Immunisation assessment is an extremely important aspect of healthcare during pregnancy. When planning a pregnancy, talk to your health care provider about any vaccines you might need beforehand. Live-attenuated vaccines should be given at least a month before conception.
Recommended vaccines
Influenza, pertussis and COVID-19 vaccines are the only vaccines routinely recommended for pregnant women. They are provided for free via the National Immunisation Program (NIP).
Some other vaccines can be administered in special circumstances but are not routinely recommended. Refer to the Australian Immunisation Handbook for further information.
Influenza
Influenza vaccination is safe and strongly recommended for pregnant women to avoid complications from influenza disease. It can be administered at any stage of pregnancy and not only aims to protect the expectant mother from disease, but also to provide passive protection to the infant.
Pregnant women are at greater risk of morbidity and mortality from influenza disease than non-pregnant women. They are more than twice as likely to be hospitalised with influenza disease as other people with influenza.
Babies less than 6-months of age are at greatest risk of disease and death from influenza and maternal vaccination will provide protection to babies for the first few months of life until they can be immunised against influenza from 6-months of age.
Pertussis
Pertussis (whooping cough) immunisation during pregnancy is a safe and effective way to protect the mother and prevent disease of the newborn. It is recommended that a single dose of the vaccine be administered between 20 and 32 weeks of pregnancy, in every pregnancy, including pregnancies that are closely spaced.
Maternal antibodies against pertussis provide protection for babies until they have at least received 2 doses of their own pertussis containing vaccine (given at 6-weeks and 4-months of age). Babies less than 6-months of age are at greatest risk of severe disease and death from pertussis.
COVID-19 vaccines
Due to an increased risk of severe outcomes for pregnant women and their unborn babies it is recommended that pregnant women are routinely offered COVID-19 vaccines. Vaccines can be given at any stage of pregnancy.
Surveillance of international data on administration of mRNA COVID-19 vaccines (Comirnaty (Pfizer) or Spikevax (Moderna)) to pregnant women has shown no significant safety concerns for either the mother or the baby. Evidence demonstrates antibodies can pass into breastmilk and cord blood which may provide protection to infants via passive immunity.
Nuvaxovid (Novavax) may be administered to pregnant and breastfeeding women however there is no immunogenicity or safety data on it’s use in this patient group.
Pregnant women have been shown to have an increased risk of needing admission to the intensive care unit and requiring mechanical ventilation if they contract COVID-19 compared with non-pregnant women of the same age.
Women who are planning pregnancy or who are breastfeeding can safely receive a COVID-19 vaccine. You do not need to stop breastfeeding before or after vaccination.
For more information refer to the following:
- Joint statement between RANZCOG and ATAGI about COVID-19 vaccination for pregnant women
- COVID-19 vaccination- ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021
- COVID-19 vaccination- COVID-19 vaccination decision guide for women who are pregnant, breastfeeding or planning pregnancy
- AJOG: COVID-19 vaccine response in pregnant and lactating women: a cohort study
Contraindicated vaccines
All live-attenuated vaccines are contraindicated during pregnancy due to the potential risk to the unborn baby [see Table 1 below]. In most circumstances the risk is hypothetical however, there is insufficient evidence to support vaccination in this patient group. The limited safety data from inadvertent administration of live-attenuated viral vaccines such as the MMR and Varicella vaccines is reassuring.
Table 1: Live-attenuated vaccines contraindicated in pregnancy
| Disease | Brand name |
|---|---|
| Rotavirus | Rotarix®, Rotateq® |
| MMR (measles-mumps-rubella) | Priorix®, MMR II® |
| MMRV (measles-mumps-rubella-varicella) | Priorix-tetra®, ProQuad® |
| Varicella (chickenpox) | Varilrix®, Varivax® |
| Zoster (shingles) | Zostavax® |
| Tuberculosis | BCG (varying brands) |
| Yellow fever | Stamaril® |
| Typhoid^ | Vivotif® |
| Japanese encephalitis | Imojev® |
^Oral vaccine
Resources
- COVID-19 vaccination- ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021.
- COVID-19 vaccination- COVID-19 vaccination decision guide for women who are pregnant, breastfeeding or planning pregnancy
- Raising Children Network: COVID-19 vaccination: pregnancy and breastfeeding
- Gray, K.J et al COVID-19 vaccine response in pregnant and lactating women: a cohort study American Journal of Obstetrics and Gynecology
- ABC News report: ‘Antivaxxer’ tells of ‘nightmare’ after passing whooping cough onto baby daughter
- Amirthalingam, G. et al Effectiveness of maternal pertussis vaccination in England: an observational study The Lancet October 2014 384(9953) 1521-1528
- Steedman, M. et al Strategies to boost maternal immunization to achieve further gains in improved maternal and newborn health Health Affairs 2016 (35)309-316
- Australian Immunisation Handbook: Vaccination for women who are planning pregnancy, pregnant or breastfeeding
- Australian Government Department of Health: Influenza and pertussis vaccination in pregnancy
- Year Round Influenza Vaccination FAQ
Monash Health immunisation resources
- 2019 Patient Information sheet Influenza vaccine during pregnancy
- 2019 Patient information sheet Boostrix during pregnancy
- Patient information sheet Rubella Vaccine
MVEC resources
- MVEC: Vaccines in Pregnancy eLearning package
- MVEC: Pertussis
- MVEC: Influenza vaccine recommendations
- MVEC: Breastfeeding and immunisations
- MVEC: COVID-19 vaccine FAQs: women’s health
Authors: Michelle Giles (Infectious Diseases Consultant, Monash Health) and Rachael McGuire (MVEC Education Nurse Coordinator)
Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)
Date: February 7, 2022
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.