Vaccine Considerations for New and Expectant Moms

New and expectant moms often have questions related to vaccines as this period of life often involves conversations and decisions related to vaccines. Expectant moms, their babies, and even those who will be around their babies, may need vaccines.

In some cases, vaccines protect pregnant women as the changes related to pregnancy make them more susceptible to infections, but in other cases, the vaccines are meant to protect the baby. Questions sometimes relate to special circumstances, such as premature birth or breastfeeding, or to other children in the home of the pregnant woman or new baby.

The information below addresses each of these issues. If you can’t find the answer to your question, please email your question to vacinfo@email.chop.edu, so we can help you.

Pregnant women

When a woman is pregnant, two changes related to her immune system can make her more susceptible to certain infections:

  • Suppressed immune system function — Because the growing fetus is not identical to his mom genetically, the female body has to undergo changes so that it does not “reject” or “attack” the fetus as a foreign entity.
  • Physical changes — As the pregnancy progresses, increased fluid volume adds stress to the heart and lungs making women more susceptible to infections, such as influenza, compared to non-pregnant women of the same age.

Read more about pregnant women and immunity in this Q&A.

Important vaccines during pregnancy

  • Influenza. Women who will be pregnant during the influenza season should receive the inactivated flu vaccine (flu shot). Pregnant women are at increased risk for influenza-related complications that require hospitalization.
  • Hepatitis B. Because many people do not know that they are infected with hepatitis B virus, and because an infant can get the disease at birth from an infected mother, your obstetrician will perform a blood test to determine whether you are infected with hepatitis B. If you are, in addition to getting vaccinated shortly after birth, your baby will be given an antibody preparation to prevent him or her from getting the disease.
  • Tdap. During each pregnancy, women should receive a dose of Tdap vaccine between 27 and 36 weeks’ gestation. While anytime during this window is fine, public health officials suggest getting this vaccine earlier rather than later. Women who did not receive the vaccine during pregnancy should get it immediately after giving birth. Dads, grandparents, and other teens and adults who will be around the baby should also get a dose if they have not had the booster.
  • Pneumococcal. If a woman is considered high risk for pneumococcal disease, she should get this vaccine. High-risk conditions include chronic disorders of the pulmonary system (but not asthma), cardiovascular disease, diabetes mellitus, chronic liver diseases, chronic renal failure, asplenia (including sickle cell disease), immunosuppressive conditions (i.e., HIV, leukemia, lymphoma, multiple myeloma, Hodgkin's disease, generalized malignancy, or organ or bone marrow transplantation), treatment with certain medications, or cochlear implants.

Vaccines to avoid during pregnancy

  • MMR. Women who are pregnant should not receive live, weakened viral vaccines, including the ones for measles, mumps and rubella (MMR). A woman should avoid becoming pregnant for four weeks after receipt of the MMR vaccine.
  • Varicella and shingles. As with MMR, these vaccines contain a live, weakened virus and should not be given to pregnant women. Additionally, women should avoid becoming pregnant for at least one month after receipt of either of these vaccines.
  • HPV. Women who have started the series before becoming pregnant should wait until after delivery to get the remaining doses.

If you have inadvertently received any of these vaccines during pregnancy, you should be aware that none has been proven to be harmful to your unborn baby. The recommendation to avoid these vaccines is theoretical. In some cases, databases are maintained by the manufacturers to track these occurrences, so if you receive one of these vaccines, you or your doctor should report it to the manufacturer:

  • Varicella-containing vaccines (varicella, MMRV, or shingles): Call 1-877-888-4231.
  • HPV vaccines: For Gardasil® call 800-986-8999.

Children in the home of someone who is pregnant

Children living in the home of a pregnant woman can receive all recommended vaccines.

Are you on Pinterest?

The VEC curated a Pinterest board specific to the needs of pregnant women. It includes a collection of VEC resources for pregnant women.

Breastfeeding

Baby

Infants who are being breastfed may receive all 14 vaccines routinely recommended for infants. Antibodies in breast milk do not interfere with any of the currently recommended vaccines.

Sometimes parents wonder whether they can forego immunizations for their baby because the baby is being breastfed; however, this is not the best decision since antibodies in human breast milk bathe the intestinal surface, but are not absorbed. Therefore, breast milk antibodies never enter the bloodstream where they would be needed to protect against certain diseases. Examples of these types of diseases include diphtheria, tetanus, pertussis; measles, mumps, rubella; varicella (chickenpox); pneumococcus; Haemophilus influenzae type b; polio; hepatitis A and hepatitis B.

