Vaccines During Pregnancy: Tetanus, Flu, Whooping Cough

Yes, some vaccines are strongly recommended during pregnancy, and they protect both you and your newborn. The main ones are a tetanus-containing vaccine, the inactivated flu vaccine and, in many countries, a whooping cough (pertussis) vaccine. A few live vaccines are avoided.

Exact schedules differ between countries and over time, so use this article to understand the reasons and then follow the plan your own doctor gives you.

Why vaccines matter in pregnancy

Newborns cannot be fully vaccinated for the first weeks or months of life. When you are vaccinated in pregnancy, your body makes antibodies and passes some of them to your baby through the placenta. This gives the baby protection during the most fragile period. The NHS also explains that pregnancy slightly weakens the immune system, which is why infections such as flu can be more serious for expectant mothers.

Tetanus vaccine

Tetanus is a serious infection caused by bacteria that can enter through unclean cuts or, in a newborn, through an unclean umbilical cord stump. The World Health Organization (WHO) explains that tetanus in a baby during the first 28 days of life is called neonatal tetanus. Most cases happen when the mother has not had enough doses of tetanus vaccine and delivery or cord care is not clean. WHO reports that deaths from neonatal tetanus have fallen by 84 percent between 2000 and 2021 because of maternal vaccination and clean delivery practices.

WHO notes that tetanus-containing vaccines are often given at antenatal visits. Schedules differ by country, and in India you should follow the plan your doctor or antenatal clinic gives you. The number of doses depends on how many you have had before, so show your earlier vaccination records to your doctor or health worker. Do not assume you are covered.

Whooping cough (pertussis) vaccine

Whooping cough causes long coughing spells and can be dangerous for young babies. Guidelines differ on timing:

• United States (CDC): one dose of Tdap in every pregnancy, ideally between 27 and 36 weeks. Giving it earlier in that window passes more antibodies to the baby. If it was missed, it can be given right after delivery.
• United Kingdom (NHS): usually offered at around 20 weeks, and can be given from 16 weeks, ideally before 32 weeks. It protects the baby until the first baby vaccine at 8 weeks.

Because guidelines vary, ask your doctor whether a whooping cough vaccine is advised for you and when to take it. Your doctor will tell you if it is combined with tetanus protection.

Flu vaccine

The CDC recommends an inactivated or recombinant flu vaccine for anyone who is or will be pregnant during flu season. The NHS recommends the inactivated vaccine because flu can cause more serious illness in pregnancy. Flu seasons and timing differ by region, so ask your doctor when to have it. The flu vaccine given as a nasal spray (live) is not used in pregnancy.

RSV vaccine

RSV is a virus that can cause serious chest infections in babies. In the United States, the CDC advises one dose of one specific RSV vaccine (Abrysvo) between 32 weeks 0 days and 36 weeks 6 days, given in the autumn and winter months. In the UK, the NHS offers it from around 28 weeks, and it protects the baby for roughly the first 6 months. Availability varies, and your doctor will tell you whether it applies to you.

When to be cautious: tell your doctor about any vaccine you have had in the last few months, a possible allergy to a vaccine, or fever on the day of your appointment. Also check before any vaccine needed for travel.

Vaccines usually avoided in pregnancy

Live vaccines contain a weakened form of a virus and are generally avoided during pregnancy as a precaution. The CDC lists these as not recommended:

• MMR (measles, mumps, rubella). The CDC advises avoiding pregnancy for 28 days after it.
• Varicella (chickenpox). Avoid pregnancy for about one month after each dose.
• Live nasal flu vaccine.
• Live oral typhoid vaccine.

The NHS also lists BCG and yellow fever as usually avoided, although yellow fever can be considered for high-risk travel. The NHS adds that there is no evidence that live vaccines given by mistake cause birth defects. If you realise you had one while pregnant, tell your doctor. Do not panic.

Tip: if you are planning a pregnancy, check your rubella and chickenpox protection early. Our preconception checkup guide explains what to review before you conceive.

Are vaccines in pregnancy safe?

The vaccines recommended in pregnancy have been studied and are used worldwide. Mild side effects such as a sore arm, tiredness or a low fever for a day are common. Serious reactions are rare. Your doctor weighs the small risks of a vaccine against the larger risks of the illness it prevents.

Myths and facts

• Myth: vaccines in pregnancy harm the baby. Fact: recommended vaccines protect the baby; live vaccines are avoided only as a precaution.
• Myth: one tetanus injection in an earlier pregnancy is enough forever. Fact: dosing depends on your past doses, so check with your doctor.
• Myth: I will pass on my flu shot because I feel healthy. Fact: pregnancy raises the chance of complications from flu.

When to see a doctor

Speak to your doctor about vaccines at your first antenatal visit. Seek care promptly if after a vaccine you have:

• Difficulty breathing, swelling of the face or throat, or a widespread rash
• A high fever that does not settle
• Severe pain, redness or swelling at the injection site that gets worse
• Reduced baby movements

Vaccination plans are part of routine antenatal checkups. For newborn protection after birth, see our guide on newborn vaccination, and read more about antenatal care.

Talk to a doctor

If you have questions about your own situation, you are welcome to book an appointment or call us on +91 944 103 0587. Chaitanya Hospital in Kadapa offers 24/7 delivery and emergency care, and teleconsultation is available. This article is for general awareness and is not a substitute for a doctor's advice.