Publications > Guidelines > Vaccinating Pregnant Women
Guidelines for Vaccinating Pregnant Women
from Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Routine:

• Hepatitis A
• Hepatitis B
• Influenza (Inactivated)
• Influenza (LAIV)*
• Measles*
• Mumps*
• Pneumococcal
• Polio (IPV)
• Rubella*
• Tetanus/Diphtheria
• Varicella*

Travel & Other:

• Anthrax
• BCG*
• Japanese Encephalitis
• Meningococcal
• Rabies
• Typhoid (Parenteral & Ty21a*)
• Vaccinia*
• Yellow Fever*

Hepatitis A

• "The safety of hepatitis A vaccination during pregnancy has not been determined; however, because hepatitis A vaccine is produced from inactivated [hepatitis A virus], the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination should be weighed against the risk for hepatitis A in women who may be at high risk for exposure to [hepatitis A virus]." 1

Hepatitis B

• "On the basis of limited experience, there is no apparent risk of adverse effects to developing fetuses when hepatitis B vaccine is administered to pregnant women (CDC, unpublished data). The vaccine contains noninfectious HBsAg particles and should cause no risk to the fetus. [Hepatitis B virus] infection affecting a pregnant woman may result in severe disease for the mother and chronic infection for the newborn. Therefore, neither pregnancy nor lactation should be considered a contraindication to vaccination of women." 2
     
• "Hepatitis B vaccine is recommended for pregnant women at risk for hepatitis B virus infection . . ." 3

Influenza (Inactivated)

• "Because of the increased risk for influenza-related complications, women who will be pregnant during the influenza season should be vaccinated." 4
     
• "Vaccination can occur in any trimester." 4
     
• "One study of influenza immunization of >2,000 pregnant women demonstrated no adverse fetal effects associated with influenza vaccine." 4

• "The following populations should not be vaccinated with LAIV . . . pregnant women. (These persons should receive inactivated influenza vaccine.)" 5

Measles

• "Measles-mumps rubella (MMR) vaccine and its
  component vaccines should not be administered to
  women known to be pregnant. Because a risk to the
  fetus from administration of these live virus vaccines
  cannot be excluded for theoretical reasons, women
  should be counseled to avoid becoming pregnant for 28
  days after vaccination with measles or mumps vaccines
  or MMR or other rubella-containing vaccines." 6
    
• "If a pregnant woman is inadvertently vaccinated or if
  she becomes pregnant within four weeks after MMR . . .
  vaccination, she should be counseled regarding the
  theoretical basis of concern for the fetus; however,
  MMR . . . vaccination during pregnancy should not
  ordinarily be a reason to terminate pregnancy." 3

Mumps

• "Measles-mumps rubella (MMR) vaccine and its component vaccines should not be administered to women known to be pregnant. Because a risk to the fetus from administration of these live virus vaccines cannot be excluded for theoretical reasons, women should be counseled to avoid becoming pregnant for 28 days after vaccination with measles or mumps vaccines or MMR or other rubella-containing vaccines." 6
     
• "If a pregnant woman is inadvertently vaccinated or if she becomes pregnant within four weeks after MMR . . . vaccination, she should be counseled regarding the theoretical basis of concern for the fetus; however, MMR . . . vaccination during pregnancy should not ordinarily be a reason to terminate pregnancy." 3
  

Pneumococcal (PPV23)

• "The safety of pneumococcal polysaccharide vaccine during the first trimester of pregnancy has not been evaluated, although no adverse consequences have been reported among newborns whose mothers were inadvertently vaccinated during pregnancy." 7

Polio (IPV)

• "Although no adverse effects of IPV have been documented among pregnant women or their fetuses, vaccination of pregnant women should be avoided on theoretical grounds. However, if a pregnant woman is at increased risk for infection and requires immediate protection against polio, IPV can be administered in accordance with the recommended schedules for adults." 8
  

Rubella

• "Measles-mumps rubella (MMR) vaccine and its component vaccines should not be administered to women known to be pregnant. Because a risk to the fetus from administration of these live virus vaccines cannot be excluded for theoretical reasons, women should be counseled to avoid becoming pregnant for 28 days after vaccination with measles or mumps vaccines or MMR or other rubella-containing vaccines." 6
     
• "If a pregnant woman is inadvertently vaccinated or if she becomes pregnant within four weeks after MMR . . . vaccination, she should be counseled regarding the theoretical basis of concern for the fetus; however, MMR . . . vaccination during pregnancy should not ordinarily be a reason to terminate pregnancy." 3
     
• "Rubella-susceptible women who are not vaccinated because they state they are or may be pregnant should be counseled about the potential risk for CRS and the importance of being vaccinated as soon as they are no longer pregnant." 9
     
• A registry of susceptible women vaccinated with rubella vaccine between three months before and three months after conception - the "Vaccine in Pregnancy (VIP) Registry" - was kept between 1971 and 1989. No evidence of CRS occurred in the offspring of the 226 women who received the current RA 27/3 rubella vaccine and continued their pregnancy to term. 9
  

Tetanus & Diphtheria (Td)

• "Td toxoid is indicated routinely for pregnant women. Previously vaccinated pregnant women who have not received a Td vaccination within the last 10 years should receive a booster dose." 3
     
• "Pregnant women who are not immunized or only partially immunized against tetanus should complete the primary series." 3
     
