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Maternal Immunization

Munoz, Flor M., MD, MSc; Jamieson, Denise J., MD, MPH

doi: 10.1097/AOG.0000000000003161
Contents: Prenatal Care: Clinical Expert Series
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Vaccines administered to women during pregnancy can provide protection against serious infectious diseases for the mother, for the newborn, or both. Maternal immunization boosts the concentration of maternal antibodies that can be transferred across the placenta to directly protect infants too young to be immunized. In addition, indirect protection through prevention of maternal infection and through breast milk antibodies can be achieved through maternal immunization. In general, inactivated vaccines are considered safe for pregnant women and their fetuses, whereas live vaccines are avoided owing to the theoretical potential risk to the fetus. However, the risks and benefits of vaccination must be carefully weighed and whenever possible, protection to the mother and her infant should be prioritized. Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines are routinely recommended for all pregnant women in the United States. Seasonal inactivated influenza vaccine is recommended for all pregnant women in any trimester of pregnancy, mainly to protect the mother, but there is growing evidence that infants benefit from passive antibody protection against influenza complications. The Tdap vaccine is recommended during the third trimester of each pregnancy to provide optimal protection to infants who are at particularly high risk of pertussis complications and mortality in the first 3 months of life. The effects of maternal immunization on the prevention of maternal and infant disease have been demonstrated in observational and prospective studies of influenza and pertussis disease in the United States and worldwide. Maternal immunization has the potential to improve the health of mothers and young infants and therefore, other diseases of relevance during this period are now targets of active research and vaccine development, including group B streptococcus and respiratory syncytial virus. Similarly, several vaccines can be administered during pregnancy in special circumstances, when maternal health, travel, or other special situations arise. This article reviews the current recommendations for vaccination of women during pregnancy.

Obstetrician–gynecologists play a key role in maternal immunization, a critical public health strategy that may substantially reduce preventable diseases in mothers and infants.

Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.

Corresponding author: Denise Jamieson, MD, MPH, Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive, Atlanta, GA 30303; email:

Financial Disclosure Dr. Munoz receives funds (paid to her institution) to conduct research on topics related to maternal immunization from the National Institutes of Health, the CDC, the Bill and Melinda Gates Foundation, the National Vaccine Program Office, and industry (Novavax, Inc). The other author did not report any potential conflicts of interest.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.