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Pregnancy

Immunisation during pregnancy is vital to protect the parent and unborn child. We recommend vaccines for whooping cough, influenza, COVID-19 and now RSV during pregnancy.

Learn more

Key Summary

  • Why vaccination matters in pregnancy
    • The immune system is naturally suppressed, increasing risk of serious illness.
    • Vaccination protects parent, unborn baby, and newborn through transferred antibodies.
    • Side effects and allergic reactions are rare; vaccines used in pregnancy are safe.
  • Before pregnancy
    • Check immunity to hepatitis B, measles, chickenpox, and rubella.
    • Get seasonal influenza vaccine if not already given.
    • Avoid pregnancy within 28 days of receiving live vaccines (measles, chickenpox, rubella).
    • COVID-19 vaccination is recommended when planning pregnancy.
  • During pregnancy (Australia)
    • Whooping cough (dTpa): 20–32 weeks (2nd to early 3rd trimester).
    • Influenza: any stage of pregnancy, annually.
    • COVID-19 (Pfizer or Moderna): safe at any stage; 2-dose course plus booster.
    • RSV (Abrysvo): 28–36 weeks to protect infants in first 6 months.
  • Risks if unvaccinated during pregnancy
    • Rubella: miscarriage, stillbirth, or birth defects.
    • Chickenpox: brain, eye, and limb defects in the baby.
    • Measles & mumps: risk of miscarriage, premature birth, stillbirth.
    • Hepatitis B: can infect baby during birth → lifelong liver disease risk.
    • Influenza: higher risk of ICU admission, premature birth, stillbirth.
    • Whooping cough: life-threatening for newborns (pneumonia, seizures, death).
    • COVID-19: 4x higher pregnancy complications; risk of preterm birth, stillbirth, ICU.
    • RSV: preterm and high-risk infants face severe disease.
  • Other protection options
    • Monoclonal antibodies (Palivizumab, Nirsevimab): protect high-risk infants (premature, chronic illness, immune issues).
  • Breastfeeding and vaccines
    • Most vaccines are safe while breastfeeding.
    • Influenza, Pfizer, and Moderna COVID-19 vaccines are recommended and safe.

About

People are particularly vulnerable during pregnancy and should receive the influenza vaccine, the whooping cough (pertussis) vaccine, and now a COVID-19 vaccine and an RSV vaccine to protect themselves and their baby. As the immune system is naturally suppressed during pregnancy, patients face an increased risk of contracting influenza or COVID-19 and associated complications.

Other infectious diseases that vaccines can protect you against are chickenpox, measles, mumps, rubella (German measles), diphtheria, tetanus, pneumococcal disease, and hepatitis B .Serious side effects or allergic reactions to vaccines are rare.

Recommended Vaccines When Planning a Pregnancy

Have a discussion with your doctor about whether you are up-to-date with your vaccinations before you become pregnant. If you are unsure if you have had any of the vaccines below, your doctor can order a blood test which can check whether you have antibodies that can fight that virus:

·   Hepatitis B

·   Measles

·   Chicken pox

·   Rubella

If you have not already had the seasonal influenza vaccine, then it is also recommended.

Avoid pregnancy within 28 days of having a live vaccine. Measles, chicken pox and rubella vaccines are live vaccines.

COVID-19 vaccine is also now recommended for anyone planning to become pregnant.

Recommended Vaccines During Pregnancy

In Australia, the following vaccines are recommended during pregnancy:

·   Whooping cough – given mid 2nd trimester and early 3rd trimester (ideally at 20-32 weeks) as a single dose

·   Influenza – given at any time during pregnancy as a single dose

·   Pfizer or Moderna COVID-19 vaccines – given at any stage of pregnancy as 2 doses 3-6 weeks apart for Pfizer and 2 doses 4-6 weeks apart for Moderna

RSV – given at 28–36 weeks as a single dose

Risk Of Infectious Diseases During Pregnancy

Catching an infectious disease while pregnant can cause harm to the unborn baby. Newborn children can also be harmed if their parents gets sick.

Examples of infections that are harmful to babies include:

·   Rubella – can cause defects in the brain, heart, eyes and ears of the baby and increases the risk of miscarriage and stillbirth.

·   Chickenpox – can cause defects in the brain, eyes, skin and limbs of the baby.

·   Measles – increases the risk of miscarriage, premature birth or stillbirth.

·   Mumps – increases the risk of miscarriage.

