Summary of the main vaccines offered in pregnancy

Here you will find the sheets of the different vaccines offered during pregnancy. See also our section on informed choice

Flu/Influenza

Recommandations

The Quebec Immunization Program specifies that this vaccine should be offered to pregnant people in the 2nd and 3rd trimesters and only in the first trimester to those with risk factors such as heart and lung disorders including asthma, diabetes, BMI of 40 and over. The exhaustive list can be found here.

Canadian recommendations: Influenza vaccine should be offered to all pregnant people at any stage of pregnancy to protect against influenza-related morbidity and mortality and to reduce infant mortality. The vaccine should also be offered to all members of the household.

The intranasal vaccine is contraindicated in pregnant people. Postpartum intranasal or injectable is appropriate. Antibodies pass through the mother’s milk and the placenta and provide protection for the baby during the first months.Tool to see the effectiveness of flu vaccines for the current year. The effectiveness is about 60% against influenza A (H1N1).

Tool to see the effectiveness of flu vaccines for the current year

Disease effects

Pregnant people are not more likely to catch the flu, but they are more vulnerable to its effects, especially during the second and third trimesters. Some studies suggest that fetuses are at increased risk of being born preterm, having low birth weight, or experiencing development issues if there is a maternal fever during the first trimester. There are more hospitalizations in pregnant people with influenza in the second and third trimesters. The Society of Obstetricians and Gynecologists of Canada (SOGC) says pregnant people are at higher risk for serious flu-related complications.

Vaccine Risks

Common: Local effects: injection site pain, injection site redness Systemic: headache, muscle aches, fatigue
Rare: seizures
Very rare: anaphylaxis, Guillain-Barré Latest studies show no increase in miscarriage or stillbirth with influenza vaccine.

References

Hepatitis B

Recommandations

The SOGC (2018) recommends that pregnant people at high risk of contracting hepatitis B during pregnancy get a series of recombinant hepatitis B vaccines, which are not contraindicated during pregnancy.

High-risk pregnant people are those:

  • having had more than one sexual partner in the last six months
  • treated for an STI during pregnancy
  • having recently or currently used injection drugs
  • having been exposed to a partner with known hepatitis B infection
  • Incarcerated
  • health care workers
  • household contacts with persons infected with hepatitis B

Disease effects

There is an increase in maternal and perinatal mortality associated with hepatitis B virus infection during pregnancy. Placental abruption, preterm delivery, gestational hypertension and fetal growth retardation have been associated with chronic HBV in pregnancy.

Chronic HBV during pregnancy increases the risk of progression to cirrhosis. Acute HBV infection in the pregnant person at birth can lead to chronic infection in the baby. Giving the vaccine and immunoglobulins to the baby within 12 hours of birth reduces transmission.

Vaccine Risks

In less than 10% of people:

  • Local effects: redness at the injection site
  • Systemic: headaches, irritability, fatigue

Although some have reported observing serious side effects and the onset of chronic diseases (chronic fatigue syndrome, multiple sclerosis, Guillain-Barré syndrome, rheumatoid arthritis, sudden infant death syndrome, etc.) after administration of the HB vaccine, the various studies carried out have not revealed a causal link. Contraindicated if history of anaphylaxis to a component of the vaccine.

References

COVID-19

Recommandations

Vaccination against COVID-19 is recommended during any trimester of pregnancy and while breastfeeding. The main indication is maternal protection. mRNA vaccines are preferred as safety and efficacy data in pregnancy are more abundant for these vaccines, but all COVID vaccines can be given. The primary series represents the first 2 vaccines received and is recommended for all pregnant people. Doses of COVID-19 vaccines received after completing the primary series are called booster doses. Booster doses increase the protection offered by a primary series, as this protection may decrease over time. Subsequent doses are booster doses and should be given at least 6 months after the primary dose or previous infection.

Bivalent COVID-19 mRNA vaccines containing the Omicron variant remain the preferred booster products. Evidence to date shows that efficacy is greater in people with hybrid immunity (vaccination and having had the disease).

A booster dose for all adults 65 years and older and people 5 to 64 years of age who are at increased risk of severe illness due to COVID-19 was offered in the fall of 2022 and will be offered again in the spring of 2023. Pregnant people are considered to be at increased risk. Provinces and territories design and implement their own immunization programs.

