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OBRx — Vaccines in Pregnancy
THE INFORMATION IN THE OBRx™ IS INTENDED SOLELY FOR USE BY THE MEDICAL PROFESSION.
The prescribing clinician must review full product labeling (DailyMed) and current CDC/ACOG guidance.
General rule of thumb: inactivated/recombinant vaccines may be used in pregnancy when indicated; live vaccines are generally contraindicated (with rare, risk/benefit travel exceptions).

Quick Index

Effectiveness of Immunizations

“Since coming into widespread use, immunizations have saved billions of lives…” — HHS NVPO

Rubella cases 1966–1997

Congenital rubella syndrome (CRS) causes miscarriage, stillbirth, hearing loss, cataracts, congenital heart disease, and developmental delay. Rubella is eliminated in the U.S. but remains endemic globally; ensure rubella immunity before pregnancy and vaccinate postpartum if needed. [1,10]

SEE ALSO

Find Vaccine Locations (Vaccines.gov)

Respiratory Syncytial Virus (RSV) — Abrysvo™ (Pfizer)

Recommended One-time maternal dose during 32–36 weeks gestation (seasonal timing varies).

Type of vaccine
Recombinant RSV prefusion F protein vaccine (subunit).
Administration
0.5 mL IM (deltoid).
How supplied
Lyophilized powder for solution (reconstitution) in single-dose presentation; see label for components, storage, and handling.
DailyMed
ABRYSVO (package insert)
Pregnancy recommendation
CDC/ACOG: administer one dose at 32–36 weeks to reduce severe RSV disease in infants (birth–6 months). Co-administration with Tdap, influenza, and COVID-19 vaccines is acceptable. [2,3]
Avoid Do not give maternal RSV vaccine and infant nirsevimab together as routine strategy—choose one approach per current guidance. [3]

COVID-19 Vaccines (CDC/ACOG)

Recommended Recommended for pregnant people in any trimester and during lactation.

Type of vaccine
mRNA vaccines (preferred); updated formulations per season/strain.
Administration
IM (deltoid); product- and age-specific schedules.
How supplied
Suspension in manufacturer-specific vials/prefilled systems; follow product storage/handling requirements.
DailyMed
COMIRNATY (Pfizer-BioNTech) | SPIKEVAX (Moderna)
Pregnancy recommendation
CDC/ACOG: vaccination reduces risk of severe maternal disease; recommended during pregnancy and breastfeeding per current schedules/boosters. [4,5]

Influenza (Inactivated or Recombinant Influenza Vaccine)

Recommended Give during any trimester, ideally before influenza activity increases.

Type of vaccine
Inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV). Live intranasal (LAIV) is contraindicated in pregnancy.
Administration
Usually 0.5 mL IM (product/age-specific).
How supplied
Manufacturer-specific single-dose prefilled syringes and/or vials (varies by product and season).
DailyMed
Example: FLUARIX (IIV) — current season label
Pregnancy recommendation
CDC/ACOG: vaccinate in any trimester; protects pregnant patient and provides passive protection to infant in early life. [6,7]

Tdap (Adacel®, Boostrix®)

Recommended Give during every pregnancy (optimal 27–36 weeks) to maximize infant pertussis protection.

Type of vaccine
Tetanus toxoid + reduced diphtheria toxoid + acellular pertussis (toxoid/subunit combination).
Administration
0.5 mL IM.
How supplied
Single-dose vials and/or prefilled syringes (varies by product).
DailyMed
BOOSTRIX | ADACEL
Pregnancy recommendation
CDC/ACOG: administer one dose each pregnancy, preferably at 27–36 weeks. If given earlier for wound management, do not repeat in same pregnancy. [8,9]

Hepatitis A (Havrix®)

Use when indicated (exposure risk, travel, chronic liver disease, etc.).

Type of vaccine
Inactivated hepatitis A virus vaccine.
Administration
IM; 2-dose series (typical adult schedule: 0 and 6–12 months).
How supplied
Injection suspension in vials/prefilled syringes (see label).
DailyMed
HAVRIX
Pregnancy recommendation
May be used in pregnancy when indicated (risk/benefit). Compatible with breastfeeding. [10,11]

Hepatitis B (Recombivax HB®)

Use when indicated (not immune + risk factors, exposure, STI risk, household contact, etc.).

Type of vaccine
Recombinant hepatitis B surface antigen (HBsAg) vaccine.
Administration
IM; standard 3-dose series (0, 1, 6 months) or per risk-based schedule.
How supplied
Injection suspension in vials and prefilled syringes (see label).
DailyMed
RECOMBIVAX HB
Pregnancy recommendation
Safe in pregnancy when indicated; recommended for susceptible pregnant patients at risk. Safe in breastfeeding. [10,11]

Pneumococcal (PPSV23) — Pneumovax 23®

Use when indicated (medical comorbidities or risk conditions).

