Vaccinations recommended during pregnancy: protecting two lives at once

Pregnancy changes the way your immune system works, and that shift makes some infections more dangerous for both you and your baby. Vaccinations are one of the clearest, most practical steps to lower those risks, yet they often arrive bundled with confusion, myths, and well-meaning but inaccurate advice. This article walks through which immunizations are routinely advised, which are avoided, and how timing, safety data, and personal circumstances shape the best plan for each pregnancy.

Why vaccines matter when you’re pregnant

When you receive certain vaccines during pregnancy, you gain direct protection while also passing antibodies to your baby through the placenta. Those maternal antibodies help cover the infant’s vulnerable first weeks and months, before newborn vaccinations begin. For illnesses like pertussis and influenza, this early protection can be lifesaving.

Pregnancy also changes the severity of some infections. Influenza and COVID-19, for example, can cause more severe illness in pregnant people than in nonpregnant people of the same age. Preventing maternal illness reduces the chance of complications such as hospitalization, premature labor, and delivery problems that can affect the baby.

Finally, vaccination during pregnancy contributes to community protection. High vaccine coverage reduces circulation of dangerous pathogens around newborns and people who cannot be vaccinated, building an indirect shield that helps the most fragile among us.

Which vaccines are routinely recommended

Health authorities in the United States, including the CDC and professional obstetric organizations, recommend a small set of vaccines as routine for most pregnancies. The two household names are influenza and Tdap; both are backed by strong evidence showing safety for pregnant people and meaningful benefit for infants. More targeted vaccines may be advised in specific situations, such as travel or medical risk factors.

Below I describe the routine vaccines in detail, explain timing, and clarify why they matter. I’ll also outline other vaccines that might be appropriate if you have certain exposures or underlying conditions.

Influenza (seasonal flu) vaccine

Influenza vaccination is recommended for everyone who is pregnant during influenza season, regardless of trimester. The inactivated influenza vaccine (IIV) is the standard choice; live attenuated influenza vaccine (the nasal spray) is not used in pregnancy. Annual vaccination reduces the mother’s chance of severe flu and helps pass protective antibodies to the baby.

Timing is seasonal: get vaccinated as soon as the vaccine is available in your community. If you are pregnant in the fall or winter months, vaccination during pregnancy offers protection for both you and your newborn through the early months of life. If you become pregnant outside the usual flu season, vaccination is typically not necessary until the next season unless otherwise advised by a clinician.

Tdap (tetanus, diphtheria, and acellular pertussis)

Tdap is recommended during every pregnancy—ideally between 27 and 36 weeks’ gestation—to maximize the transfer of pertussis (whooping cough) antibodies to the fetus. These maternal antibodies significantly lower the newborn’s risk of severe pertussis during the first months of life, when pertussis can be especially dangerous and before the infant completes their own vaccine series.

If a pregnant person did not receive Tdap in that window, it should be given as soon as feasible during pregnancy. For women who were not vaccinated during pregnancy, postpartum vaccination is less effective at protecting the newborn but still provides personal protection and helps limit household transmission.

COVID-19 vaccines

Current guidance (as of the most recent public health recommendations) supports the use of COVID-19 vaccines, including mRNA boosters, in pregnancy. Vaccination reduces the risk of severe COVID-19, hospitalization, and adverse pregnancy outcomes associated with infection. Pregnant people who are unvaccinated or not up to date on boosters are at higher risk for severe disease.

Timing can be flexible: initial vaccination and recommended booster doses are advised during pregnancy if indicated. Studies have shown that mRNA COVID-19 vaccines do not increase the risk of adverse pregnancy outcomes and that vaccinated pregnant people pass antibodies to their infants. Discuss any specific booster schedules with your provider to align with updated recommendations and your personal risk.

Hepatitis B

Hepatitis B vaccine is safe during pregnancy and should be given to pregnant people who are at risk of infection or are not previously vaccinated. Risk factors include exposure to an infected household contact, injection drug use, occupational exposure in healthcare settings, and other situations identified during prenatal screening.