Therefore, recommendations related to vaccination, including the timing of vaccination and vaccines offered may vary from one region to another.

Disease Effects

Increased risk of morbidity associated with COVID-19, increased hospitalizations, intensive care unit admissions and need for ventilation. More incidence of preterm births.

Vaccine Risks

Data consistently indicates that mRNA vaccines against COVID-19 do not cause pregnancy complications and have no adverse effects on breast milk (data from hundreds of thousands of pregnant people worldwide).

Pregnant people experience the same rates of local and systemic effects as the general public, which includes mild to moderate effects:

  • Injection site pain
  • Headache
  • Redness or swelling at the injection site
  • Muscle aches
  • Chills

Rare: myocarditis, Bell’s palsy

It is possible to directly consult the monographs of a specific vaccine such as that of Pfizer

In the monograph it is stated that the safety and efficacy in pregnancy has not yet been established but that animal studies do not demonstrate a hazard in pregnancy. It is also stated that the excretion in milk during lactation has not been determined.

References

Whooping cough (TDAP)

Recommandations

TDAP vaccination should be offered to all pregnant people for every pregnancy, regardless of their vaccination history, as a way to protect the baby against pertussis.The National Advisory Board on Immunization recommends vaccination between 27 and 32 weeks; the SOGC recommends TDAP vaccination between 21 and 32 weeks.The vaccine may be given until the end of the pregnancy if it was not given before 33 weeks of gestation (PIC).It takes 4 weeks for the body to maximize the antibodies against pertussis.

Immunization between 13 and 26 weeks might also be considered in certain situations (e.g. pregnancies at increased risk of preterm delivery) to allow for longer placental exposure to higher antibody titers and maximized antibody transfer. In all cases itis preferable that immunization be given sufficiently in advance of birth (i.e. four weeks).

Anyone in close contact with the baby (e.g. partner, household members) should also be vaccinated within the same time frame.

Disease Effects

Babies who have not been vaccinated or whose mothers have not been vaccinated are most at risk. They can suffer serious complications, such as pneumonia, collapsed lungs, eye and skull-to-brain bleeding, seizures, brain damage, hernias, and death.

Premature babies are at even greater risk of death if exposed to pertussis, hence the advantage of having the vaccination as early as 26 weeks to ensure that babies who are born prematurely are protected. Vaccination of pregnant people  reduces approximately 90% of hospitalizations (9 out of 10) and 95% of deaths (19 out of 20) related to pertussis in children under 3 months.

In Canada, between 2006 and 2015, the hospitalization rate for pertussis in babies less than one year old was 33.6 cases per 100,000 people (or 0.00034%), compared to less than one person per 100,000 in the general population (0.00001%). (Information taken directly from: Introduction to vaccines, CAM)

Vaccine Risks

  • Redness and reactions at the injection site
  • Despite an initial analysis reporting a low relative risk of increased chorioamnionitis after vaccination, subsequent research has not demonstrated a causal link between DCAT vaccination and chorioamnionitis. No other complications were demonstrated.

References

Rubella

Recommandations

Immunity to rubella can be assumed if there is documentation that the individual received a dose of a rubella vaccine (e.g. MMR) after 12 months of age, a laboratory-confirmed illness or laboratory evidence of immunity.

No additional rubella vaccination is required postpartum for clients who meet the above criteria, even if there is no detectable rubella IgG by conventional testing.

If vaccination after 12 months was not  documented and there is no serological evidence of immunity or confirmed disease, a rubella vaccine booster in the postpartum period is considered best practice. The SOGC advises delaying rubella vaccination if the client has received Rh immunoglobulins or other blood products.The vaccine should not be administered during pregnancy as it is a live attenuated vaccine.

Disease effects

The extent to which the baby is affected will vary depending on when the mother is infected with the disease.Infection, particularly in the first trimester, can lead to congenital rubella as well as growth retardation, microcephaly, deafness, cataracts, heart problems, spleen and liver damage.

There is also an increased incidence of miscarriage, preterm delivery and intrauterine fetal demise.

Vaccine Risks

Should not be administered during pregnancy or during the month preceding pregnancy due to the theoretical risk of transmission of the disease to the fetus. No cases of this transmission have been reported. However, in certain situations where the potential benefits of MMR vaccine may outweigh the risks, such as during an outbreak of measles or rubella, vaccination may be considered as recommended by public health officials.

