Guidelines for Vaccinating Pregnant Women

*Live attenuated vaccine

¹Hepatitis A Vaccine: Weigh risk vs. benefit in pregnant women at high risk for exposure.

²Hepatitis B Vaccine: Vaccination is recommended for all previously unvaccinated pregnant adults. Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data.

³Human Papillomavirus (HPV) Vaccine: HPV vaccines are not recommended for use in pregnant women. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3‑dose series should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination. If a vaccine dose has been administered during pregnancy, no intervention is needed.

⁴Inactivated Influenza Vaccine (IIV): Women who are or will be pregnant during influenza season should receive IIV. Age appropriate vaccine formulation must be given.

⁵Meningococcal (MenACWY) Vaccine and Meningococcal B Vaccines: Pregnancy should not preclude vaccination with MenACWY, if indicated. Defer vaccination with MenB vaccine unless benefits outweigh risks.

⁶Pneumococcal Conjugate Vaccine (PCV13, PCV15, PCV20): ACIP currently has no recommendation for PCV vaccination but ACOG recommends vaccination in pregnant patients at high risk for severe pneumococcal disease.

⁷Pneumococcal Polysaccharide Vaccine (PPSV23): The safety of PPV23 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.

⁸Inactivated Polio Vaccine (IPV): 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, IPV can be administered in accordance with the recommended schedules for adults.

⁹Tetanus, Diphtheria, acellular Pertussis (Tdap) Vaccine: One dose of Tdap should be administered during each pregnancy irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks of gestation although Tdap may be given at any time during pregnancy. For women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, Tdap should be administered immediately postpartum. Wound Management: If a Td booster is indicated for a pregnant woman, Tdap should be administered. Unknown or Incomplete Tetanus Vaccination: Pregnant women who never have been vaccinated against tetanus should receive three doses containing tetanus and reduced diphtheria toxoids. The recommended schedule is 0, 4 weeks and 6 through 12 months. Tdap should replace 1 dose of Td, preferably between 27 and 36 weeks gestation.

¹⁰Anthrax Vaccine: In a pre-event setting with low risk for exposure to aerosolized B. anthracis spores, vaccination of pregnant women is not recommended and should be deferred until after pregnancy. In a post-event setting with a high risk of exposure, pregnancy is neither a precaution nor a contraindication to PEP. Pregnant women at risk for inhalation anthrax should receive AVA and 60 days of antimicrobial therapy as described.

¹¹Japanese Encephalitis (JE) Vaccine: No controlled studies have assessed the safety, immunogenicity, or efficacy of Ixiaro in pregnant women. Vaccination during pregnancy may be considered if travel to an area with endemic infection is unavoidable and risk of disease outweighs risk of adverse effects in pregnancy.

¹²Rabies Vaccine: Because of the potential consequences of inadequately managed rabies exposure, pregnancy is not considered a contraindication to post-exposure prophylaxis. If risk of exposure to rabies is substantial, pre-exposure prophylaxis might be indicated during pregnancy.

¹³Typhoid Vaccine: No data have been reported on the use of any of the typhoid vaccines in pregnancy. Vi polysaccharide vaccine should be given to pregnant women if clearly needed.

¹⁴Vaccinia (smallpox) Vaccine: Should not be administered in a pre-event setting to pregnant women or to women who are trying to become pregnant. If a pregnant woman is inadvertently vaccinated or if she becomes pregnant within 4 weeks after smallpox vaccination, she should be counseled regarding concern for the fetus. Smallpox vaccination during pregnancy should not be a reason to terminate pregnancy. Pregnant women who have had a definite exposure to smallpox virus (ie, 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. 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.

¹⁵Yellow Fever Vaccine: Pregnancy is a precaution for YF vaccine administration. If travel is unavoidable, and the risks for YFV exposure outweigh the vaccination risks, a pregnant woman should be vaccinated. If the risks for vaccination outweigh the risks for YFV exposure, pregnant women should be issued a medical waiver to fulfill health regulations. Although no specific data are available, a woman should wait 4 weeks after receiving YF vaccine before conceiving.

¹⁶COVID-19 Vaccine:Vaccination is recommended for all pregnant patients, those who might become pregnant, recently pregnant or breastfeeding. A growing body of evidence on safety and efficacy of vaccination indicates that benefits outweigh any potential risks. Those unvaccinated prior to pregnancy or previously received only monovalent vaccine are recommended to receive bivalent mRNA vaccine.

¹⁷Zoster Vaccine (RZV): Consider delaying vaccination until after pregnancy due to insufficient data. The live attenuated vaccine (ZVL) is no longer available.