Are the Flu, Tdap, and RSV Vaccines Safe During Pregnancy?

Yes. The flu, Tdap, and RSV vaccines are generally recommended during pregnancy, because the infections they prevent can be more serious when you are pregnant and can be dangerous for a newborn. Side effects are usually mild, such as a sore arm or a low-grade fever. Severe allergic reactions (anaphylaxis) are uncommon but need 911. This article explains each vaccine, its timing, what to expect afterward, and when to get urgent help.

Are the flu, Tdap, and RSV vaccines safe during pregnancy?

For most pregnant people, the answer is yes. Clinicians who provide prenatal care and national immunization schedules generally recommend these vaccines during pregnancy because pregnancy changes your immune system, heart, and lungs, and that can make some infections harder on you. Antibodies you make after vaccination can also cross the placenta and may give your baby some protection in the first months of life, before the baby can be vaccinated.

No vaccine is risk free, and your own history matters. Your clinician can weigh your health, your due date, the season, and any past reactions. This page explains the general approach to vaccines during pregnancy so you can have a better conversation at your next visit.

Not every vaccine is treated the same way. Some vaccines made from weakened live viruses, such as the MMR and chickenpox vaccines, are generally avoided during pregnancy. The flu shot, Tdap, and RSV vaccines used in pregnancy are not live-virus vaccines.

The flu shot during pregnancy

Pregnancy can raise the chance that flu leads to serious illness, including pneumonia and hospital stays. A flu shot is generally recommended in any trimester and is an important way to lower your chance of getting the flu and passing it to others. The vaccine is generally given each flu season (MedlinePlus: Flu Shot).

Which flu vaccine to choose

During pregnancy, the injected flu shot is the form that is generally used. The nasal spray vaccine contains weakened live virus and is usually not given to pregnant people. If you are offered the spray at a pharmacy, tell the staff you are pregnant and ask for the shot instead.

Timing

The shot can generally be given in any trimester once the season's vaccine is available. Many clinicians suggest getting it as soon as it is offered rather than waiting, because flu season timing varies. Your clinician can help you decide the best date if you are early in pregnancy or have a health condition.

What it can do for your baby

Babies cannot get a flu shot until they are about 6 months old. Antibodies passed through the placenta may help protect them during that gap. This is one reason clinicians encourage vaccination even if you feel healthy.

The Tdap vaccine: whooping cough protection for your newborn

Tdap protects against tetanus, diphtheria, and pertussis (whooping cough). MedlinePlus (NIH) explains that these vaccines protect against three serious bacterial illnesses, and pertussis in particular can be dangerous for infants (MedlinePlus: Tetanus, Diphtheria, and Pertussis Vaccines). A newborn can have pauses in breathing and trouble feeding with whooping cough, and very young babies are too young to complete their own vaccine series.

Every pregnancy, not once in a lifetime

The CDC adult immunization schedule, based on ACIP recommendations, recommends one Tdap dose during each pregnancy, even if you had one recently or a few years ago, preferably in the early part of weeks 27 through 36. The antibody level you pass to the baby may be higher when the dose is given during the current pregnancy. Because schedules are updated over time, ask your clinician to confirm the current recommendation and the date that fits your care.

If you missed it during pregnancy

Tell your clinician. A dose after delivery can still protect you, which lowers the chance you pass pertussis to your baby. Anyone who will be around the baby, such as partners and grandparents, can also ask their own clinician whether their Tdap is up to date.

The RSV vaccine: two ways to protect a newborn

Respiratory syncytial virus (RSV) is a common cause of cold-like illness in adults, but in young infants it can lead to bronchiolitis and pneumonia. If you want to know how to tell RSV from a cold once your baby is born, see the article on telling a cold from RSV in a baby. This section covers prevention before birth.

There are two general strategies, and your clinician and your baby's pediatric clinician can help you pick:

• An RSV vaccine for you (Abrysvo): a single dose given late in pregnancy, at 32 through 36 weeks according to the vaccine's labeling, generally during the RSV season, which runs roughly September through January in most of the continental US. Your clinician will confirm your dates. Antibodies pass to the baby through the placenta.
• An RSV antibody product for your baby (nirsevimab or clesrovimab): given to the infant, usually in or just before the first RSV season, which in most of the continental US runs roughly October through March. It is not a vaccine, but it is also aimed at protecting young infants. Your baby's clinician will advise on eligibility.

Most babies need only one of the two. Your baby's clinician will tell you whether your baby also needs the antibody. For example, CDC guidance says a baby may still need it if the mother was vaccinated less than 14 days before delivery, so confirm with your baby's clinician. Which approach is better for you can depend on your due date, the time of year, your insurance, and what your hospital stocks.

What to discuss about the RSV vaccine

The prescribing information (label) for the maternal RSV vaccine notes a numerical imbalance in preterm births in the trials that led to its approval, and the vaccine is labeled for use at 32 through 36 weeks of pregnancy, generally September through January in most of the continental US. Experts have not settled exactly what the imbalance means. Discuss with your clinician how this applies to you, especially if you have had a preterm birth before or have a condition that raises that risk. Your clinician can decide with you whether the vaccine or the baby's antibody is the better fit.

