Do not counsel pregnancy termination for women who inadvertently received live vaccines during pregnancy 2, 4

Pre-Pregnancy Counseling

  • All pregnant women should be evaluated for immunity to rubella and tested for HBsAg in every pregnancy 1
  • During pre-pregnancy counseling, vaccination for MMR should be offered, with advice to avoid pregnancy for one month 6, 4
  • All women of childbearing age should be evaluated for the possibility of pregnancy before immunization 4

References

1
Guideline

Vaccination Recommendations During Pregnancy

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Vaccines Contraindicated in Pregnancy

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Research

Immunization in pregnancy.

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2008

5
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

6
Research

Vaccines - safety in pregnancy.

Best practice & research. Clinical obstetrics & gynaecology, 2021

7
Guideline

Vaccination of Close Contacts of Pregnant Women

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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