Routine prenatal screening for hepatitis B surface antigen helps identify newborns who will need additional steps at birth to prevent transmission. If you are hepatitis B–negative but at risk, vaccination during pregnancy protects you and reduces the chance of horizontal transmission within the household after delivery.

Pneumococcal and meningococcal vaccines

Pneumococcal and meningococcal vaccines are not routinely recommended for all pregnant people but may be advised for those with medical conditions or risk exposures. For example, people with chronic lung disease, heart disease, or immunocompromising conditions may be candidates for pneumococcal vaccination. Meningococcal vaccination may be recommended for travel to areas with outbreaks or certain occupational risks.

In these cases, the benefits of vaccination—protecting against severe bacterial infections—often outweigh theoretical risks. Decisions should be individualized between you and your clinician, taking into account current circulation of these bacteria and your personal health status.

Hepatitis A and other targeted vaccines

Hepatitis A vaccine may be recommended for pregnant people who are at increased risk of exposure, such as travelers to endemic areas or those with chronic liver disease. The vaccine uses an inactivated virus and is considered safe when the benefit outweighs potential risks.

Other targeted immunizations—such as rabies pre-exposure vaccination when occupational risk exists—are evaluated case-by-case. Post-exposure treatment (for rabies, for example) is safe and recommended during pregnancy if warranted by exposure; delaying treatment could be far more dangerous.

Vaccines to avoid while pregnant

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Live attenuated vaccines are generally contraindicated during pregnancy because they contain weakened, replicating forms of the virus. The primary examples are measles-mumps-rubella (MMR) and varicella (chickenpox) vaccines. If a pregnant person needs immunity to these diseases, vaccination is typically deferred until after delivery.

If a pregnant person inadvertently receives a live vaccine, current guidance advises discussing the exposure with a clinician and public health authorities, but termination of pregnancy is not generally recommended solely because of inadvertent vaccination. Careful follow-up is recommended instead.

MMR and varicella

MMR and varicella vaccines are highly effective but use live viruses and therefore are avoided in pregnancy. Women are routinely screened for immunity to rubella and varicella during prenatal care; if nonimmune, vaccination is advised after delivery. For those planning pregnancy, getting these vaccines before conception is best.

When immunity is unknown and there has been a significant exposure to measles or varicella during pregnancy, clinicians may use immune globulin or other measures depending on timing and risk. Active infection during pregnancy, however, carries its own risks and deserves immediate clinical attention.

HPV and other nonpregnancy vaccines

Human papillomavirus (HPV) vaccine is not recommended for pregnant people. If a dose is given inadvertently during pregnancy, the guidance is to delay remaining doses until after delivery. The HPV vaccine does not have established benefits for fetal protection and is primarily a preventive vaccine for future health risks.

Similarly, routine vaccines intended for older children or nonpregnant adults that do not directly protect newborns are often deferred until after delivery unless a specific exposure or risk dictates otherwise.

How maternal antibodies protect newborns

When you get certain vaccines during pregnancy, your immune system makes antibodies that cross the placenta and provide passive immunity to your baby. This transfer is especially efficient in the third trimester, which explains why timing matters for some vaccines like Tdap. The antibodies wane over time, but they can protect infants through the first critical months when they are not yet fully vaccinated.

Breastfeeding adds another layer of defense. While breastmilk antibodies are not the same as placental IgG, they provide mucosal protection and help reduce infections like gastrointestinal and respiratory illnesses. Vaccination during pregnancy, paired with breastfeeding when possible, gives newborns a better start against several dangerous pathogens.

Timing matters: when to get each vaccine

Td and Tdap are timed to maximize antibody passage, influenza is tied to seasonal availability, and COVID-19 timing aligns with personal vaccine status and community transmission patterns. Talking through a calendar with your prenatal provider helps place each vaccine at the moment that offers the most benefit to both you and your baby.

For many vaccines, the third trimester is optimal for antibody transfer, but if risk of infection is immediate, earlier vaccination is justified. For example, if local flu activity peaks while you’re in your second trimester, getting the vaccine then still protects you and contributes some protection to the fetus.