Mom

Women who are breastfeeding can receive any vaccines they need during this time. Although some live viral vaccines may replicate and cause viruses to be excreted in breast milk, the viruses are weakened sufficiently that they will not harm the baby.

In most cases, women are recommended to have received the live viral vaccines (specifically, MMR and chickenpox) prior to becoming pregnant because the diseases they prevent may be harmful to a developing fetus if the woman is infected during pregnancy.

Preterm infants

Any baby born before the 37th week of pregnancy is considered to be preterm. About 12 percent of births in the United States are preterm.

Maternal antibodies

Preterm babies acquire lesser quantities of antibodies through the placenta than full-term babies. Since these antibodies are present at lower levels, they do not last as long as those of full-term babies. Because preterm infants rely on their own immune systems for protection sooner than full-term babies, it is important that they receive needed vaccinations so they can protect themselves against disease.

Chronologic age

Vaccines should be given according to a baby's chronologic age — the time since delivery.

Hepatitis B vaccine

Preterm infants of mothers infected with hepatitis B should receive the hepatitis B vaccine at or shortly after birth. If the baby weighs less than 2,000 grams, the dose should not be counted as part of the hepatitis B series, and the baby should start the three-dose series one month after birth.

Preterm infants of mothers who are not infected with hepatitis B should get the vaccine one month after birth.

Preterm babies discharged before 1 month of age may get the vaccine at discharge as long as they are considered medically stable and have been consistently gaining weight.

In both cases, later doses should be given at least four weeks after the dose at 1 month. The third dose should be given at least 16 weeks after the first dose and at least eight weeks after the last dose, but not before 6 months of age.

Vaccines typically administered at 2 months

In addition to hepatitis B, 2-month-old babies require vaccination against diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, pneumococcus and rotavirus. Preterm infants should receive these vaccines at the chronologic age of 2 months, even if they are still hospitalized.

These vaccines should continue to be given at the appropriate chronologic ages according to the Centers for Disease Control and Prevention's vaccine schedule until each series is completed.

Other vaccines

Other vaccines should also be given according to the recommended schedule; these include vaccines for measles, mumps, rubella, varicella and hepatitis A.

Influenza vaccine is not recommended until 6 months of age. At 6 months of age, the baby may get the inactivated version of the vaccine. Healthcare workers and family members in contact with a baby less than 6 months old should be immunized to lessen the baby's chance of being infected with influenza.

Vaccines: Birth to 2 years of age

For questions related to the vaccines your baby is recommended to receive in the months after birth, the following resources are available:

Other questions you may have

What do I need to know about Zika virus and how to avoid it if I am pregnant?

Zika virus is spread through mosquito bites. Most people who are infected do not have any symptoms and a few (about 1 in 5) will have symptoms such as fever, rash, joint pain or pink eye. The most concerning aspects of Zika virus infection are for pregnant women because of the adverse effects on the developing fetus.

Read the Zika Virus: What you Should Know Q&A sheet for more information.

Should medicine be given before a child gets vaccinated to prevent or control fever?

Fevers are actually a sign that the immune system is responding to a challenge. If children are given fever-reducing medications before vaccinations, they may not develop a fever, but their immune response to the vaccines may also be lower.

Read the Infectious Diseases and Fevers: What You Should Know Q&A sheet for more information about fevers, what they are, and how to treat them.

Additional resources

Materials developed by the Vaccine Education Center at Children’s Hospital of Philadelphia:

  • Vaccines and Your Baby — this video and booklet series describes vaccines commonly given in the first few years of life and the diseases they prevent.
  • Vaccines on the Go: What You Should Know — this free mobile app is available for iPhone and Android devices. In addition to easily having vaccine information any place you need it, you can email the VEC with questions and view additional resources including Q&A sheets and videos.

Immunization for Women is an immunization website offered by the American College of Obstetricians and Gynecologists (ACOG) that includes pregnancy information for expectant women.

The Centers for Disease Control and Prevention (CDC) also offers a variety of materials related to maternal vaccinations.

Reviewed by Paul A. Offit, MD on May 16, 2017

Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center 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. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.