• "Although no evidence exists that tetanus and diphtheria toxoids are teratogenic, waiting until the second trimester of pregnancy to administer Td is a reasonable precaution for minimizing any concern about the theoretical possibility of such reactions." 10

Varicella

• "The effects of the varicella virus vaccine on the fetus are unknown; therefore, pregnant women should not be vaccinated. Nonpregnant women who are vaccinated should avoid becoming pregnant for one month following each injection. For susceptible persons, having a pregnant household member is not a contraindication to vaccination." 11
     
• "Because the virulence of the attenuated virus used in the vaccine is less than that of the wild-type virus, the risk to the fetus, if any, should be even lower." 11
     
• "If a pregnant woman is inadvertently vaccinated or if she becomes pregnant within four weeks after . . . varicella vaccination, she should be counseled regarding the theoretical basis of concern for the fetus; however, . . . varicella vaccination during pregnancy should not ordinarily be a reason to terminate pregnancy." 3
     
• "VZIG [Varicella Zoster Immune Globulin] should be strongly considered for susceptible, pregnant women who have been exposed." 11
     
• The manufacturer & CDC have established a VARIVAX® Pregnancy Registry to monitor outcomes of women who got the vaccine three months before or any time during pregnancy. Call 1-800-986-8999.
  

Anthrax

• "No studies have been published regarding use of anthrax vaccine among pregnant women. Pregnant women should be vaccinated against anthrax only if the potential benefits of vaccination outweigh the potential risks to the fetus." 12
  

• "Although no harmful effects to the fetus have been associated with BCG vaccine, its use is not recommended during pregnancy." 13
  

• "No specific information is available on the safety of JE vaccine in pregnancy. Vaccination poses an unknown but theoretical risk to the developing fetus, and the vaccine should not be routinely administered during pregnancy." 14
     
• "Pregnant women who must travel to an area where risk of JE is high should be vaccinated when the theoretical risks of immunization are outweighed by the risk of infection to the mother and developing fetus." 14
  

• Studies have shown the vaccine to be both safe and efficacious when given to pregnant women. While high antibody levels were found in umbilical cord blood following vaccination during pregnancy, antibody levels in the infants decreased during the first few months after birth. Subsequent response to meningococcal vaccination was not affected.
     
• "Based on data from studies involving use of meningococcal vaccines administered during pregnancy, altering meningococcal vaccination recommendations during pregnancy is unnecessary." 15
  

• "Because of the potential consequences of inadequately treated rabies exposure, and because there is no indication that fetal abnormalities have been associated with rabies vaccination, pregnancy is not considered a contraindication to postexposure prophylaxis." 16
     
• "If the risk of exposure to rabies is substantial, preexposure prophylaxis might also be indicated during pregnancy." 16
  

• "No data have been reported on the use of any of the
  three typhoid vaccines among pregnant women." 17

• "Live-viral vaccines are contraindicated during pregnancy; therefore, vaccinia vaccine should not be administered to pregnant women for routine nonemergency indications." 18
     
• "However, vaccinia vaccine is not known to cause congenital malformations. Although <50 cases of fetal vaccinia infection have been reported, vaccinia virus has been reported to cause fetal infection on rare occasions, almost always after primary vaccination of the mother." 18
     
• "Pregnant women who have had a definite exposure to smallpox virus (i.e., face-to-face, household, or close-proximity contact with a smallpox patient) and are, therefore, at high risk for contracting the disease, should . . . be vaccinated. Smallpox infection among pregnant women has been reported to result in a more severe infection than among nonpregnant women. Therefore the risks to the mother and fetus from experiencing clinical smallpox substantially outweigh
  any potential risks regarding vaccination. In addition, vaccinia virus has not been documented to be teratogenic, and the incidence of fetal vaccinia is low." 18
     
• "When the level of exposure risk is undetermined, the decision to vaccinate should be made after assessment by the clinician and the patient of the potential risks versus the benefits of smallpox vaccination." 18
  

• "The safety of yellow fever vaccination during
  pregnancy has not been established, and the vaccine
  should be administered only if travel to an endemic
  area is unavoidable and if an increased risk for
  exposure exists." 19
     
• ". . . infection of the fetus with YF17D apparently occurs
  at a low rate . . . and has not been associated with
  congenital anomalies." 19
     
• "If international travel requirements are the only reason
  to vaccinate a pregnant woman, rather than an increased
  risk of infection, efforts should be made to obtain a
  waiver letter from the traveler's physician." 19
     
• "Pregnant women who must travel to areas where the
  risk of yellow fever is high should be vaccinated and,
  despite the apparent safety of this vaccine, infants born
  to these women should be monitored closely for
  evidence of congenital infection and other possible
  adverse effects resulting from yellow fever
  vaccination" 19
     
• "If vaccination of a pregnant woman is deemed
  necessary, serologic testing to document an immune
  response to the vaccine can be considered, because the
  seroconversion rate for pregnant women in a developing
  nation has been reported to be substantially lower than
  that observed for other healthy adults and children. To
  discuss the need for serologic testing, the appropriate
  state health department or the Division of Vector-Borne
  Infectious Diseases (telephone: 970-221-6400) or the
  Division of Global Migration and Quarantine (telephone:
  404-639-1600) at CDC should be contacted." 19
  

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