Vaccination During Pregnancy Guide

A guide on how to best protect the mother and unborn child with vaccinations.

Immunisation Coalition

About Pregnancy and Vaccinations

Vaccinations During PregnancyPregnant women are particularly vulnerable and should receive the influenza vaccine, the whooping cough vaccine, and now a COVID-19 vaccine to protect themselves and their baby. As the immune system is naturally suppressed during pregnancy, they face an increased chance of contracting influenza or COVID-19 and associated complications.

Influenza, whooping cough (pertussis) and COVID-19 are serious illnesses that can affect both mother and baby. Vaccination can help keep mothers and babies healthy and protect the newborn in the first 6 months of life.

This Vaccination During Pregnancy guide is currently undergoing updates and will be available to download as a PDF soon.

Download the Guide

Whooping Cough Vaccination During Pregnancy

Whooping cough is a highly infectious bacterial disease that causes severe bouts of coughing. In adults, the symptoms can be mild, but for a baby who is not yet vaccinated, it can be life threatening.

Vaccination during pregnancy (preferably between 20-32 weeks) means the body produces antibodies that are passed on to the baby before birth.

These antibodies will protect the baby until they are able to receive their own vaccination at 6 weeks of age.

Studies have found that whooping cough vaccination during pregnancy is safe and effective for both mother and baby.

Studies from the US and UK involving more than 40,000 pregnant women found only mild side effects such as pain or redness in the arm where the vaccination was given. It does not increase the risk of serious pregnancy complications such as premature birth. The National Health and Medical Research Council (NHMRC) has recently updated recommendations for pregnant women to be vaccinated in their mid 2nd trimester and early 3rd trimester(ideally at 20-32 weeks).

Influenza Vaccination During Pregnancy

How does the influenza affect mother and baby?

Influenza is a potentially severe disease that can affect mother and baby. It can affect the mother in the second and third trimesters and the baby in the first few months after birth, even causing death. 

What is the risk?

In Australia, it is estimated that over 3000 people have died every year of influenza and tens of thousands have been hospitalised due to influenza and its complications[1]. Pregnant women bear a disproportionate burden from influenza infection. 

In Australia, the 2009 epidemic of influenza A(H1N1)pdm09 resulted in increased admissions to intensive care. The highest excess ICU admission rate was in Aboriginal people (17/100,000) and pregnant women (14/100,000)[2]. Overall, nearly 10% of women admitted to ICU with AH1N1v in pregnancy died, over 10% suffered pregnancy losses and more than 50% of the remaining women delivered preterm, emphasising the severity of the disease in pregnancy[3]. 

Considerable decreases in influenza have been reported since April 2020 due to the COVID-19 epidemic in Australia. Physical distancing, travel restrictions, emphasis on hygiene, changes in testing priorities and diversion of resources to the COVID-19 response may all have affected numbers.[4][5]

What are the complications?

The fact that the immune system is naturally suppressed during pregnancy may lead to an increased chance of contracting influenza. Additionally, pregnant women have an increased risk of severe complications: stillbirth, premature birth and suboptimal foetal growth. 

How can pregnant women protect themselves and the baby?

Influenza vaccination protects against these three complications. Although vaccination rates have recently increased, pregnant women seem to underestimate the risk to the unborn baby – especially from influenza. Not enough mums understand that the baby cannot be vaccinated against influenza in the first 6 months of life. Multiple studies show that influenza vaccine at any stage of pregnancy is associated with a 20% reduction in risk of stillbirth.

What do pregnant women need to know?

Elizabeth McCarthy, Senior Lecturer, Department of Obstetrics and Gynecology, University of Melbourne, Perinatal Center, Mercy Hospital for Women:

“The influenza vaccine is nationally approved and free for pregnant women.

The vaccine is the best way to protect the mother and baby.

Vaccinating pregnant women against influenza gives a three for one benefit:

  • Protects the mum during pregnancy and in the early months of motherhood
  • Protects the unborn baby by transplacental antibodies
  • Protects the young infant by antibodies in breast milk”
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1 https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu

2 Schaffer et al BMC Public Health 2012 12:869

3 Knight M, Pierce M, Seppelt I, et al. Critical Illness with AH1N1v Influenza in Pregnancy: A Comparison of Two Population-based Cohorts. BJOG. 2011;118(2)232-9

4 Department of Health Australian Influenza Surveillance Report and Activity Updates page last updated 1/10/2021

5 Bright A et al Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.85) Epub 5/11/2020

COVID-19 Vaccination During Pregnancy

COVID-19 can cause harm to pregnant women and their babies

When compared to pregnant women without COVID-19, pregnant women with COVID-19 are:

  • five times more likely to be hospitalised 
  • up to three times more likely to be admitted to ICU and
  • three times more likely to need a ventilator 

When compared to the babies of pregnant women without COVID-19, the babies of pregnant women with COVID-19 are:

  • one and a half times more likely to be born prematurely
  • three times more likely to be admitted to a hospital newborn care unit
  • more likely to be stillborn
  • more likely to experience distress during birth

COVID-19 vaccination

Pfizer or Moderna COVID-19 vaccines are recommended for pregnant women at any stage of pregnancy. If Pfizer or Moderna are not available, AstraZeneca can be considered if the benefits to the individual outweigh the potential risks.

Pfizer can be given as two doses 3-6 weeks apart and Moderna can be given as two doses 4-6 weeks apart.

COVID-19 vaccination effectiveness during pregnancy

Results from a vaccination program in pregnant women in Israel show that the Pfizer COVID-19 vaccine is effective in preventing COVID-19 in pregnant women[6]. Research shows that antibodies produced during vaccination cross the placenta and may provide some protection to newborn babies.

In the UKOSS study of COVID-19, from 1 February – 30 September 2021, 1714 pregnant women where admitted to hospital with symptomatic COVID[7].

  • 98.1% of these women were unvaccinated
  • 1.5% had received one vaccine dose and
  • 0.4% had received two doses.

14% of the women hospitalised (235 women) were admitted to intensive care.

  • 98.7% of these women were unvaccinated
  • 1.3% (3 women) had received a single dose of vaccine and
  • none had received two doses.

During the third wave (delta wave) of COVID-19 in the UK, the maternal deaths were mainly seen in unvaccinated women.

COVID-19 vaccine safety during pregnancy

There is evidence from other countries to show that the Pfizer COVID-19 and the Moderna COVID-19 vaccines are safe in pregnant women. A US study[8] of more than 35,000 pregnant women showed that the side effects after vaccination in pregnant and non-pregnant women were similar. The possible side effects include pain at the injection site, tiredness, fever, headache, muscle and joint pain, chills and diarrhoea.

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6 Goldshtein I, Nevo D, Steinberg DM, et al. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. JAMA. Published online July 12, 2021. doi:10.1001/jama.2021.11035
7 UKOSS study of COVID-19 vaccine during pregnancy, Infographic summary October 11, 2021
8 Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. Published online April 21, 2021. doi:10.1056/nejmoa2104983

Page Published: 7 March 2017 | Page Updated: 22 November 2021