What side effects are common, and what is not typical

MedlinePlus (NIH) notes that vaccines are tested for safety and monitored after they are in use (MedlinePlus: Vaccine Safety). Most reactions in pregnancy are the same as in anyone else, and many people have none.

• Soreness, redness, or mild swelling where the needle went in
• Tiredness, headache, or muscle aches for a day or two
• A low-grade fever, sometimes with chills
• Feeling lightheaded, which can come from the needle or from standing quickly (see MedlinePlus: Fainting)

Sitting for about 15 minutes after the shot, if your clinic asks you to, lets staff help quickly in the uncommon case of a severe allergic reaction.

Managing a fever or aches

A fever after a vaccine is often mild, but fever in pregnancy deserves attention. Acetaminophen (Tylenol) is a fever reducer clinicians commonly recommend in pregnancy, generally at the lowest effective dose for the shortest time, as your clinician advises and within the label limits. The details are covered in the article on Tylenol and pregnancy. Ask your clinician before using ibuprofen or aspirin, and ask your clinician or pharmacist how much acetaminophen to use and for how long. If a fever reaches 100.4°F (38°C) or higher, call your clinician the same day, whether or not acetaminophen brings it down, because the fever may or may not be from the vaccine. Go to the emergency room if a fever comes with a stiff neck, trouble breathing, or confusion.

Severe allergic reactions: the uncommon event that needs 911

Anaphylaxis can cause trouble breathing, swelling of the lips, tongue, or throat, hives spreading over the body, a racing heartbeat, repeated vomiting, or a feeling of faintness or collapse. It generally starts soon after an exposure and can worsen quickly. If you notice these signs, call 911, even if symptoms seem to improve. Do not drive yourself. A sore, red spot at the injection site or a few mild hives is not the same thing, but tell your clinician about it.

Tell every vaccine provider if you have had a serious allergic reaction to a vaccine or to an ingredient before. Egg allergy is a common question for flu shots, and many people with egg allergy can still be vaccinated, but the details depend on how severe your reaction was. If you have had a severe reaction to an egg-containing product or to any vaccine, tell your clinician before the shot so they can choose the setting and the vaccine.

Getting sick when you are pregnant: why vaccines during pregnancy matter

MedlinePlus (NIH) lists infections that can affect pregnancy and a baby's health on its pregnancy infections page (MedlinePlus: Infections and Pregnancy). Vaccines lower the chance of some of them, but they do not remove it. You may still catch flu or another respiratory illness after vaccination, and the illness is often milder.

If you develop flu-like symptoms, such as fever, cough, body aches, and sore throat, call your clinician the same day, even before you have been tested. CDC influenza guidance recommends starting antiviral treatment as soon as possible for pregnant people with suspected flu, without waiting for test results. Your clinician decides which medicine is appropriate for you.

Go to the emergency room or call 911 for trouble breathing, chest pain or pressure, confusion, or fainting. Some flu symptoms need prompt same-day care in pregnancy: vomiting that will not stop or that keeps you from holding down fluids, which can lead to dehydration; a fever of 100.4°F (38°C) or higher; and new dizziness without the emergency features above. If dizziness comes with a severe headache, vision changes, or heavy bleeding, call 911.

Two pregnancy warning signs need 911 on their own, even without any illness: heavy vaginal bleeding at any point in pregnancy, and a severe headache that does not go away or vision changes such as blurring, spots, or flashing lights, which can be a sign of a blood pressure emergency such as preeclampsia. If your baby's movements are noticeably reduced or different from your usual pattern, whether or not you have been ill, call your clinician or labor and delivery right away, because this needs prompt evaluation. Do not wait for your next appointment, and if you cannot reach anyone promptly, go to labor and delivery or the emergency room. Related questions about other medicines are covered in the article on which medications are safe during pregnancy.

Questions to bring to your prenatal visit

Advice differs by trimester, season, and your health, so it helps to bring a short list. Consider telling your clinician about:

• Any past allergic reaction to a vaccine, latex, or a medicine
• Whether you had a Tdap, flu, or RSV dose recently, and the date
• Whether you have a history of Guillain-Barre syndrome, because your clinician may want to consider that when choosing a flu vaccine
• Your due date, so the RSV vaccine or infant antibody can be planned for the right season
• A fever, new cough, or exposure to someone with whooping cough, flu, or RSV

It is fine to ask where to get each vaccine. Many obstetric offices stock some, while others send you to a pharmacy or health department. Keep your vaccine record so the dates are in your chart.

COVID-19 and other vaccines to ask about

These three are not the whole list. COVID-19 vaccination in pregnancy is a common question. Recommendations have changed over time, so ask your clinician what current CDC guidance means for your situation and your due date. Your clinician may also talk with you about hepatitis B or others if you have specific risks. MedlinePlus (NIH) has a general overview of vaccines (MedlinePlus: Vaccines). If you are planning travel while pregnant, ask early, since some travel vaccines are not suitable in pregnancy (MedlinePlus: Traveler's Health).

Planning ahead is easier than catching up. If you are thinking about pregnancy, ask your clinician which vaccines to update before conception, since some live vaccines need time before pregnancy begins.

When to Seek Medical Care