Vaccines during pregnancy: Which vaccinations are recommended – and why
From DTaP to RSV, here are some of the vaccinations your doctor might recommend you get while pregnant – and why they're so important
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Vaccinating your baby on schedule is the most effective way to protect them against life-threatening, preventable diseases. But to keep infants (and their mothers) as safe as possible, vaccinations shouldn't only happen after birth.
Why are some vaccinations recommended in, or before, pregnancy?
First, they protect the fetus from vaccine-preventable diseases that can cause congenital anomalies, neurological disorders, and even miscarriage or stillbirth.
Second, it takes time for the immune system to mount its full response to a vaccine. This means that even if newborns are vaccinated at birth, they remain vulnerable for several weeks. However, when a mother is immunized in pregnancy, the antibodies she builds in response are taken up by the fetus. This means that, if a mother is immunized in pregnancy, her baby is protected from infectious diseases as soon as they are born.
Third, vaccination in pregnancy protects mothers. Because of the toll pregnancy takes on the body (and the immune system), pregnant people are more vulnerable to more serious complications and side effects of certain infections, and even death.
Here are some of the vaccinations that the World Health Organization recommends either in or before pregnancy, why – and how they protect both mother and baby.
Why the measles, mumps and rubella (MMR) is recommended before pregnancy
Measles increases the risk of both preterm birth and of babies being born low birth weight. Both can have long-term consequences for a child's development. Another common complication of measles for pregnant women is pneumonia, which affects around 18 out of every 100 pregnant women. In many countries, pneumonia in pregnancy is one of the most common causes of death from infection.
Mumps increases the chance of stillbirth.
Rubella increases the risk of miscarriage or stillbirth. It also can cause congenital anomalies, including deafness and heart anomalies. Rubella is especially likely to cause these side effects if it is contracted in the first trimester, with around half of all babies whose mothers were infected between 12-16 weeks of pregnancy having congenital anomalies. However, congenital anomalies can result from rubella if the mother is infected at any time during pregnancy.
Measles, mumps and rubella all can be asymptomatic, meaning a pregnant woman might not know she has been infected.
Most people receive the MMR vaccine in childhood. It usually confers lifetime immunity. This means that, if you are planning to get pregnant and you were immunized for MMR as a child, you are unlikely to need the vaccine.
However, because contracting measles, mumps or rubella can be extremely dangerous for both a pregnant mother and the fetus, if you have not received the MMR vaccine and are planning to get pregnant, talk to your healthcare provider.
Because the MMR vaccine uses a weakened version of the live virus, it is not recommended that women get it in pregnancy.
Read more about measles and the MMR vaccine here.
Why the TDaP vaccine is recommended during pregnancy
Whooping cough – which sometimes lasts so long, it is referred to as the "100-day cough" – can be especially dangerous for infants. For every 20 unvaccinated babies who contract whooping cough, about 1 will experience health complications that can cause death. Even today, whooping cough kills more than 150,000 children under five every year. (Read more about whooping cough and how to prevent it).
Tetanus is caused by a type of bacteria that is found everywhere in the environment. If tetanus gets into the body, such as through a cut, it can cause severe complications, including death. Of babies who contract tetanus – such as through their umbilical stump – 1 in 10 dies. Those who survive can have long-term neurological disorders, such as cerebral palsy.
Diphtheria is a severe respiratory infection. Around 1 in 10 people infected with diphtheria die, but the risk is far greater for pregnant women, where it can be up to 1 in 2. Of pregnant women with diphtheria who survive, around 1 in 3 will lose their pregnancies due to miscarriage or stillbirth.
Since the 1940s, a safe, effective vaccine has been available that protects children against tetanus, diphtheria and pertussis all at once. Since the 1980s, a newer version of this vaccine has been in use. In children, it is called the DTaP vaccine; in adults, it is called the TDaP vaccine. The World Health Organization recommends that the first DTaP dose be administered to infants at six weeks of age, the second dose at 10-14 weeks, and the third at 14-18 weeks. A fourth dose is given at 15 to 18 months of age, and a fifth dose is provided at four years old.
However, this leaves infants vulnerable to whooping cough, tetanus and diphtheria when they are first born and not yet vaccinated. Because it also takes multiple doses for the immune system to mount its full response against these diseases, vaccinated babies are also more vulnerable the earlier in the vaccine schedule they are.
This is why the World Health Organization also recommends that pregnant women additionally receive the TDaP vaccination. Being vaccinated in pregnancy offers 90 per cent protection against whooping cough to the baby between birth and being able to receive the first vaccination dose. It also protects the baby from tetanus and from diphtheria.
There is no indication that receiving a DTaP vaccine in pregnancy presents any risk of harm to the fetus.
Why the RSV vaccine is recommended during some pregnancies
Respiratory syncytial virus, or RSV, is one of the leading cause of hospitalization and death in infants worldwide. In Europe, around 1 out of every 55 babies in Europe are hospitalized with RSV before the age of one. Globally, around 1 out of every 30 deaths of babies under six months old is caused by RSV.
RSV immunizations are now available for infants under six months old. In countries that administer this immunization to babies, it is usually at birth.
An alternative is that women get vaccinated for RSV in the third trimester of pregnancy. Because the fetus takes up the mother's antibodies, this also has been proven to be highly effective in preventing RSV infections in babies.
The World Health Organization recommends either one or the other – a RSV vaccine in pregnancy, or a baby's immunization at birth. Talk to your healthcare provider about your local guidelines.
Why the influenza vaccine is recommended during pregnancy
The flu is never pleasant, but pregnant women and their fetuses are more at risk when they contract it. Pregnant women are at a greater risk of experiencing severe distress to their cardiovascular and respiratory systems, hospitalization and even death from the flu than women who are not pregnant.
Getting the flu while pregnant also can pose a risk to the developing fetus. Complications from the flu can lead to a baby being born low birth weight, as well as having congenital anomalies, including heart anomalies and neural tube anomalies. It also increases the risk of neurological disorders, including schizophrenia.
Therefore, the World Health Organization recommends that women who are pregnant during flu season receive the inactivated flu vaccine. This version of the vaccine has been used in pregnancy for more than 50 years. There is no indication that it poses any risk to the fetus, and, because the inactivated version of the vaccine does not use live virus, it cannot 'give' you or your fetus the flu.
Why the Covid-19 vaccine is recommended during pregnancy
Like the flu, Covid-19 is a respiratory illness that puts both pregnant women and babies at a higher risk of hospitalization and other complications. As a result, the World Health Organization recommends that pregnant women receive the Covid-19 vaccination to protect both them and their baby. There is no indication that it poses any risk to the fetus, and, because the Covid-19 vaccine does not use live virus, it cannot 'give' you or your fetus Covid-19.