Practical timing examples

If you’re due during flu season, getting the flu shot at any point in pregnancy is recommended as soon as it’s available. For Tdap, aim for the 27–36-week window, so that the baby is more likely to have higher antibody levels at birth. COVID-19 vaccination follows the same patient-centered approach—update or begin the series according to current recommendations and your risk profile.

When you’re traveling or face occupational exposures, discuss timing well before travel or planned exposures. Sometimes a preconception vaccine makes the most sense; other times, delivering the vaccine during pregnancy is the clearer choice based on the immediacy of risk.

Safety data and common side effects

Large studies and registry data have consistently shown that inactivated vaccines given during pregnancy—such as influenza, Tdap, and mRNA COVID-19 vaccines—do not increase the risk of congenital anomalies, pregnancy loss, or preterm delivery. Surveillance continues, but the existing body of evidence supports safety for both mother and fetus.

Common side effects are usually mild and transient: sore arm, low-grade fever, fatigue, and sometimes mild myalgias. These symptoms are generally short-lived and not harmful to the pregnancy. If fever arises after vaccination, it’s reasonable to treat it according to clinical guidance, because high fever can affect pregnancy and should be managed promptly.

When to call your clinician

Contact your prenatal provider if you experience a persistent high fever after vaccination, severe allergic reactions (such as difficulty breathing or hives), or any concerning symptoms. Immediate care is important for severe allergic responses; such events are rare but require rapid attention. For most common side effects, symptomatic care and routine follow-up are sufficient.

Also notify your provider if you believe you received a live vaccine in error while pregnant. They will guide you through monitoring and any necessary tests without causing unnecessary alarm.

Special situations: travel, outbreaks, and exposures

Pregnancy does not occur in a vacuum—people travel, outbreaks happen, and occupational exposures exist. Vaccination decisions in these contexts are individualized. Travel to areas with endemic diseases may prompt consideration of vaccines that are not part of routine prenatal care.

Some travel vaccines are live (for example, yellow fever) and are generally avoided in pregnancy unless travel is unavoidable and the risk of disease is higher than the potential risk of vaccination. In such cases, public health authorities recommend weighing the risks and benefits carefully and taking precautions to avoid exposure when possible.

Yellow fever and other travel vaccines

Yellow fever vaccine is a live attenuated vaccine and is generally discouraged during pregnancy. However, if travel to an area with yellow fever transmission is unavoidable, vaccination may be recommended after a risk assessment. In situations where a vaccine cannot be given, a medical waiver and strict mosquito avoidance strategies should be implemented.

Other travel vaccines—such as inactivated hepatitis A or injectable typhoid vaccine—may be offered when the protective benefits outweigh any theoretical risks. Consult a travel medicine specialist well ahead of travel to allow time for vaccine series and to discuss alternative strategies if pregnancy complicates vaccine choices.

Exposure to diseases during pregnancy

If you are exposed to a disease like varicella or measles in pregnancy, your clinician will assess your immunity status and may recommend immune globulin or other interventions depending on timing and severity of exposure. Proactive prenatal screening for some infections helps identify vulnerability before exposure occurs.

For pertussis exposure in the household, vaccination of close contacts and early prophylaxis for exposed newborns might be considered. Reducing household transmission risk is a practical and effective measure to protect infants who are too young to be fully vaccinated.

How prenatal care teams approach vaccination

Most prenatal clinics integrate vaccination counseling into early visits, with reminders for the third-trimester Tdap and seasonal flu. Many practices can administer vaccines on-site, reducing barriers. Bringing immunization records to prenatal appointments helps clinicians make an informed recommendation quickly.

Communication matters. A good prenatal provider will explain the rationale for each vaccine, discuss safety data candidly, and tailor recommendations to your health history and lifestyle. If you have reservations, ask for sources and data that address your specific concerns so you can make an informed choice.

Shared decision-making and cultural considerations

Shared decision-making respects individual values and concerns. For some people, cultural or religious beliefs influence vaccine decisions. Clinicians can offer alternatives—such as enhanced infection-control measures, timing adjustments, or targeted immunizations for close contacts—to reduce risk when vaccination is delayed or declined.

