O&G · Antenatal care — maternal immunisation
Vaccination in pregnancy
Also known as Maternal immunisation · Vaccines in pregnancy · Pertussis in pregnancy · Influenza in pregnancy · RSV vaccine in pregnancy · Antenatal vaccination
Exam-exhaustive FRANZCOG fellowship reference on vaccination in pregnancy — the four routinely recommended vaccines (influenza, pertussis/dTpa, COVID-19, RSV) with their timing and doses, the contraindicated live vaccines (MMR, varicella, BCG), transplacental IgG transfer, the effectiveness evidence (pertussis VE 93%, influenza VE 63%, RSV VE 81.8%), RANZCOG C-Obs 44 signposting the ATAGI/Australian Immunisation Handbook, and the management of inadvertent live-vaccine exposure. RANZCOG-primary, globally tagged to MRCOG and ABOG.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Live vaccines — MMR, varicella, BCG and live-attenuated influenza — are contraindicated in pregnancy; if given inadvertently, reassure and document, do not recommend termination
- A rubella-seronegative woman at booking does NOT get MMR in pregnancy — defer it to the postpartum period, before discharge
- Pertussis and RSV vaccines are given in EVERY pregnancy — antibody wanes between pregnancies and the protection is pregnancy-specific
- Influenza vaccine is safe and recommended at any stage of pregnancy — do not defer it for trimester or season
- A missed antenatal vaccination is a missed opportunity — every contact is a chance to offer and document
A woman sits in your booking clinic at 10 weeks. Before she leaves, you have a window that determines whether her newborn enters the world already armed against pertussis, influenza and RSV — the three infections that hospitalise and kill infants in the first months of life. Vaccination in pregnancy is the topic that turns a routine antenatal visit into a life-saving intervention, and the examiner wants to hear you know the four recommended vaccines, their timing, the contraindicated live vaccines, and the evidence that backs every dose.[4]
Overview and definition
Maternal immunisation is vaccination of a pregnant woman to protect two people at once — her, through her own active antibody response, and her infant, through passive transfer of maternal IgG across the placenta. That dual protection is the entire rationale.[4]
The vaccines fall into two lists, and the station lives or dies on knowing which list a vaccine belongs to:[4]
- Routinely recommended: influenza, pertussis (dTpa), COVID-19, RSV. All inactivated or recombinant — safe in pregnancy.[4]
- Contraindicated (live-attenuated): MMR, varicella, BCG, and live-attenuated influenza (LAIV). Theoretical risk of fetal infection; do not give in pregnancy.[4]
References6ShowHide
- [1]Zaman K, Roy E, Arifeen SE, et al. Effectiveness of maternal influenza immunization in mothers and infants N Engl J Med, 2008.PMID 18799552
- [2]Dabrera G, Amirthalingam G, Andrews N, et al. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012-2013 Clin Infect Dis, 2015.PMID 25332078
- [3]Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants N Engl J Med, 2023.PMID 37018474
- [4]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 741: Maternal Immunization Obstet Gynecol, 2018.PMID 29794683
- [5]Morgan JA, Biggio JR Jr, Martin JK, et al. Pregnancy Outcomes in Patients After Completion of the mRNA Coronavirus Disease 2019 (COVID-19) Vaccination Obstet Gynecol, 2023.PMID 36735413
- [6]Fleming-Dutra KE, Jones JM, Roper LE, et al. Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023 MMWR Morb Mortal Wkly Rep, 2023.PMID 37824423