Vaccines During Pregnancy: What Expectant Parents Should Know

Why Vaccination During Pregnancy Matters

Pregnancy creates a unique immunological window. A pregnant person's immune response shifts to accommodate the developing baby, which can also leave both mother and child more vulnerable to certain infections. Immunization during this period serves two purposes: protecting the mother from illness that can complicate pregnancy, and passing protective antibodies to the baby before birth.

Newborns cannot receive most vaccines for weeks or months after birth. Maternal antibodies — transferred through the placenta during pregnancy and through breast milk afterward — can bridge that gap. This is why public health organizations such as the CDC and the American College of Obstetricians and Gynecologists (ACOG) specifically recommend certain vaccines during pregnancy rather than simply before or after.

For a broader view of how immunization recommendations evolve throughout life, see the Immunization Across a Lifetime guide.

Which Vaccines Are Generally Recommended During Pregnancy

Two vaccines have consistently strong support from U.S. public health guidance for use during pregnancy:

• Influenza vaccine (inactivated): Recommended during any trimester. Influenza infection during pregnancy carries elevated risks of serious complications. The inactivated form — not the live nasal spray — is used.
• Tdap vaccine: Protects against tetanus, diphtheria, and pertussis (whooping cough). Pertussis is especially dangerous for newborns. Guidance generally targets the 27–36 week window of the third trimester to maximize antibody transfer to the baby.

Depending on individual health history and evolving guidance, providers may also discuss vaccines for RSV or COVID-19 during pregnancy. Recommendations in these areas can be updated as new evidence emerges, so your provider is the best source for current guidance specific to your situation.

Vaccines Typically Avoided During Pregnancy

Live-attenuated vaccines — those containing a weakened but active form of a virus or bacterium — are generally not given during pregnancy. Because they contain live organisms, there is a theoretical concern about risk to the developing baby, even though documented harm is rare. Examples include:

• MMR (measles, mumps, rubella)
• Varicella (chickenpox)
• The live attenuated influenza vaccine (nasal spray form)

If you are not immune to rubella or varicella, your provider will typically recommend receiving those vaccines after delivery rather than during pregnancy. This is one reason a thorough vaccination review before conception — or early in prenatal care — is valuable. See the adult vaccine schedule overview for context on where these fit in lifelong immunization.

How to Have the Conversation with Your Provider

Your first prenatal appointment is an ideal time to raise the topic of vaccines. Come prepared to share your vaccination history, including any records you have, and mention any prior reactions to vaccines. Key questions to consider asking include:

1. Which vaccines do you recommend for me during this pregnancy, and when?
2. Are there vaccines I should catch up on after delivery?
3. Should my partner or other household members update their vaccinations?

If you feel uncertain or want to understand the reasoning behind a recommendation, it is entirely appropriate to ask your provider to explain the evidence. A productive dialogue leads to better decisions. The guide to talking with your doctor about vaccines offers practical framing for these conversations.

This article is for informational purposes only and is not a substitute for professional medical advice. Pregnant individuals should consult their obstetrician, midwife, or other qualified healthcare provider regarding any decisions about vaccines or other aspects of prenatal care.

Protecting Your Newborn: The Cocooning Strategy

Even with optimal maternal vaccination, newborns are still vulnerable in the first weeks of life. A strategy called cocooning addresses this gap by ensuring that the people closest to the baby — partners, grandparents, siblings, and regular caregivers — are current on relevant vaccines themselves.

The most important vaccines for close contacts include:

• Tdap: Anyone who has not received a Tdap booster as an adult should get one before the baby arrives, especially if it has been more than ten years since their last tetanus booster.
• Influenza: Annual flu vaccination for all household members helps reduce the baby's exposure during flu season.

Cocooning is a team effort — every vaccinated person in the baby's circle adds a layer of protection during the months before the infant can receive their own immunizations. This community-level thinking is a cornerstone of preventive health for the youngest and most vulnerable members of a household.