Summary of Maternal Immunization Recommendations

Resources for health care professionals

Last Updated December 2018

 Vaccine* Indicated During

Every Pregnacy

May Be Given 

During Pregnancy

in Certain Populations

Contraindicated 

During Pregnancy

Can Be Initiated

Postpartum or When

Breastfeeding or Both 

 Inactivated influenza

Tetanus toxoid, reduced

diptheria toxoid and 

acellular pertussis (Tdap) 

Pneumococcal vaccines

Meningococcal 

conjugate

(MenACWY) and 

Meningococcal 

serogroup B

Hepatitis B

Human

papillomavirus (HPV)**

Measles, mumps, 

and rubella

Varicella

Vaccines help keep your pregnant patients and their 

growing families healthy.

X†,1,2

X‖,7

X¶,8

X#,9,10

X‡

X§,5,6

X¶,8

X#,9,10

X**,11,12

X††,13,14

X††,13,15,16

X††

X††

X§,5,6

X†,3,4

X‖,7

X‡

Reprinted from Maternal immunization. ACOG Committee Opinion No. 741. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e214–7

*An “X” indicates that the vaccine can be given in this window. See the corresponding numbered footnote for details.

† Inactivated influenza vaccination can be given in any trimester and should be given with each influenza season as soon as the vaccine is available. The Tdap 

vaccine is given at 27–36 weeks of gestation in each pregnancy, preferably as early in the 27–36-week window as possible. The Tdap vaccine should be given during

each pregnancy in order to boost the maternal immune response and maximize the passive antibody transfer to the newborn. Women who did not receive 

Tdap during pregnancy (and have never received the Tdap vaccine) should be immunized once in the immediate postpartum period.1–3

‡ Vaccination during every pregnancy is preferred over vaccination during the postpartum period to ensure antibody transfer to the newborn.3,4

§ There are two pneumococcal vaccines: 1) the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended in reproductive-age women who have 

heart disease,lung disease, sickle cell disease, and diabetes as well as other chronic illnesses; 2) the 13-valent pneumococcal vaccine (PCV13) is recommended for 

reproductive-aged women with certain immunocompromised conditions, including human immunodeficiency virus (HIV) infection and asplenia. The PCV13 vaccine

should be deferred in pregnant women, unless the woman is at increased risk of pneumococcal disease and after consultation with her health care provider 

the benefits of vaccination are considered to outweigh the potential risks.

5,6

‖ Quadrivalent conjugate meningococcal vaccine is routinely recommended for adolescents aged 11–18 years, along with individuals with HIV infection, complement

component deficiency (including eculizumab use), functional or anatomic asplenia (including sickle cell disease), exposur

outbreak, travel to endemic or hyperendemic areas, or work as a microbiologist routinely exposed to

preclude vaccination. The serogroup B vaccine should be deferred in pregnant women, unless the woman is at incr

             

e during a meningococcal disease 

. If indicated, pregnancy should not 

eased risk of serogroup B meningococcal disease7

and, after consultation with her health care provider, the benefits of vaccination are considered to outweigh the potential risks.7

¶ Pregnant women with any of the conditions that increase the risk of either acquiring or having a severe outcome from hepatitis A infection (eg, having chronic liver

disease, clotting-factor disorders, traveling, using injection and noninjection drugs, and working with nonhuman primates) should be vaccinated during pregnancy if

not previously vaccinated. Pregnant women at risk of hepatitis A infection during pregnancy should also be counseled concerning all options to prevent hepatitis A

infection. Any woman who wants to be protected from hepatitis A or has an indication for use may receive the vaccine during pregnancy or during the 

postpartum period.8

# Hepatitis B vaccination is recommended for women who are identified as being at risk of hepatitis B infection during pregnancy (eg, women who have household

contacts or sex partners who are hepatitis B surface antigen–positive; have more than one sex partner during the previous 6 months; have been evaluated or treated

for a sexually transmitted infection; are current or recent injection-drug users; have chronic liver disease; have HIV infection; or have traveled to certain countries). 

