Vaccines During Pregnancy: What You Need to Know About Flu, COVID-19 and RSV

Pregnancy changes many things about your body, including how your immune system responds to certain infections. Illnesses that may normally cause several uncomfortable days can sometimes become more serious during pregnancy. At the same time, newborn babies are particularly vulnerable to respiratory illnesses during their first months of life.

That is why vaccines are an important part of prenatal care.

At Women's Health Associates in Overland Park and Leawood, Kansas, we understand that patients often have questions about which vaccines are recommended during pregnancy, when they should receive them, and whether vaccination can also help protect their baby.

Current guidance from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recommends influenza, COVID-19, and respiratory syncytial virus (RSV) vaccination during pregnancy when patients are eligible.

Understanding what is recommended and why can help you make informed decisions about protecting both yourself and your baby.

Quick Answer: Which Vaccines Are Recommended During Pregnancy?

Current ACOG guidance recommends several routine vaccines during pregnancy, including:

• Influenza vaccine: Recommended during pregnancy if you are pregnant during flu season. It can be given during any trimester.
• COVID-19 vaccine: ACOG recommends an updated COVID-19 vaccine during pregnancy. It can be administered during any trimester.
• RSV vaccine: Pfizer's Abrysvo is recommended for eligible pregnant patients between 32 weeks 0 days and 36 weeks 6 days during RSV season.

One important benefit of maternal vaccination is that protection doesn't stop with mom. Antibodies created after vaccination can cross the placenta and provide babies with some protection during their first vulnerable months of life.

Why Vaccination During Pregnancy Matters

Pregnancy creates normal changes in the immune, heart and respiratory systems. Those changes can make pregnant women more vulnerable to complications from respiratory infections.

Influenza and COVID-19 can lead to more serious illness during pregnancy, including an increased risk of hospitalization. Certain infections may also increase the risk of pregnancy complications.

RSV presents a somewhat different concern. While adults frequently experience mild symptoms, RSV can cause serious lower respiratory tract illness in newborns and young infants.

Vaccination during pregnancy can therefore accomplish two important goals: protecting the mother from serious illness and, depending on the vaccine, helping provide protection to the baby after birth.

As Nancy Raile, MSN, CNM, often explains to patients, "Vaccines during pregnancy are not only about protecting mom. The antibodies your body produces can cross the placenta and help give your baby protection during those first months when they are especially vulnerable."

Flu Vaccine During Pregnancy: What Is Recommended?

ACOG recommends that women who are pregnant during influenza season receive an inactivated or recombinant influenza vaccine.

The flu vaccine can safely be given during any trimester of pregnancy. Ideally, vaccination occurs before influenza begins circulating widely, but vaccination later in the season is still encouraged while flu viruses are circulating.

The nasal spray flu vaccine is a live attenuated vaccine and is not recommended during pregnancy.

Why Is the Flu Vaccine Important During Pregnancy?

Influenza can be more serious during pregnancy than it is for otherwise healthy adults who are not pregnant.

Pregnant women who develop influenza have a greater risk of serious illness and hospitalization. Influenza during pregnancy has also been associated with pregnancy complications.

Vaccination helps lower the mother’s risk of severe influenza. Antibodies produced following vaccination can also cross the placenta, helping protect the newborn.

That protection is especially valuable because babies cannot receive their own influenza vaccine until they are 6 months old.

COVID-19 Vaccine During Pregnancy: What Is Recommended?

ACOG and the Society for Maternal-Fetal Medicine continue to recommend an updated COVID-19 vaccine during pregnancy.

Vaccination may occur during any trimester, and patients do not need to wait until a particular point in pregnancy to receive it.

This is an area where patients may encounter conflicting information. Federal recommendations have changed, but professional organizations specializing in obstetric and high-risk pregnancy care continue to recommend COVID-19 vaccination during pregnancy based on the available evidence regarding maternal and infant benefits.

Why Is COVID-19 Vaccination Important During Pregnancy?

Pregnancy increases the risk of developing severe illness from COVID-19 compared with people of reproductive age who are not pregnant.

Severe COVID-19 can increase the likelihood of hospitalization, intensive care and pregnancy complications. Vaccination reduces the risk of severe illness.

