Vaccines in Pregnancy: What’s Recommended and When?

Top Takeaways

• Routinely recommend 3 vaccines during pregnancy: Tdap, influenza, and COVID-19.

• Screen for other vaccines which may be appropriate based on individual risk factors or history and that are safe to give during pregnancy (respiratory syncytial virus [RSV], hepatitis B, etc).

• Avoid live vaccines (MMR, etc) in pregnancy due to theoretical risk to the fetus, and defer certain vaccines (zoster, etc) until after delivery.

You’re in a prime position to help ensure pregnant patients get the right vaccines at the right times.

Use recommendations from Health Canada and our table below to guide your discussions...and continue to follow your provincial guidelines.

Routinely recommend 3 vaccines during pregnancy: Tdap for pertussis protection...influenza...and COVID-19.

For Tdap, recommend 1 dose of Adacel or Boostrix between weeks 27 and 32 of EACH pregnancy...regardless of the time of year.

Continue to recommend inactivated flu vaccine and an updated COVID-19 vaccine, ideally in early fall for patients in ANY trimester. Evidence continues to demonstrate that this is safe...and also helps protect the infant who can’t receive these vaccines until 6 months of age.

Screen for additional vaccines based on risks, vaccine history, etc.

For example, consider 1 dose of Abrysvo between 28 through 36 weeks if the baby will not receive an RSV monoclonal antibody (nirsevimab) after birth. Avoid Arexvy and mResvia...they’re NOT approved in pregnancy.

Explain that if mom delivers within 2 weeks after getting Abrysvo, the baby should get nirsevimab after birth. Clarify that most babies do NOT need both approaches for protection.

Also advise hepatitis B vaccine for pregnant patients not previously vaccinated. HepA, Men-C-ACWY, and pneumococcal may also be given if needed. No safety signals have been identified with these in pregnancy.

Generally defer vaccines with more limited data in pregnant patients. For instance, usually delay recombinant zoster vaccine (Shingrix) until after pregnancy.

Avoid live vaccines (MMR, varicella, intranasal flu vaccine, etc). They’re contraindicated in pregnancy...due to a theoretical risk of transmitting the vaccine virus to the fetus which could cause infection.

Also recommend that patients planning pregnancy wait at least 4 weeks after MMR or varicella vaccination before trying to get pregnant.

Explain that breastfeeding moms may safely receive all routine vaccines that are indicated. But point out that some vaccines, such as the smallpox vaccine (ACAM2000, Imvamune) and yellow fever vaccine (YF-Vax), should generally be avoided.

Refer to our vaccine-specific resources...Tetanus Prevention and Vaccination, RSV Vaccines, etc...for more guidance.

• FAQ: Communicating About Flu Vaccination
  
• FAQ: Tetanus Prevention and Vaccination
• Chart: RSV Vaccines