Any woman who wants to be protected from hepatitis B or has an indication for use may receive the vaccine during pregnancy and the postpartum

period. Pregnant women at risk of hepatitis B infection during pregnancy should be counseled concerning other methods to prevent hepatitis B infection.1,9

** The HPV vaccination in pregnancy is not recommended, however, inadvertent HPV vaccination during pregnancy is not associated with adverse events for the

woman or her fetus. The HPV vaccine can be given to postpartum and breastfeeding women. The HPV vaccine should be administered to women through age 

26 years who were not previously vaccinated. Vaccination timing and number of doses should follow Centers for Disease Control and Prevention and American 

College of Obstetricians and Gynecologists’ guidance.11,12

†† Live attenuated vaccines including, measles–mumps–rubella, varicella, and live-attenuated influenza vaccine are contraindicated for pregnant women. 

If indicated (ie, among seronegative women), the measles–mumps–rubella vaccine and the varicella vaccine should be given during the postpartum period.

Inadvertent administration during pregnancy has not been associated with congenital rubella or congenital varicella syndromes.13–16

Hepatitis A
1. Influenza vaccination during pregnancy. Committee Opinion No. 732. American College of Obstetricians and Gynecologists. Obstet Gynecol 

2018;131:e109–14.

2. Centers for Disease Control and Prevention. Pregnant women and influenza. Atlanta (GA): CDC; 2017.

3. Centers for Disease Control and Prevention. Pregnancy and whooping cough. Atlanta (GA): CDC; 2017.

4. Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Committee Opinion No. 718. American College of Obstetricians 

and Gynecologists. Obstet Gynecol 2017;130:e153–7.

5. Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine 

for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). 

MMWR Morb Mortal Wkly Rep. 2012;61:816–9.

6. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide 

vaccine (PPSV23). Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices. 

MMWR Morb Mortal Wkly Rep. 2010;59:1102–6.

7. Folaranmi T, Rubin L, Martin SW, Patel M, MacNeil JR. Use of serogroup B meningococcal vaccines in persons aged ≥10 years at increased risk for 

serogroup B meningococcal disease: recommendations of the Advisory Committee on Immunization Practices, 2015. Centers for Disease Control 

[published erratum appears in MMWR Morb Mortal Wkly Rep. 2015;64:806]. MMWR Morb Mortal Wkly Rep. 2015;64:608–12.

8. Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on

Immunization Practices (ACIP). Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2006;55(RR-7):1–23.

9. Viral hepatitis in pregnancy. ACOG Practice Bulletin No. 86. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110:941–56.

10. Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B 

virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults 

[published erratum appears in MMWR Morb Mortal Wkly Rep. 2007;56:1114]. MMWR Recomm Rep 2006;55(RR-16):1–33; quiz ce1–4.

11. Human papillomavirus vaccination. Committee Opinion No. 704. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e173–8.

12. Petrosky E, Bocchini JA Jr, Hariri S, Chesson H, Curtis CR, Saraiya M, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV

vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64:300–4.

13. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 8th ed. Elk Grove Village (IL): AAP; 

Washington, DC: American College of Obstetricians and Gynecologists; 2017.

14. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary 

recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention [published erratum 

appears in MMWR Recomm Rep. 2015;64:259]. MMWR Recomm Rep. 2013;62(RR-4):1–34.

15. Centers for Disease Control and Prevention. Updated recommendations for use of VariZIG—United States, 2013. MMWR Morb Mortal Wkly 

Rep. 2013;62:574–6.

16. Marin M, Guris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP).

 Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention. MMWR Recomm Rep. 2007;56(RR-4):1–40.

This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as 

inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in 

practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in 

knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this 

document can be found on www.acog.org or by calling the ACOG Resource Center.

While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. ACOG does 

not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or 

claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.

Please be advised that this guidance may become out-of-date as new information on influenza in pregnant women becomes available from the Centers for Disease Control and Prevention (CDC). 

Copyright December 2018. American College of Obstetricians and Gynecologists