Vaccinations and pregnancy

If you are pregnant or planning pregnancy, ask your healthcare provider if your vaccinations are up to date. Some infections can harm a pregnant woman and her baby. Vaccines can protect you and your baby against some of these infections. Some vaccines are safe in pregnancy, and others are not. Your provider can tell you what vaccines are right for you before, during and after pregnancy.

How Do Vaccines Work?
Tiny organisms (like viruses and bacteria) can invade the body and cause infections that can make you ill. When you get an infection, your body produces special disease-fighting substances called antibodies to fight the organism. In many cases, once your body has created antibodies against an organism, you become immune to the infection it causes. This means you won’t get the infection again in the future.

Vaccines usually contain a small amount of the organism that causes an infection. The organisms used in vaccines are generally weakened or killed so they won’t make you sick. The vaccine causes your body to produce antibodies against the organism. This allows you to become immune to an infection without having the illness first.

There are three main kinds of vaccines:

• Those that contain a live, but weakened organism
• Those that contain a killed (inactivated) organism
• Those that contain toxoids (chemically changed proteins from bacteria)

Generally, live-virus vaccines are not recommended for pregnant women.

Which Vaccines Are Recommended Before Pregnancy?
The best time to talk to your healthcare provider about vaccinations is before you are pregnant. This way you can get any vaccines you need to protect you and your baby before you conceive. It's a good idea for all women to have a medical checkup before they get pregnant.

Certain vaccine-preventable illnesses, such as rubella (German measles) and chickenpox, can cause birth defects and other problems in the baby if you get them during pregnancy. These vaccines are made from live viruses. The U.S. Centers for Disease Control and Prevention (CDC) does not recommend them during pregnancy. At a checkup before pregnancy, the provider can do a blood test to find out if you are immune. If you’re not, you can safely be vaccinated before pregnancy. After you’re vaccinated, you should wait for one month before trying to conceive.

The Tdap vaccine protects you against three diseases:

-Tetanus, a serious central nervous system disease
-Diphtheria, a dangerous respiratory infection
-Pertussis (whooping cough)

If you've never had the Tdap vaccine, ask your provider if you should get the shot before pregnancy. The Tdap vaccine should replace your next tetanus/diphtheria (Td) booster (generally recommended every 10 years, though you can receive Tdap if your last Td booster was at least two years ago). CDC does not recommend the pertussis part of this vaccine during pregnancy because there is limited information on its safety in pregnancy. (The pertussis vaccine is made from inactivated parts of the bacterium.) The Td shot, which is made with toxoids, is safe in pregnancy. If you get a deep cut during pregnancy and need a tetanus shot, you can safely receive the Td shot.

If you are 26 years old or younger, your healthcare provider may recommend that you get the HPV virus (also called Gardasil). HPV stands for human papillomavirus. HPV is the most common sexually transmitted infection in the United States. It can cause genital warts, cervical cancer and other types of cancer. More than half of sexually active men and women are infected with HPV at some time in their lives.

Which Vaccines Are Recommended During Pregnancy?
The CDC recommends that all women who will be pregnant during the flu season receive a flu shot. The flu season is usually November through March. The shot is made from killed viruses and is safe for mother and baby. Pregnant women who come down with the flu are more likely than other adults to have serious complications, such as pneumonia.

The CDC also recommends that pregnant women receive the H1N1 (swine flu) vaccine. This will help protect mom and baby from the disease, which can be very serious for some pregnant women. Check with your healthcare provider about getting the vaccine. Learn more by reading our article on H1N1.

Which Other Vaccines Are Sometimes Recommended in Pregnancy?
If you are at increased risk for an infection, your provider may suggest that you receive a vaccination that isn't routinely recommended for pregnant women. You may be at increased risk for infection if you

• Work in a healthcare facility
• Travel to areas where infection is common
• Have certain chronic conditions, such as diabetes

According to the CDC, the following vaccinations are recommended for pregnant women who are at risk for an infection:

• Hepatitis B
• Meningococcal
• Pneumococcal
• Rabies

Talk to your provider about the benefits and risks of each vaccination. None of these vaccines contain live viruses, so experts believe they don’t pose risks to the baby. But there is limited information on the meningococcal and pneumococcal vaccines in pregnancy.

What Vaccinations Should Be Avoided in Pregnancy?
According to the CDC, the following live-virus vaccines are not recommended during pregnancy:

• Nasal spray flu vaccine (pregnant women should get the flu shot, which is made with killed viruses)
• Measles
• Mumps
• Rubella (German measles)
• MMR (combined measles, mumps and rubella vaccine)
• Varicella (chicknpox)
• BCG (tuberculosis)

You should postpone pregnancy for one month after receiving any of these vaccinations.

Experts know little about how the following vaccinations may affect your baby:

• Polio (IPV)
• Hepatitis A
• Anthrax
• Japanese encephalitis
• Typhoid
• Vaccinia (smallpox)
• Yellow fever

Some of these vaccines contain live viruses. You and your doctor should carefully weigh the risks and benefits of using these vaccines during your pregnancy.

Women should not get the HPV vaccine when they are pregant. The vaccine appears to be safe for both the mother and the baby. But it is still being studied and has not yet been approved for use during pregnancy.

What Vaccinations Are Recommended After Pregnancy?
If you are not immune to rubella and chickenpox, the CDC recommends that you get vaccinated soon after delivery. This way you will be protected in future pregnancies.

If you were not vaccinated with the Tdap vaccine before pregnancy, you should probably be vaccinated soon after delivery. (If it has been less than two years since your last Td booster, your provider may postpone your Tdap vaccine.) Getting vaccinated with Tdap either before or right after pregnancy prevents you from contracting pertussis and passing it on to your newborn. Infants who contract pertussis are at high risk of complications and even death. Babies are routinely vaccinated with the childhood version of this immunization (called DTaP) at 2, 4 and 6 months of age, but they are at risk for the disease until they have had one or two DTaP shots.

If you are under 26 years of age, you may want to consider the HPV vaccine. See "Which Vaccines Are Recommended Before Pregnancy?" above for more information.

If you are breastfeeding, it is safe for you to be vaccinated according to CDC's usual adult vaccination schedule.  There is no known risk to your baby.

Courtesy of the March of Dimes