Vaccines in pregnancy: which ones are recommended, and when?

Why get vaccinated during pregnancy?

Vaccination during pregnancy has two benefits:

• it protects the mother-to-be against infections that are more severe during pregnancy, such as flu or COVID-19;
• it protects the newborn during the first months of life, before the baby can be vaccinated: antibodies made by the mother cross the placenta and protect the baby after birth. This is how the whooping cough and RSV vaccines work.

Ideally, your vaccinations are reviewed before pregnancy, at a preconception appointment: this is the time to check your immunity to rubella and chickenpox and to catch up on live vaccines, which can no longer be given once you are pregnant. Pregnancy care and planning for the birth are described on the Childbirth in Paris page.

Which vaccines are recommended in pregnancy, and at how many weeks?

Flu

Pregnancy increases the risk of severe flu. The inactivated vaccine can be given at any stage; many reviews of the evidence have found no increased risk of birth defects, miscarriage or premature birth.

Whooping cough

Whooping cough can be very serious in babies under three months. In France, vaccinating the mother in every pregnancy has been recommended since 2022, all year round. When the mother has been vaccinated, close contacts do not need to be, unless the baby is born less than a month after the vaccination. If the mother was not vaccinated during pregnancy, she should be vaccinated right after the birth if her last booster was more than 5 years ago, as should the baby's close contacts: this is known as the “cocooning” strategy.

RSV

Respiratory syncytial virus (RSV) is the main cause of bronchiolitis. According to the HAS, maternal vaccination reduces severe RSV respiratory infections in babies during their first months. The alternative is an antibody (nirsevimab) given directly to the baby after birth: the HAS regards these two strategies as alternatives, and parents choose after being informed. If the baby is born less than 14 days after the vaccination, or is premature, the baby is given nirsevimab. In a later pregnancy, the antibody for the baby is preferred.

Which vaccines can be given in pregnancy in special situations?

Other non-live vaccines can be given during pregnancy when the risk of infection justifies it, after medical advice:

• Hepatitis B: in case of occupational exposure (healthcare or laboratory workers) or a partner who carries the virus.
• Hepatitis A, meningococcal, pneumococcal, injectable polio, injectable typhoid: depending on travel, an outbreak or a chronic illness.
• Tetanus (toxoid): for a high-risk wound if your booster is not up to date.
• Immunoglobulins: for example after contact with chickenpox in a woman who is not immune (see chickenpox in pregnancy).

Before travelling, visit a travel vaccination clinic: some destinations are not advised during pregnancy, notably because of malaria or viruses such as Zika.

Which vaccines should be avoided during pregnancy?

Live attenuated vaccines are not given as a precaution, because the weakened germ could theoretically reach the baby:

• measles, mumps and rubella (MMR);
• chickenpox (varicella);
• BCG (tuberculosis);
• yellow fever: not given in principle, although it can be discussed if travel to an at-risk area cannot be postponed;
• some oral vaccines (oral typhoid, live cholera).

MMR and chickenpox vaccines should be given before pregnancy if you are not immune, with effective contraception for 1 month after each dose. If you have not had two doses of MMR, your vaccination will be brought up to date straight after the birth, including if you are breastfeeding. See rubella in pregnancy.

What if I was vaccinated before I knew I was pregnant?

This is common and generally reassuring. Follow-up data on women vaccinated by mistake in early pregnancy, including with MMR or chickenpox vaccines, have not shown an increase in birth defects. An accidental vaccination is not a reason to end the pregnancy.

Tell your doctor or midwife: it will be recorded in your notes and your pregnancy will be followed as usual. In France, you can also report it to the regional pharmacovigilance centre, which helps build knowledge.

Are vaccines safe during pregnancy?

The vaccines recommended in pregnancy have been the subject of many safety studies. According to the HAS, these vaccines do not increase the risk of miscarriage, premature birth, birth defects or developmental problems in the child, and they remain under monitoring after marketing.

The most common side effects are a sore arm, tiredness or a mild fever for 24 to 48 hours. Paracetamol can be used if needed (see medicines in pregnancy).

These vaccines are compatible with breastfeeding. Several vaccines can be given on the same day: the RSV vaccine can be given at the same time as the flu or COVID-19 vaccine, but an interval of at least 2 weeks (14 days) is recommended between the whooping cough and RSV vaccines.

When should I seek medical help quickly after a vaccination?

Serious reactions are very rare. In France, call 15 or 112 (or your local emergency number) if your face or lips swell, you have difficulty breathing or you feel faint in the minutes or hours after the injection.

As at any point in pregnancy, go to the maternity emergency department where you are registered (Sainte-Félicité Maternity Unit or Clinique Sainte-Thérèse) if you have:

• a fever of 38 °C or more that lasts longer than 48 hours or makes you feel unwell;
• regular contractions, bleeding or leaking fluid;
• fewer baby movements.

A persistent fever is not an expected effect of the vaccine and another cause should be looked for (see fever during pregnancy).

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.