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Influenza Vaccine in Pregnancy

Routine Maternal Vaccination for Influenza Prevention with Maternal and Neonatal Benefits

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Influenza Vaccine in Pregnancy?

Influenza vaccination during pregnancy is a Category A recommendation by major health authorities (WHO, CDC, ACOG, RCOG) for all pregnant women during influenza season, regardless of trimester.

The inactivated influenza vaccine (IIV3 trivalent, IIV4 quadrivalent) is the recommended formulation in pregnancy; live attenuated influenza vaccine (LAIV) is contraindicated due to live virus content.

Pregnant women are at increased risk for severe influenza complications including pneumonia, ARDS, hospitalization, and death due to physiologic changes (decreased lung volume, immunologic shifts, increased oxygen demand).

Maternal vaccination provides direct maternal protection (60–70% reduction in influenza-confirmed illness) and passive immunization to the infant in the first 6 months of life through placental antibody transfer.

Symptoms

Indications: all pregnant women in any trimester during influenza season (typically October to May in northern hemisphere)
Higher priority for women with comorbidities: chronic lung disease (asthma, COPD), cardiovascular disease, diabetes mellitus, immunosuppression, obesity (BMI ≥40)
Increased maternal symptoms during influenza infection: fever, myalgia, cough, fatigue, dyspnea; risk of severe pneumonia and ARDS particularly in third trimester
Possible obstetric complications from influenza infection: preterm labor, fetal distress, intrauterine growth restriction, increased miscarriage and stillbirth
Most women experience only mild side effects after vaccination: local arm soreness, low-grade fever, mild fatigue lasting 1–2 days

Risk Factors

Pregnancy itself increases susceptibility to severe influenza, especially in second and third trimester
Comorbid conditions: asthma, diabetes, cardiovascular disease, immunocompromise, BMI ≥40 increase severity
Adolescent pregnancy and advanced maternal age
Healthcare workers and household contacts should also be vaccinated to protect mother and infant ('cocooning' strategy)
Women with severe egg allergy can still receive vaccine: standard inactivated vaccine is safe with monitoring; egg-free recombinant alternatives available
True contraindications are rare: severe allergic reaction to prior dose, severe egg-protein anaphylaxis (with caution), Guillain-Barré syndrome within 6 weeks of prior vaccination

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pregnancy at any gestational age during influenza season
  • History of severe allergic reaction to a previous influenza vaccine
  • Concerns about vaccine safety, side effects, or efficacy
  • Symptoms suggestive of influenza infection during pregnancy (fever, cough, myalgia) — warrant urgent evaluation and antiviral therapy
  • Postpartum mothers who were not vaccinated during pregnancy: receive vaccine before discharge if influenza season

Treatment Methods

01
Preconception counseling: discuss vaccination plans, encourage influenza vaccine in pre-pregnancy if season; ensure other vaccines (MMR, varicella) are up to date before conception
02
Vaccine selection: inactivated influenza vaccine (IIV4 quadrivalent preferred) intramuscular injection in deltoid; standard adult dose 0.5 mL
03
Timing: any gestational age during influenza season; optimal timing aligns with vaccine availability and seasonal influenza circulation; both early and late pregnancy vaccination provide maternal and infant benefits
04
Co-administration: can be safely given with Tdap (typically given at 27–36 weeks for pertussis prevention), COVID-19 vaccine, and other inactivated vaccines
05
Live attenuated influenza vaccine (LAIV, FluMist): contraindicated in pregnancy; use only in non-pregnant healthy individuals 2–49 years
06
Egg allergy considerations: standard inactivated vaccines (egg-based or recombinant) are safe; minor egg allergy (only hives) — standard administration; severe egg allergy with cardiovascular or respiratory symptoms — administer in healthcare setting with allergy expertise; recombinant vaccine available as egg-free option
07
Side effect counseling: local arm soreness, redness (most common), low-grade fever, mild fatigue, headache lasting 1–2 days; very rare serious events (anaphylaxis 1.3 per million doses, Guillain-Barré 1–2 per million doses)
08
Maternal benefits: 60–70% reduction in laboratory-confirmed influenza, reduced respiratory hospitalization, reduced preterm birth (especially during pandemic seasons), reduced fetal distress
09
Infant benefits: reduced infant influenza in first 6 months of life through transplacental IgG transfer; reduced influenza-related hospitalization and mortality in young infants
10
Influenza infection during pregnancy: prompt antiviral therapy with oseltamivir 75 mg twice daily for 5 days regardless of pregnancy stage; pregnancy is a Category C indication but benefits outweigh risks; chemoprophylaxis 75 mg daily for high-risk exposed contacts
11
Documentation: record vaccination in prenatal records, immunization registry, and patient health record; counsel about continued vigilance, hygiene, and prompt evaluation of influenza symptoms
12
Postpartum and breastfeeding: continue or initiate vaccination postpartum if not done; influenza vaccine is safe during lactation
13
Surveillance: monitor for adverse events for 15–30 minutes after administration in office; report any serious adverse events through vaccine safety monitoring systems (VAERS)

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.