Vaccines in Pregnancy: Which Vaccines and When?

Why are vaccines important in pregnancy?

Because of changes in the immune system and breathing during pregnancy, respiratory infections such as flu and COVID-19 can be more severe in pregnant women. Some vaccines given in pregnancy protect the mother and also allow her antibodies to cross the placenta to the baby. This gives the baby some protection against whooping cough, flu and RSV in the first months of life, before the baby is old enough for its own vaccines.

The vaccines recommended in pregnancy are inactivated, meaning they contain no live germs and cannot infect the baby. Which vaccine is given and when is planned with your doctor according to the national schedule, your vaccination history, the season and your individual risks.

Pregnancy vaccine schedule: summary

The list below is a general framework. In Türkiye, vaccination follows the Ministry of Health Expanded Programme on Immunization; points that differ from international guidelines are noted.

Whooping cough, tetanus and diphtheria (Tdap / Td)

• Türkiye: since 2 April 2025, one dose of Tdab (tetanus, diphtheria, acellular pertussis) is given in every pregnancy between 18 and 24 weeks.
• Depending on the number of previous tetanus doses and the timing of the last one, an additional Td (tetanus-diphtheria) dose may be needed at least 4 weeks after Tdap. Women who have never been vaccinated are advised to have two doses 4 weeks apart, at least one of them Tdap.
• Protection reaches adequate levels about one month after the second dose, so the schedule should be completed at least one month before birth.
• International recommendation: in the United States, the CDC and ACOG recommend one dose of Tdap in every pregnancy between 27 and 36 weeks, preferably early in this window.
• Vaccines are usually given at family health centres and recorded in your pregnancy notes.

Flu (influenza) vaccine

• Can be given at any stage of pregnancy, including the first trimester, during flu season (usually autumn and winter).
• A single dose is given and repeated in every pregnancy.
• Only the inactivated (injected) flu vaccine is used; the live nasal spray vaccine is not given in pregnancy.
• Vaccinating the mother also helps protect the baby, who cannot receive the flu vaccine before 6 months of age.

COVID-19 vaccine

• Pregnancy is a risk factor for severe COVID-19.
• The COVID-19 vaccine can be given at any stage of pregnancy. Current recommendations may change with the season and national announcements.
• ACOG recommends an updated COVID-19 vaccine for women who are or plan to be pregnant during autumn and winter. You can discuss current practice in Türkiye with your doctor.

RSV vaccine

• RSV (respiratory syncytial virus) is a common virus that can cause bronchiolitis and pneumonia in babies, and it can be severe in the first 6 months.
• Some countries recommend a single dose of maternal RSV vaccine (RSVpreF). In the United States it is given between 32 and 36 weeks during RSV season; the World Health Organization recommends it in the third trimester from 28 weeks.
• An alternative is a long-acting antibody (nirsevimab) given to the baby after birth. For most babies one of these two options is sufficient.
• The licensing and availability of the maternal RSV vaccine in Türkiye may vary; discuss the current situation and national recommendations with your doctor.

Hepatitis B vaccine

• Can be given during pregnancy to women who are not immune and are at risk (for example a partner or household member with hepatitis B, frequent blood products or dialysis).
• Pregnancy is not a contraindication to hepatitis B vaccination.
• Hepatitis B screening is routine in pregnancy. If the mother is a carrier, the baby receives hepatitis B vaccine and immunoglobulin within the first hours after birth.

Vaccines not given in pregnancy

Live (attenuated) vaccines are not given in pregnancy because of a theoretical risk to the baby:

• Measles-mumps-rubella (MMR) vaccine
• Chickenpox (varicella) vaccine
• The live nasal spray flu vaccine
• Some travel vaccines such as yellow fever, considered only when travel is unavoidable and the disease risk is high

These vaccines should be given before pregnancy, and pregnancy should be avoided for at least one month afterwards. There is no evidence of harm to the baby when one of these vaccines is given before a pregnancy is known, and this alone is not a reason to end a pregnancy, but you should inform your doctor.

The HPV vaccine series is not started in pregnancy and is postponed until after birth.

Before pregnancy: checking immunity

• Rubella: rubella in pregnancy, especially in the first trimester, can cause congenital rubella syndrome with hearing loss and eye and heart defects. Women who are not immune receive the MMR vaccine before pregnancy.
• Chickenpox: women unsure whether they have had chickenpox can have a blood test; those who are not immune receive two doses 4-8 weeks apart.
• Hepatitis B and tetanus: hepatitis B immunity and the tetanus doses on your vaccination card are reviewed.
• Women found not to be immune during pregnancy receive MMR and chickenpox vaccines after birth; breastfeeding is not a barrier.

Rh-negative mothers and the anti-D injection

Anti-D immunoglobulin is not a vaccine, but it is often asked about among the injections given in pregnancy. If an Rh-negative mother carries an Rh-positive baby and the baby's blood cells enter her circulation, she may develop antibodies against them (Rh sensitisation). These antibodies can destroy the baby's blood cells in later pregnancies, causing anaemia and jaundice. Anti-D helps prevent these antibodies from forming.

• Rh-negative women with a negative antibody test (indirect Coombs) usually receive anti-D immunoglobulin at around 28 weeks.
• If the baby is Rh-positive, another dose is given within 72 hours of birth.
• Extra doses may be needed after bleeding, miscarriage, ectopic pregnancy, procedures such as amniocentesis, or abdominal trauma.

Are vaccines safe?

The safety of the inactivated vaccines recommended in pregnancy has been assessed in large studies with long-term follow-up. Temporary side effects such as pain and redness at the injection site, mild fever and tiredness can occur; paracetamol can be used for fever. Tell the health professional about any allergies or previous reactions to vaccines.

The vaccines recommended in pregnancy can be given on the same day if needed, with planning based on your stage of pregnancy and vaccination history.

Individual assessment

The plan may differ for women with chronic conditions, those taking immunosuppressive medicines, those who conceived through IVF or those planning international travel. Bringing your vaccination card to antenatal visits and recording every vaccine in your pregnancy notes helps with accurate planning.

Frequently Asked Questions

The information on this website is for general information only and does not replace a medical consultation.

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