Patient education: Vaccination during pregnancy (Beyond the Basics)
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Peter F Weller, MD, MACP
Peter F Weller, MD, MACP
- Editor-in-Chief — Infectious Diseases
- Section Editor — Tropical Medicine
- William Bosworth Castle Professor of Medicine
- Harvard Medical School
- Professor of Immunology and Infectious Diseases
- Harvard T. H. Chan School of Public Health
Vaccines work by stimulating the immune system to produce antibodies, which can fight infections and prevent you from becoming ill. Some immunizations are safe to give during pregnancy, while others should be given at least one month before becoming pregnant. Some immunizations are recommended for all women during pregnancy, while others may be recommended for women who are at high risk of becoming infected during pregnancy, but are not recommended for pregnant women at low risk of infection.
Immunizations for nonpregnant adults are discussed separately. (See "Patient education: Adult vaccines (Beyond the Basics)".)
VACCINES RECOMMENDED BEFORE PREGNANCY
Women planning pregnancy should have received all routine vaccinations as recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). (See "Patient education: Adult vaccines (Beyond the Basics)" and "Standard immunizations for children and adolescents".)
The measles, mumps, rubella, and chickenpox (varicella) vaccines are particularly important for women of childbearing age who are susceptible to these infections and who may become pregnant because these vaccines are contraindicated during pregnancy, and infection occurring in nonimmune pregnant women can adversely affect pregnancy outcome. Most American women of childbearing age are immune to these infections because of routine vaccinations given during childhood. (See "Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)".)
Measles, mumps, rubella (MMR) — Your health care provider can determine if you are immune to these infections by performing a blood test. If you are not immune, you should have the MMR vaccine at least one month before becoming pregnant. Contracting a measles, mumps, or rubella (German measles) infection in early pregnancy can cause miscarriage. Rubella infection in early pregnancy can also cause severe birth defects, including deafness and defects involving the eyes, heart, and/or brain. Maternal infection in the second half of pregnancy is unlikely to cause these problems.
Varicella (chickenpox) — Becoming infected with chickenpox (varicella) during pregnancy, especially early pregnancy, increases the risk of birth defects. Chickenpox anytime in pregnancy can cause serious complications for the pregnant woman, such as pneumonia.
If you have never had chickenpox or the varicella vaccine, your health care provider can determine if you are immune by performing a blood test. If you are not immune, you should have the varicella vaccine at least one month before becoming pregnant.
If you are not immune to varicella and are exposed to someone with chickenpox while pregnant, contact your health care provider as soon as possible. There is a treatment called varicella-zoster immune globulin (VariZIG) that can help to reduce the risk of becoming infected with chickenpox. VariZIG can be given within 10 days of exposure, but should be given as soon as possible.
Shingles is much less contagious than chickenpox and usually requires very close contact or direct exposure to open skin lesions for transmission to occur. If you are not immune to varicella and have been exposed to someone with shingles, you should call your health care provider and he/she will decide whether treatment with VariZIG is appropriate. (See "Varicella-zoster virus infection in pregnancy".)
Human papillomavirus — The human papillomavirus (HPV) vaccine is recommended for nonpregnant girls and women 9 to 26 years of age. Administration of the HPV vaccine during pregnancy is not recommended, although evidence suggests it is safe if pregnant women receive it inadvertently.
VACCINES RECOMMENDED FOR ALL WOMEN IN EVERY PREGNANCY
Influenza (flu) — Pregnant women are at especially high risk of developing complications of the flu. Vaccination against the seasonal flu is recommended for all women who are or will be pregnant during influenza season. Influenza vaccine injection (flu shot) during pregnancy has no known harmful effects on the unborn baby, and can help protect the baby from influenza in the first six months after birth, before the baby is eligible for the flu vaccine. The nasal spray influenza vaccine should be avoided because it is made from a live virus. (See "Patient education: Influenza prevention (Beyond the Basics)".)
Tetanus, diphtheria, and pertussis — The tetanus, diphtheria, acellular pertussis (Tdap) vaccine is recommended for pregnant women in each pregnancy, and should be given as early as possible between 27 and 36 weeks of gestation, to help protect the newborn from pertussis infection. (See "Immunizations during pregnancy".)
VACCINES RECOMMENDED FOR SELECTED PREGNANT WOMEN
Pregnant women who are at high risk of certain infections due to travel or other circumstance should consider additional vaccines.
