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Vaccine Recommendations During Pregnancy

Prenatal Screening for Vaccine-Preventable Diseases
The ACIP currently recommends prenatal screening for rubella and hepatitis B. "Prenatal serologic screening...is indicated for all pregnant women who lack acceptable evidence of rubella immunity. Upon completion or termination of their pregnancies, women who do not have serologic evidence of rubella immunity or documentation of rubella vaccination should be vaccinated with MMR before discharge from the hospital, birthing center, or abortion clinic." ACIP, Measles, Mumps, and Rubella - Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps.

All pregnant women should be routinely tested for hepatitis B surface antigen (HBsAg) during an early prenatal visit in each pregnancy. HBsAg-positive mothers identified during screening may have hepatitis B virus-related acute or chronic liver disease and should be evaluated by their physicians.

Click here for further information on hepatitis B and the Utah Immunization Program's Perinatal Hepatitis B Prevention Program.

Vaccinating Pregnant Women
Risk from vaccination during pregnancy is largely theoretical. The benefit of vaccination among pregnant women usually outweighs the potential risk when either the risk for disease exposure is high or when infection would pose a special risk to the mother or fetus and the vaccine is unlikely to cause harm.

Generally, live-virus vaccines are contraindicated for pregnant women because of the theoretical risk of transmission of the vaccine virus to the fetus. If a live-virus vaccine is inadvertently given to a pregnant woman, or if a woman becomes pregnant within 4 weeks after vaccination, she should be counseled about the potential effects on the fetus. But it is not ordinarily an indication to terminate the pregnancy.

Whether live or inactivated vaccines are used, vaccination of pregnant women should be considered on the basis of whether the risk of the vaccination outweighs the benefits of protection in a particular circumstance.

Passive Immunization during Pregnancy
There is no known risk to the fetus from passive immunization of pregnant women with immune globulin preparations.

Passive Immunity
Passive immunity, (the transfer of antibody produced by one human or animal to another), is immunity to disease passed from a mother to the child. Antibodies are transported across the placenta during the last 1-2 months of pregnancy. As a result, a full-term infant will have the same antibody "profile" as its mother. These antibodies will protect the infant from certain diseases for up to a year. Protection is better against some diseases (e.g., measles, rubella, tetanus) than others (e.g., polio, pertussis).

Vaccinating Women who are Breast-feeding
Neither killed nor live vaccines affect the safety of breast-feeding for mothers or infants. Additionally, breast-feeding does not decrease the response to routine childhood vaccines and is not a contraindication for any vaccine.

The following applies to varicella vaccine, which was licensed after the ACIP General Recommendations were published: "Whether attenuated vaccine [varicella zoster vaccine] VZV is excreted in human milk and, if so, whether the infant could be infected are not known. Most live vaccines have not been demonstrated to be secreted in breast milk. Attenuated rubella vaccine virus has been detected in breast milk but has produced only asymptomatic infection in the nursing infant. Therefore, varicella vaccine may be considered for a nursing mother." ACIP, Prevention of Varicella.

Breast-feeding also does not extend or improve passive immunity to vaccine-preventable disease provided by maternal antibody.

CDC's publication titled "Guidelines for Vaccinating Pregnant Women" is available through the National Immunization Program.This publication provides detailed recommendations for pregnancy for all routine vaccines as well as additional vaccines that may be considered for pregnant travelers.