Pregnancy Immunization Recommendations

Whether your office provides immunizations or you refer out for them, vaccines play an important role in keeing a pregnant woman and her baby healthy before, during, and after pregnancy.

Before Pregnancy

Before becoming pregnant, a woman should be up-to-date on routine adult immunizations. The Center’s for Disease Control and Prevention’s Immunizations and Pregnancy Vaccines Chart outlines recommendations that can be used to help assess the immunizations your patient needs.  You may want to check if your patient has a yellow immunization record of her immunization history. 

Of particular importance are:

• Tdap (tetanus, diphtheria, pertussis) – this is important for preventing pertussis (whooping cough) and can be given if it has been 2 years, or less in some cases, since the most recent Td vaccine.  It should be given in place of Td vaccine, when tetanus protection is indicated.
• MMR (measles, mumps, rubella)
• varicella
• influenza – if your patient might be pregnant during flu season
• hepatitis B 

Live vaccines (including MMR and varicella) should be given a month or more before pregnancy. Inactivated vaccines can be given before or during pregnancy, as needed.

HPV vaccine is recommended for females from 11 through 26 years of age. More research is needed about HPV vaccine and pregnancy.  For now, pregnant women should wait until their pregnancy is over before getting the vaccine. If a woman finds out she is pregnant after she has started getting the vaccine series, she should wait until her pregnancy is over before finishing the three-dose series.

During Pregnancy

Flu Vaccine
It is safe, and very important, for a pregnant woman to receive the inactivated flu vaccine. A pregnant woman who gets the flu is at risk for serious complications and hospitalization. In California, the influenza vaccine given to pregnant women is preservative-free. 

Pregnant women should not be vaccinated with live, attenuated influenza vaccine (LAIV), the influenza nasal spray vaccine.

Learn more about pregnancy and influenza vaccine recommendations.

Travel
Many vaccine-preventable diseases, rarely seen in the United States, are still common in other parts of the world. Information about travel vaccines can be found at CDC’s traveler’s health website.

After Pregnancy

Some immunizations should be given in the hospital before discharge to protect your patient from diseases that can be dangerous if spread to her newborn or to future babies. It is safe for a woman to receive vaccines right after giving birth, even while she is breastfeeding.

Pertussis and Influenza
Babies can get very sick from pertussis and influenza, but are too young to be immunized. 

A woman who has not received the new vaccine for the prevention of tetanus, diphtheria, and pertussis (Tdap) should be vaccinated right after delivery.  A woman may receive Tdap at an interval as short as 2 years, or less in some cases, since the most recent Td vaccine.  Vaccinating a new mother against pertussis (whooping cough) also reduces the risk to her infant.  Learn more about the new Tdap recommendations on preventing tetanus, diphtheria, and pertussis among your pregnant and postpartum patients and their infants.

In order to further protect your patient’s newborn, Tdap and influenza vaccine are needed for:

• anyone who lives with,
• or takes care of her baby.

MMR and Varicella
A woman who is not immune to measles, mumps, or rubella should be vaccinated with MMR before leaving the hospital.  Your patient should also receive varicella vaccine before discharge if she does not have evidence of immunity. 

If the first-ever dose of MMR or varicella vaccine is given after delivery, then the 2nd doses should be given 4-8 weeks later.

California Vaccines for Children (VFC) Program

The California Vaccines for Children (VFC) program helps families by providing free vaccines to doctors who serve eligible children through age 18 years.  That way, children can get the routine immunizations they need at little or no out-of-pocket cost to the family. 

California Thimerosal (Mercury) Law

The new Mercury-Free Act took effect on July 1, 2006. The Act prohibits administering vaccines containing more than trace thimerosal preservative to pregnant women or to children under age three.