·   Hepatitis B – can cause acute hepatitis B infection that can be passed on to the baby during birth, and both parent and baby have the potential to become ‘carriers’ of hepatitis B (the virus is not cleared from the body).

·   Influenza – increases the risk of miscarriage, premature birth or stillbirth and increases the risk of severe illness and death.

·   Whooping cough – can cause pneumonia (infection causing inflammation of air sacs in the lungs), seizures, encephalopathy (damage to the brain) and the death of the baby.

·   COVID-19 – increases the chance of the unborn baby being born prematurely (before 37 weeks of pregnancy) and having to go to hospital for care. The baby is also more likely to show distress during birth or to be still born.

RSV – is associated with increased morbidity among preterm babies and infants born with chronic health conditions such as respiratory and/or cardiac complications.

Whooping Cough Vaccination During Pregnancy

What is whooping cough?
Whooping cough (also called pertussis) is a very contagious bacterial infection that causes severe coughing fits.

  • Adults often get mild symptoms
  • For newborn babies, it can be life-threatening

How can you protect your baby?
Getting the whooping cough vaccine during pregnancy—ideally between 20 and 32 weeks—helps protect your baby.

  • After you’re vaccinated, your body makes antibodies
  • These antibodies pass through the placenta to your baby
  • This gives your baby protection until they can get their own vaccine at 6 weeks old

Is the vaccine safe during pregnancy?
 Yes.

  • Studies from the US and UK involving over 40,000 people found the vaccine is safe during pregnancy
  • Only mild side effects were reported, like a sore or red arm
  • It does not increase the risk of serious problems like premature birth

Australia’s health experts (the NHMRC) recommend getting the whooping cough vaccine in the middle of the second trimester to early third trimester, between 20–32 weeks.

Influenza Vaccination During Pregnancy

How does the flu affect you and your baby?
Getting the flu while pregnant can be serious. It can make you very sick, especially in the second and third trimesters, and it can also harm your baby in the first few months of life. In rare cases, the flu can even cause death.

What is the risk?
Every year in Australia, the flu causes around 100 deaths and over 5,000 hospital stays1. You  are more likely to be seriously affected while pregnant.
During the 2009 flu outbreak, many people needed intensive care during their pregnancy2:

  • Almost 1 in 10 died
  • Over 1 in 10 lost their pregnancy
  • More than half of the rest had their babies early (premature birth)3

What are the possible complications?
When you’re pregnant, your immune system naturally becomes weaker. This makes it easier to catch the flu and harder for your body to fight it off. Getting the flu during pregnancy can lead to serious problems like:

  • Premature birth
  • Stillbirth
  • Poor growth for the baby

How can you protect yourself and your baby?
Getting the flu vaccine is the best way to protect both you and your baby. Some people don’t realise that babies can’t get the flu shot until they’re six months old—so your vaccination helps protect your baby during this vulnerable time.

COVID-19 Vaccination And Pregnancy

How does COVID-19 affect pregnancy?
Getting COVID-19 while pregnant can increase the risk of serious health problems for both the parent and baby. If you’re pregnant and catch COVID-19, you are:

  • Over 4 times more likely to have pregnancy complications4
  • More likely to end up in intensive care, need breathing support, or die from the illness
  • More likely to need a caesarean, develop preeclampsia (a dangerous pregnancy condition), or get blood clots5

COVID-19 can also affect your baby. Babies born to people who had COVID-19 during pregnancy are:

  • More likely to be born early (premature)
  • More likely to be stillborn
  • More likely to need special care in hospital
  • At greater risk of distress during birth

Is the COVID-19 vaccine safe in pregnancy?
Yes. The Pfizer and Moderna COVID-19 vaccines have been used by millions of people around the world and are considered safe during pregnancy and breastfeeding. Although we have less data on the newer versions of these vaccines, no extra safety concerns have been found.There’s less information available about the Novavax vaccine, so Pfizer or Moderna are preferred during pregnancy.

When should I get vaccinated?

  • Pfizer: 2 doses, 3–6 weeks apart
  • Moderna: 2 doses, 4–6 weeks apart

You should also get a booster for better protection, especially against newer variants like Omicron6.

