Vaccination in Pregnancy

Aka: Vaccination in Pregnancy, Immunization in Pregnancy, Vaccines in Pregnancy

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II. Prevention: Vaccinations

  1. See Prenatal Care
  2. Influenza Vaccine to all pregnant women (after first trimester)
  3. Hepatitis B Vaccine if non-immune and at risk of exposure
  4. Give Tdap at 27-36 weeks gestation in each pregnancy, regardless of interval (Pertussis protection)
    1. Allows time for maternal Pertussis antibodies to transfer to the baby (passive Immunity)
  5. RSV Vaccine
    1. Pfizer Bivalent RSVpreF Vaccine (Abrysvo) ONLY
      1. Do NOT use Arexvy in pregnant women (associated with Preterm Labor)
    2. Administer to unvaccinated mothers at 32 to 36 weeks, in September to January
      1. Allows for RSV passive Antibody protection in newborns and young infants
  6. Covid-19 Vaccine
    1. Administer during any trimester of each pregnancy (as soon as available for season)
  7. Rh Immune Globulin (RhoGAM) 300 mcg for Rh Negative, non-sensitized women
    1. Given at 28 weeks
    2. Given within 72 hours of delivery of an Rh Positive infant
    3. Given at times of risk of fetal-maternal transfusion (e.g. Amniocentesis, Abdominal Trauma, Vaginal Bleed, Miscarriage)
      1. RhoGAM is not needed if undergoing abortion or pregnancy loss <12 weeks (per ACOG, 2024)
        1. However, RhoGAM is still recommended in Ectopic Pregnancy <12 weeks or when dates are uncertain
        2. (2024) Obstet Gynecol 144(6): e140-3 +PMID: 39255498

  8. Other Vaccines if indicated
    1. Hepatitis A Vaccine
      1. Give if travel to endemic area or IVDA in pregnancy (or other risks)
    2. Hepatitis B Vaccine
      1. Administer in all pregnant patients if not previously immunized
    3. MenACWY Conjugate Vaccine (Meningococcal Vaccine)
      1. Standard indications (dormitory, barracks, travel)

III. Contraindications: Vaccines that are NOT recommended in pregnancy

  1. Live Vaccines (e.g. MMR Vaccine, Varicella Vaccine, intranasal flu Vaccine)
    1. Theoretical risk to fetus
  2. HPV Vaccine
    1. Has not been studied in pregnancy
    2. However, accidental human exposures have not been linked to birth defects or adverse pregnancy outcomes
  3. Serotype B Meningococcal Vaccine
    1. Generally avoided in pregnancy, but may be given in pregnancy if benefit outweighs risk
    2. However, MenACWY Conjugate Vaccine may be used in pregnancy when indicated based on risk
  4. Recombinant Zoster Vaccine (Shingrix)
    1. Not recommended for use in pregnancy

IV. Class C: Small risk in controlled animal studies

  1. Tdap (Tetanus Diptheria Acellular Pertussis Vaccine)
    1. Give Tdap at 27-36 weeks gestation in each pregnancy
    2. Allows time for maternal Pertussis antibodies to transfer to the newborn (passive Immunity)
    3. (2013) Ann Intern Med 158(3):191-9 [PubMed]
  2. Hepatitis A Vaccine
    1. Give if travel to endemic area or IVDA in pregnancy (or other risks)
  3. Hepatitis B Vaccine
    1. Administer in all pregnant patients if not previously immunized
  4. Influenza Vaccine
    1. Indicated if pregnant in Influenza season
    2. Immunize after first trimester
  5. MenACWY Conjugate Vaccine (Meningococcal Vaccine)
    1. Standard indications (dormitory, barracks, travel)
    2. Although MenACWYVaccine may be given, Serotype B Meningococcal Vaccine is generally avoided in pregnancy
      1. However Serotype B Meningococcal Vaccine may be given in pregnancy if benefit outweighs risk
  6. Plague Vaccine
  7. Polyvalent Pneumococcal Vaccine
    1. ACIP recommends avoiding during pregnancy
    2. Vaccinate high risk women before pregnancy (and may consider during pregnancy if benefit outweighs risk)
      1. Chronic illness (Diabetes Mellitus, persistent Asthma, chronic heart disease, Chronic Kidney Disease)
      2. Immune disorders (HIV Infections, Asplenia)
  8. Polio Vaccine (live and inactivated)
    1. Avoid during pregnancy in most cases
    2. Use IPV in pregnancy if high risk Polio exposure
  9. Rabies Vaccine
  10. Tularemia Vaccine
  11. Typhoid Vaccine

V. Class D: Strong evidence of risk to the human fetus

  1. Yellow Fever Vaccine

VI. Class X: Very high risk to the human fetus

  1. BCG vaccine (Bacille Calmette-Guerin Vaccine)
  2. MMR Vaccine (MeaslesVaccine, Mumps Vaccine, RubellaVaccine)
    1. Give MMR dose immediately post-delivery if Rubella non-immune
  3. Small Pox Vaccine
  4. TC-83 Venezuelan Equine EncephalitisVaccine
  5. Varicella Vaccine (Varivax)
    1. Risk if vaccinated within 4 weeks of conception
    2. Theoretic risk only; not an indication for EAB

VII. Resources

  1. CDC Guidelines for vaccinating pregnant women
    1. http://www.cdc.gov/nip/publications/preg_guide.htm

VIII. References

  1. (2026) Presc Lett 33(8): 1-3
  2. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
  3. Black (2003) Am Fam Physician 67(12):2517-24 [PubMed]
  4. Larimore (2000) Prim Care 27(1):35-53 [PubMed]
  5. Sur (2003) Am Fam Physician 68(2):299-304 [PubMed]

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