Vaccines for Use in Pregnancy and Breastfeeding

Vaccines and Pregnancy | Vaccines and Breastfeeding | References

Vaccines and Pregnancy 

Below is a table summarizing which routinely recommended vaccines in the U.S. are also routinely recommended during pregnancy, which are not routinely recommended in pregnancy, and which are contraindicated during pregnancy. Included in this table is information most relevant to women of child-bearing age for certain vaccines. For further information about these vaccines and their use, please see the individual vaccine summaries that are linked in the table.

More information on vaccinating during pregnancy can be found on the website hosted by the American College of Obstetricians and Gynecologists (ACOG): http://immunizationforwomen.org/patients/pregnancy/pregnancy.php; as well as the website hosted by the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/vaccines/pregnancy/pregnant-women/index.html.

Vaccines and Pregnancy

Vaccine

Indication During Pregnancy

Information Relevant to Women of Child-Bearing Age

Hepatitis A

Not routinely recommended in pregnancy

The low theoretical risk of vaccination should be weighed against the risk of hepatitis A infection among pregnant women at high risk of exposure.

Hepatitis B

Not routinely recommended in pregnancy

In order to prevent perinatal hepatitis B infection, all pregnant women should be routinely screened for hepatitis B surface antigen (HBsAg), and subsequent postexposure immunoprophylaxis should be administered to infants born to women who are HBsAg-positive or of unknown HBsAg status.

Haemophilus influenzae type b (Hib)

Not routinely recommended in pregnancy

 

Herpes Zoster

Contraindicated during pregnancy

 

Human Papillomavirus (HPV)

Not routinely recommended in pregnancy

If a woman is discovered to be pregnant after receiving HPV vaccine, no intervention is indicated. The remaining doses in the series should be delayed until after the pregnancy.

Influenza (IIV)

Routinely recommended during pregnancy

Pregnant women and young children are at increased risk of complications and hospitalizations from influenza.

Influenza (LAIV)

Contraindicated during pregnancy

 

Measles, Mumps and Rubella (MMR)

Contraindicated during pregnancy

Vaccination against rubella is emphasized for all non-pregnant women of childbearing age, especially those born outside of the U.S. Those without evidence of immunity should be given MMR vaccine, excluding women who are pregnant or currently attempting to become pregnant. Pregnancy should be avoided for at least 4 weeks following MMR vaccination; however, inadvertent MMR vaccination should not be considered an indication for termination of the pregnancy.

Meningococcal

Not routinely recommended in pregnancy

Pregnancy should not preclude indicated MenACWY vaccination. MenB vaccination should be deferred in pregnant and lactating women unless the woman is at increased risk and the benefits of vaccination outweigh the potential risks.

Pneumococcal

Not routinely recommended in pregnancy

Women who are at high risk of pneumococcal disease should be vaccinated before pregnancy, if possible.

Polio (IPV)

Not routinely recommended in pregnancy

Vaccination of pregnant women with IPV should generally be avoided. However, if a pregnant woman is at increased risk for polio infection and requires immediate protection, IPV can be administered in accordance with the recommended schedule.

Tetanus, Diphtheria and Pertussis (Tdap)

Routinely recommended during pregnancy

Most deaths from pertussis occur in the first few months of life prior to receipt of routine infant vaccines against pertussis. Vaccination with Tdap during pregnancy helps protect infants from pertussis.

Varicella

Contraindicated during pregnancy

Pregnancy should be avoided for at least 4 weeks following varicella vaccination; however, inadvertent varicella vaccination should not be considered an indication for termination of the pregnancy.

Vaccines and Breastfeeding 

Smallpox and yellow fever vaccinations should not be given to women who are currently breastfeeding. However, these vaccines are not routinely recommended to the general population in the United States. Other vaccines that are currently routinely recommended to the general population in the U.S.* do not affect the safety of breastfeeding for women or their infants.

According to the ACIP’s 2011 report General Recommendations on Immunization [1]:

“Neither inactivated nor live-virus vaccines administered to a lactating woman affect the safety of breastfeeding for women or their infants. Although live viruses in vaccines can replicate in vaccine recipients (i.e., the mother), the majority of live viruses in vaccines have been demonstrated not to be excreted in human milk. Varicella vaccine virus has not been found in human milk. Although rubella vaccine virus might be excreted in human milk, the virus usually does not infect the infant. If infection does occur, it is well tolerated because the virus is attenuated. Inactivated, recombinant, subunit, polysaccharide, and conjugate vaccines, as well as toxoids, pose no risk for mothers who are breastfeeding or for their infants. Breastfeeding is a contraindication for smallpox vaccination of the mother because of the theoretical risk for contact transmission from mother to infant. Yellow fever vaccine should be avoided in breastfeeding women. However, when nursing mothers cannot avoid or postpone travel to areas endemic for yellow fever in which risk for acquisition is high, these women should be vaccinated.
Limited data indicate that breastfeeding can enhance the response to certain vaccine antigens. There are no data to suggest that passive transfer of antibodies in human milk can affect the efficacy of live-virus vaccines. Breastfed infants should be vaccinated according to the recommended schedule.”


References 

1. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60:1-64.