Side Effects: Fever, irritability, slight swelling of glands (lymph nodes), measles-like rash, hives, fatigue, sore throat, dizziness, headache, nausea, vomiting, diarrhea, body aches, cough, runny nose, fatigue.

References

Varicella

Recommandations

Immunization against varicella is recommended in the  preconception period. Pregnancy should be avoided at least 4 weeks after receiving the univalent varicella vaccine.

During pregnancy, varicella immunity is assumed following either a previous infection or the confirmation of vaccines received against varicella (2 doses).If in doubt or if a person does not know: offer a blood test to assess if the person is immune. A pregnant person who has not had the disease or who has not been vaccinated is at risk of contracting varicella when working with children or if they have unimmunized children at home.

Since the implementation of vaccination against varicella as part of the regular immunization schedule for children in Quebec, this disease is much less common. It can occur at any time of the year, especially in children. For unimmunized individuals: it is important to explain the risks of the disease for the pregnant person and the baby and to avoid infectious contact.

If an unimmunized pregnant person (or whose immune status is unknown) is in contact with a person infected with chickenpox an urgent blood test  should be ordered. Immunoglobulins should be offered if the person is unimmunized or if the results of the blood test cannot be obtained in less than 96 hours. Immunoglobulins should ideally be given within 96 hours of exposure.

The varicella vaccine should not be given during pregnancy, but if received inadvertently there is no need to terminate the pregnancy. It poses a theoretical risk to the fetus. However, there is no indication that this vaccine carries a teratogenic risk. The vaccine should be offered in the post-partum period to those who are not immunized to varicella.

It is also recommended that other people who live with the newborn be immunized against varicella.

Disease effects

Among the people considered at risk of severe complications are pregnant women, babies born at less than 28 weeks, newborns whose mothers developed varicella in the 5 days preceding delivery or in the 48 hours following delivery as well as immunocompromised people.

Chez la personne enceinte

  • Risque d’atteinte pulmonaire plus sévère particulièrement au troisième trimestre

Chez le bébé

  • Risque de varicelle congénitale avant la 28ième semaine (moins de 2% de chance).
  • La varicelle congénitale peut entraîner retard de croissance, malformations des yeux et problèmes cérébraux.
  • Risque de 1% de faire un zona dans les premières années de vie.

For the pregnant person:

  • risk of more severe lung damage, particularly in the third trimester

For the baby:

  • Risk of congenital varicella before the 28th week (less than 2% chance).
  • Congenital chickenpox can lead to stunted growth, eye defects and brain problems.
  • 1% risk of getting shingles in the first years of life.

If infection occurs within 5 days before birth or within 2 days after birth: risk of severe neonatal varicella: bronchopneumopathy, peptic ulcers, meningoencephalitis, hepatitis (30% mortality reduced to 7% since treatment became available)

Before the vaccine, there were approximately 350,000 cases of chickenpox in Canada and between 1,500 and 2,000 varicella-related hospitalizations each year in Canada, mainly in healthy children under 12 years of age.

Vaccine Risks

The vaccine can be administered alone (monovalent) or in combination (conjugated) with that of measles, rubella, mumps. The preferred vaccine in adults and postpartum is the monovalent vaccine.

Frequent

  • Pain, redness at the injection site.
  • Chickenpox-like pimples at the injection site or elsewhere on the body.
  • These pimples are not very contagious and heal quickly

Very rare

  • Febrile convulsions in young children (12-23 months when receiving the combined vaccine).

References

Société des obstétriciens et gynécologues du Canada, No. 274. Management of Varicella Infection (Chickenpox) in Pregnancy, Récupéré de https://www.jogc.com/article/S1701-2163(18)30497-3/fulltext le 24 avril 2023

Gouvernement du Canada, Vaccin contre la varicelle : Guide canadien d’immunisation. Récupéré de https://www.canada.ca/fr/sante-publique/services/publications/vie-saine/guide-canadien-immunisation-partie-4-agents-immunisation-active/page-24-vaccin-contre-varicelle.html, le 24 avril 2023

Réseau périnatal de Champagne-Ardenne, Varicelle-Grossesse-Nouveau-Né, Récupéré de https://reseaux-sante-ca.org/IMG/pdf/protocole_varicelle_grossesse_nouveau_ne_vd.pdf le 24 avril 2023