Does the vaccine work during pregnancy?
 Yes. Research from around the world shows that COVID-19 vaccines:

  • Lower your risk of getting very sick
  • Help protect your baby by passing on antibodies during pregnancy
  • Reduce the chance of pregnancy-related complications

Booster doses provide even better protection6:

  • 2 doses reduced the risk of severe illness by 48%
  • 3 doses reduced it by 76% compared to unvaccinated people

What about side effects?
A large study in the U.S. found that receiving the vaccine while pregnant results in the same mild side effects as everyone else7. These may include:

  • A sore arm
  • Tiredness
  • Headache
  • Fever or chills
  • Muscle or joint pain
  • Diarrhoea

RSV Vaccination And Pregnancy

RSV is a highly infectious virus, and most children will get it at least once before they turn 2 years of age8.

RSV is associated with increased morbidity among preterm babies and infants born with chronic health conditions such as respiratory and/or cardiac complications9.

How can you protect your baby?
There is now a vaccine called Abrysvo that can be given during pregnancy to help protect your baby from RSV. When you get the vaccine, your body makes antibodies that are passed to your baby through the placenta. This helps protect your baby from getting very sick with RSV in the first 6 months of life.

How effective is the RSV vaccine?
Getting vaccinated during pregnancy can reduce your baby’s risk of severe RSV illness by about 70% in their first 6 months10.

When should you get vaccinated?

  • The RSV vaccine is usually recommended between 28 and 36 weeks of pregnancy.
  • It can technically be given from 24 weeks, but it’s not commonly recommended before 28 weeks until more research is available.
  • The vaccine can be given at any time of the year—it doesn’t depend on the season or your due date.

RSV Prevention In High-Risk Infants

What is a high-risk infant?
Some babies are more likely to get very sick if they catch RSV (respiratory syncytial virus). These high-risk babies include:

  • Premature infants
  • Babies with heart or lung problems
  • Babies with weakened immune systems

How can we protect them?
There are special medications called monoclonal antibodies that can help protect high-risk babies from RSV. These are not vaccines but work in a similar way by giving babies protective antibodies directly.

Types of monoclonal antibody treatments:

1. Palivizumab

  • This is an injection that helps protect high-risk babies from serious RSV illness.
  • It’s often used for babies with certain health conditions and has been shown to lower the chance of needing intensive care if they get RSV.
  • It is given as a muscle injection and targets a specific part of the RSV virus.

2. Nirsevimab

  • Nirsevimab is a newer long-lasting antibody that protects babies for at least 5 months with just one dose.
  • It’s currently available in WA, QLD, and NSW through special programs (as of August 2024).
  • It is used to protect:
    • All infants entering their first RSV season
    • High-risk children under 2 entering their second RSV season

Important:
These medications can only be prescribed by a doctor and must be used according to official medical guidelines.

Breastfeeding And Vaccinations

You can safely receive most vaccines while breastfeeding.

The seasonal influenza vaccine is recommended if not already received.

Research shows that the Pfizer COVID-19 or the Moderna COVID-19 vaccine can be given safely to people who are breastfeeding.

References

  1. Australian Government Department of Health and Aged Care. Respiratory syncytial virus (RSV) | The Australian Immunisation Handbook [Internet]. Canberra: Australian Government; 2024 [cited 22 May 2025]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/respiratory-syncytial-virus-rsv#vaccine-efficacy-in-infants-of-vaccinated-pregnant-women
  2. Australian Government Department of Health. Influenza (flu) | The Australian Immunisation Handbook [Internet] 2023 [cited 22 May 2025]. Available from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu
  3. Schaffer et al BMC Public Health 2012 12:869
  4. Knight M, Pierce M, Seppelt I, et al. Critical Illness with AH1N1v Influenza in Pregnancy: A Comparison of Two Population-based Cohorts. BJOG. 2011;118(2)232-9
  5. Herrera-Ceballos E, Herrera Ceballos M, Villalba García Y. Impact of SARS-CoV-2 infection in pregnant women and their babies. J Matern Fetal Neonatal Med. 2023;36(5):1077-1085. doi:10.1016/j.jmatern.2023.03.008. Available from https://www.sciencedirect.com/science/article/pii/S0213911123000535
  6. American College of Obstetricians and Gynecologists. Coronavirus (COVID-19), Pregnancy, and Breastfeeding. 2023. Available from https://www.acog.org/womens-health/faqs/coronavirus-covid-19-pregnancy-and-breastfeeding
  7. Australian Government Department of Health. COVID-19 vaccination: Shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy. 2024 Jan. Available from https://www.health.gov.au/sites/default/files/2024-01/covid-19-vaccination-shared-decision-making-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregnancy.pdf
  8. Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. Published online April 21, 2021. doi:10.1056/nejmoa2104983
  9. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed August 2023
  10. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated December 2023