Vaccination during pregnancy also produces antibodies that cross the placenta. Research has shown that maternal COVID-19 vaccination can help protect babies against COVID-19 hospitalization during the first months of life, before they are old enough to receive their own vaccine.

Nancy Raile, MSN, CNM reminds patients, "Pregnancy is a time when we want to prevent serious illness whenever we safely can. Our recommendations are based on the evidence we have about protecting both maternal health and pregnancy outcomes."

RSV Vaccine During Pregnancy: What Is Recommended?

RSV vaccination is newer to prenatal care than flu vaccination, so it understandably generates more questions.

RSV, or respiratory syncytial virus, is a common respiratory virus. In healthy adults, it often causes cold-like symptoms. In newborns and young babies, however, RSV can cause serious lower respiratory tract infections and may lead to hospitalization.

The maternal RSV vaccine offers a way to provide protection before the baby is even born.

For pregnant women, Pfizer's Abrysvo is the RSV vaccine approved for use during pregnancy.

ACOG recommends giving one dose to eligible pregnant patients between 32 weeks 0 days and 36 weeks 6 days of pregnancy during RSV season.

Timing matters because the mother's immune system needs time to produce antibodies and transfer those antibodies across the placenta before delivery.

Why Is the RSV Vaccine Important?

The primary goal of maternal RSV vaccination is to protect the baby during the first months after birth, when RSV can be particularly dangerous.

After vaccination, the mother's immune system produces antibodies against RSV. Those antibodies cross the placenta and provide passive protection to the baby.

There is also another option for protecting infants against severe RSV disease: a preventive monoclonal antibody given directly to the baby after birth. Your OB provider and pediatrician can help determine which approach is appropriate for your family.

If you received an RSV vaccine during a previous pregnancy, current guidance generally does not recommend another maternal RSV dose during a subsequent pregnancy. Instead, the newborn can receive an RSV monoclonal antibody. Recommendations continue to evolve as additional evidence becomes available, so discuss your vaccination history with your provider.

Can You Receive More Than One Vaccine at the Same Appointment?

Yes.

Recommended maternal vaccines can generally be given during the same appointment when timing and eligibility overlap.

For example, depending on the time of year and how far along you are in your pregnancy, you may be eligible for influenza, COVID-19 or RSV vaccination at the same prenatal visit.

Receiving vaccines together does not reduce their effectiveness and can make it easier to ensure you and your baby receive recommended protection at the appropriate time.

Are Vaccines During Pregnancy Safe?

Questions about vaccine safety are completely reasonable, particularly when you are making decisions that affect both you and your developing baby.

Maternal vaccines recommended during pregnancy have been studied for safety and effectiveness. ACOG’s current guidance notes that evidence supports the safety of recommended mRNA, inactivated virus, bacterial, and toxoid vaccines used during pregnancy.

Importantly, some vaccines should not be given during pregnancy. Live vaccines, such as the measles, mumps and rubella (MMR) vaccine and the varicella vaccine, are generally given before pregnancy or after delivery when needed.

This is one reason reviewing your vaccination history with your OB-GYN is an important part of prenatal care.

Frequently Asked Questions About Vaccines During Pregnancy

Your Vaccine Plan Should Be Part of Prenatal Care

There is a lot of vaccine information available online, and recommendations can be confusing, particularly when public health guidance changes.

Your prenatal care team can help you sort through that information and develop a vaccination plan based on current evidence, your stage of pregnancy, your vaccination history, and your individual health needs.

At Women's Health Associates in Overland Park and Leawood, KS, we encourage patients to ask questions about vaccines during their prenatal appointments. Our goal is not simply to tell you what is recommended, but to help you understand why it is recommended and how it may protect both you and your baby.

If you have questions about flu, COVID-19, RSV, or other vaccines during pregnancy, call 913-677-3113 to speak with a nurse or schedule an appointment at one of our convenient locations in Overland Park or Leawood, Kansas.

This article is for informational purposes only and does not replace professional medical advice. Vaccine recommendations can change as new evidence and seasonal guidance become available. Talk with your healthcare provider about recommendations specific to your pregnancy.