When language barriers or mistrust of the health system exist, clinics with culturally competent care and patient navigators can make a meaningful difference. Finding a provider who listens and addresses questions without judgment encourages better outcomes for both pregnant people and newborns.

Common myths and straightforward answers

Myths about vaccines causing infertility, autism, or other long-term problems persist, despite extensive evidence to the contrary. Scientific research does not support these claims. The rigorous safety monitoring systems and thousands of studies over decades reinforce the safety profile of recommended inactivated vaccines in pregnancy.

Another common worry is that vaccines will harm the fetus. In fact, recommended vaccines reduce fetal risk by preventing maternal infections that can trigger miscarriage, preterm labor, or severe maternal illness. Addressing myths with clear, sourced information helps people make choices grounded in evidence.

Practical answers to specific concerns

If you worry about additives, thimerosal-free options exist for inactivated influenza vaccines and many prenatal vaccines; discuss product choices with your clinician. If you have egg allergy, most flu vaccines are safe for people with egg allergy, but healthcare providers will follow established protocols to avoid reactions and provide safe monitoring.

For concerns about immune overload from multiple vaccines, the immune system routinely handles many more challenges daily than those posed by a few inactivated vaccines. Studies show no evidence that the recommended prenatal vaccine schedule overloads the immune system or harms pregnancy.

Real-life examples and personal experience

As a writer who has spoken with dozens of families and clinicians, I’ve heard many stories that illustrate the real-world value of vaccination in pregnancy. One friend received Tdap in her third trimester; her newborn was exposed to pertussis at two weeks of age, but thanks to maternal antibodies the baby experienced only a mild cough and recovered quickly.

I’ve also sat in clinic rooms where pregnant people expressed anxiety about vaccines, and observed how clear, empathetic counseling changed minds. When providers explained the timing, mechanism, and safety data—and listened to personal concerns—people often chose vaccination with relief rather than reluctance.

A cautionary tale

Another family I know delayed influenza vaccination because they underestimated flu risk. That winter, the pregnant parent contracted influenza and was hospitalized with pneumonia. The episode led to a premature delivery and a difficult neonatal course. The family now advocates for prenatal flu vaccination, sharing their experience to help others avoid the same outcome.

These real-life stories underscore that theoretical risks from vaccination are small compared with the well-documented risks of disease during pregnancy. Personal narratives often help translate abstract statistics into meaningful decisions for expectant families.

Practical checklist for expecting parents

Prepare for conversations with your prenatal care team by gathering your immunization history and making a list of questions. Below is a practical checklist you can use during prenatal appointments to ensure your vaccine needs are discussed and addressed.

• Bring any previous vaccine records or immunization cards to your first prenatal visit.
• Ask whether you should receive influenza vaccine this season and whether Tdap will be scheduled between 27–36 weeks.
• Discuss your COVID-19 vaccine status and any recommended boosters.
• Tell your provider about travel plans, occupational exposures, or household contacts at risk for hepatitis B or other infections.
• If you have chronic medical conditions or immune suppression, ask if additional vaccines (e.g., pneumococcal) are indicated.

Using a checklist helps you and your provider plan effectively and reduces surprises later in pregnancy. It also ensures newborn protection strategies are in place before delivery.

Summary table: quick reference guide

The table below provides a concise overview of common vaccines and how they’re typically handled during pregnancy. This is a summary and not a substitute for individualized medical advice.

Vaccine	Routine recommendation in pregnancy	Timing	Live or inactivated
Influenza (IIV)	Yes (seasonal)	As soon as available during flu season	Inactivated
Tdap	Yes (every pregnancy)	27–36 weeks gestation (ideal)	Inactivated (toxoid)
COVID-19 (mRNA)	Yes if indicated	Any trimester per current guidance	Nonreplicating (mRNA)
Hepatitis B	Recommended if at risk	Any trimester if indicated	Inactivated
Pneumococcal/meningococcal	Selective, for high-risk people	Any trimester if indicated	Inactivated (most formulations)
Hepatitis A	Selective, for high-risk or travel	Any trimester if indicated	Inactivated
MMR	No—defer until postpartum	Do not give during pregnancy	Live attenuated (avoid)
Varicella	No—defer until postpartum	Do not give during pregnancy	Live attenuated (avoid)

How to talk to family and support people

Vaccination decisions during pregnancy often affect the whole household. Encourage close contacts—partners, grandparents, caregivers—to be up to date on vaccines such as pertussis and influenza to create a cocoon of protection around the newborn. This “cocooning” strategy reduces the chance of bringing preventable infections into the home.