Hepatitis A — Hepatitis A is a virus that can cause severe illness in pregnant women and can be passed to the fetus. The vaccine carries no known risks to the developing fetus.
The hepatitis A vaccine is recommended for pregnant women who are at risk for developing the illness. (See "Patient education: Hepatitis A (Beyond the Basics)".)
Hepatitis B — Hepatitis B is a serious infection that causes inflammation of the liver. A series of three hepatitis B vaccines is now routinely given during childhood, although many adults have not been vaccinated. The vaccine carries no known risks to the developing fetus.
The hepatitis B vaccine is recommended for pregnant women who are at high risk for acquiring hepatitis B during pregnancy (eg, unimmunized women who live with someone infected with hepatitis B), and also for women who started the immunization series before becoming pregnant. (See "Patient education: Hepatitis B (Beyond the Basics)".)
Poliomyelitis — Poliomyelitis (polio) is caused by a virus that can lead to permanent paralysis. Polio has been eliminated from the Americas and most other developed countries, but a number of other countries are still affected by large polio outbreaks. Pregnant women should avoid travel, if possible, to areas where polio is present. (See "Patient education: General travel advice (Beyond the Basics)".)
A vaccine is available to prevent polio. However, polio vaccination is not usually recommended during pregnancy due to a lack of information about the vaccine's safety. If travel to an area where polio is prevalent is not avoidable, you should be immunized with the inactivated polio vaccine (IPV). (See "Poliovirus vaccination".)
Pneumococcus — Pneumococci are bacteria that are the leading cause of pneumonia and a number of other infections, including otitis media (ear infection) and meningitis. Women at high risk for pneumococcal infections should be given the pneumococcal vaccine.
Ideally, the vaccine should be given before pregnancy. However, the pneumococcus vaccine appears to be safe when given in the second and third trimesters (there is not enough information about the safety of the vaccine during the first trimester). (See "Immunizations during pregnancy".)
Yellow fever — Yellow fever is a viral disease transmitted by mosquitoes. It is associated with liver and kidney damage and hemorrhage, and often leads to death. The disease occurs in tropical regions of South America and sub-Saharan Africa; these areas should be avoided during pregnancy, if possible.
If travel is not avoidable and the risk of yellow fever is high, immunization with a live virus vaccine may be considered. You should consult an infectious disease specialist if yellow fever vaccination is needed. (See "Immunizations during pregnancy".)
Other immunizations — Vaccines against a number of other infections are available, including cholera, meningococcus, plague, rabies, Japanese encephalitis, typhoid, smallpox, and Haemophilus influenzae B. A health care provider can determine the risk of exposure to these illnesses and the need for immunization during pregnancy. (See "Immunizations during pregnancy".)
Zoster vaccine should not be administered to pregnant women as it is a live vaccine. Although it is indicated for patients ≥50 years of age, which is past the age of natural childbearing, childbearing with use of assisted reproductive techniques occurs in this age group.
WHERE TO GET MORE INFORMATION
Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Vaccines and pregnancy (The Basics)
Patient education: Avoiding infections in pregnancy (The Basics)
Patient education: Vaccines (The Basics)
Patient education: Vaccines for adults (The Basics)
Patient education: How to plan and prepare for a healthy pregnancy (The Basics)
Patient education: Group B streptococcal disease (The Basics)
Patient education: Rubella (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Avoiding infections in pregnancy (Beyond the Basics)
Patient education: Adult vaccines (Beyond the Basics)
Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)
Patient education: Influenza prevention (Beyond the Basics)
Patient education: Hepatitis A (Beyond the Basics)
Patient education: Hepatitis B (Beyond the Basics)
Patient education: General travel advice (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Approach to immunizations in healthy adults
Hepatitis B virus vaccination
Immunizations during pregnancy
Rubella in pregnancy
Seasonal influenza vaccination in adults
Varicella-zoster virus infection in pregnancy
The following organizations also provide reliable health information.
●National Library of Medicine
●Centers for Disease Control and Prevention (CDC)
Toll-free: (800) 311-3435
●Infectious Diseases Society of America
- Committee on Obstetric Practice. ACOG Committee Opinion No. 521: Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Obstet Gynecol 2012; 119:690.
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 468: Influenza vaccination during pregnancy. Obstet Gynecol 2010; 116:1006.
- Centers for Disease Control and Prevention. Guidelines for vaccinating pregnant women. http://www.cdc.gov/vaccines/pubs/preg-guide.htm (Accessed on January 03, 2013).
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.