Sharing clear, concise information with family members can reduce anxiety and resistance. Explain that inactivated vaccines are safe and that vaccinating close contacts protects the baby directly. If family members have questions, suggest they speak with the prenatal care team or a trusted healthcare professional.

Practical tips for convincing reluctant loved ones

Frame vaccination as protecting the baby rather than as a personal endorsement. For those who resist, offer compromises like getting vaccinated at the hospital before visiting the newborn or reviewing reputable resources from national health agencies together. Small steps often open the door to further acceptance.

Remind family and friends that some vaccines—like Tdap for adults who will have close contact with the baby—are recommended even if the adults are not pregnant. Protecting the newborn is a shared responsibility, and many people respond positively when presented with that perspective.

Record-keeping and documentation

Keep copies of all vaccines and discussions recorded in your prenatal chart and in a personal pregnancy folder. Accurate documentation is useful at delivery, for newborn care planning, and for postnatal visits where vaccinations for the mother or household members may still be arranged. Electronic health records often allow patients to download immunization histories for convenience.

If you receive a vaccine at a pharmacy or travel clinic, request a record to share with your prenatal provider. Consistent documentation helps avoid unnecessary repeat vaccinations and ensures your care team has the information they need to make informed recommendations for you and your baby.

Navigating special medical conditions and allergies

People with immune disorders, severe allergies, or other chronic conditions should have vaccine decisions coordinated between their prenatal provider and relevant specialists. Some vaccines may be particularly important for those with underlying illness, while others require adjustments to monitoring or timing.

For those with a history of severe allergic reactions to vaccine components, specialists can recommend safe alternatives or supervised vaccination with emergency measures available. Allergy to latex, for instance, can sometimes be addressed by choosing vaccines packaged without latex stoppers.

Insurance, access, and equity considerations

Access to vaccines during pregnancy should not be a barrier. Many insurance plans cover recommended prenatal vaccines, and public health clinics often provide low-cost or free options. If cost or access is a concern, discuss options with your prenatal clinic or a local health department to find available resources.

Health equity matters: historically underserved communities may face additional barriers, including limited clinic hours, transportation issues, or mistrust of healthcare systems. Community-based outreach, mobile clinics, and culturally tailored education can improve access and uptake for pregnant people who need these vaccines most.

Looking ahead: future vaccines and ongoing research

Research continues into vaccines designed specifically to protect pregnant people and their infants—such as group B streptococcus and improved maternal RSV (respiratory syncytial virus) vaccines. Early trial results are promising, and vaccine development focused on maternal immunization could expand the protective toolbox for newborns in coming years.

As new vaccines become available, safety monitoring and clear guidance will be key. Pregnant people should be included in discussions about novel vaccines, with transparent data and well-designed studies to establish efficacy and safety for this population.

Key takeaways for planning your pregnancy immunizations

Vaccination during pregnancy is a shared decision grounded in solid evidence: inactivated vaccines like influenza and Tdap are recommended because they protect both mother and newborn. Additional vaccines may be appropriate for specific risks, while live vaccines are generally avoided until after delivery. Planning and communication with your prenatal provider make vaccination straightforward and effective.

Bring immunization records to appointments, discuss travel and occupational risks early, and involve household members in protection strategies. With thoughtful planning, vaccines can be a simple but powerful way to reduce the chances of severe illness for you and your baby.

If you want a printable checklist or links to reputable sources from public health agencies, your prenatal clinic can provide tailored materials and answer follow-up questions so you feel confident about each step you choose to take.