Type of vaccine
Pneumococcal polysaccharide vaccine (23-valent).
Administration
0.5 mL IM or SC (per label/clinical context).
How supplied
0.5 mL single-dose vial and single-dose prefilled syringe. (See label.)
DailyMed
PNEUMOVAX 23
Pregnancy recommendation
May be given in pregnancy if indicated by risk conditions. [10,11]

MMR (Rubella-containing vaccine) — M-M-R II® / PRIORIX®

Live vaccine Contraindicated in pregnancy; give postpartum if susceptible.

Type of vaccine
Live attenuated measles, mumps, rubella vaccine.
Administration
SC.
How supplied
Lyophilized vaccine with diluent for reconstitution (see label for storage/handling).
DailyMed
M-M-R II | PRIORIX
Pregnancy recommendation
Contraindicated during pregnancy; vaccinate postpartum if non-immune. Counsel to avoid pregnancy for 4 weeks after live vaccination. [10,11]

Chickenpox (Varicella) — Varivax®

Live vaccine Contraindicated in pregnancy; vaccinate postpartum if non-immune.

Type of vaccine
Live attenuated varicella virus vaccine.
Administration
SC.
How supplied
Lyophilized powder for suspension; requires reconstitution (see label).
DailyMed
VARIVAX
Pregnancy recommendation
Contraindicated during pregnancy; vaccinate postpartum if susceptible. If exposure occurs during pregnancy, manage per CDC/ACOG guidance (consider VariZIG when indicated). [10,11]

Shingles (Herpes Zoster) — Shingrix®

Not routine in pregnancy Generally defer until postpartum unless a specialist-guided exception.

Type of vaccine
Recombinant zoster vaccine (adjuvanted).
Administration
IM; 2-dose series.
How supplied
Two-component kit (antigen + adjuvant) for reconstitution/mixing per label.
DailyMed
SHINGRIX
Pregnancy recommendation
Not routinely recommended during pregnancy; defer until after delivery in most cases. [10,11]

Travel & Special-Situation Vaccines (Pregnancy)

Travel vaccines in pregnancy: Prefer risk avoidance (destination/activity changes) when feasible. When travel is unavoidable, use a risk/benefit approach and consult CDC Yellow Book and product labeling. [R11,R12]

Anthrax — BioThrax® (AVA) and CYFENDUS® (AVA, adjuvanted)

Special situation Occupational / lab / bioterrorism preparedness; post-exposure prophylaxis (PEP) is time-sensitive.

Type of vaccine
BioThrax: Anthrax Vaccine Adsorbed (AVA) — non-live; made from cell-free filtrates containing protective antigen (PA) and adsorbed to aluminum hydroxide.
CYFENDUS: Anthrax Vaccine Adsorbed, Adjuvanted — non-live; same active ingredient as AVA with an added adjuvant (PEP indication).
Administration
BioThrax:
  • Pre-exposure: 0.5 mL IM at 0, 1, 6 months; boosters per label.
  • Post-exposure: 0.5 mL SC at 0, 2, 4 weeks with antimicrobial therapy.
CYFENDUS: 0.5 mL IM x 2 doses, 2 weeks apart (Week 0 and 2) with antimicrobial therapy.
How supplied
BioThrax: 5 mL multi-dose vial containing ten 0.5 mL doses (see label for NDC, storage, and latex stopper warning).
CYFENDUS: multi-dose vials containing ten 0.5 mL doses (see label for NDC and storage/handling).
DailyMed
BIOTHRAX (Anthrax Vaccine Adsorbed) | CYFENDUS (Anthrax Vaccine Adsorbed, Adjuvanted)
Pregnancy recommendation
Pre-event In a pre-event setting (low likelihood of exposure), CDC guidance generally recommends deferring anthrax vaccination during pregnancy. [10,17]
Post-event / high-risk exposure In a post-event setting with high-risk exposure, CDC guidance states pregnancy is neither a precaution nor a contraindication to anthrax PEP; pregnant patients at risk for inhalation anthrax should receive AVA + 60 days of antimicrobial therapy per public health guidance. [10,18]
Label note: Anthrax vaccine product labeling includes pregnancy warnings and advises weighing benefits against potential fetal risk; follow CDC/public health incident guidance for real-world exposure events. (See DailyMed labeling.)

Chikungunya

Travel / occupational Vaccination may be considered for some travelers or lab workers at higher risk.

Type of vaccine
VIMKUNYA: recombinant chikungunya vaccine (virus-like particle platform).
IXCHIQ: live-attenuated chikungunya vaccine (see note).
Administration
VIMKUNYA: IM per label schedule.
IXCHIQ: IM per label schedule (product availability may be restricted; see note).
How supplied
VIMKUNYA: injection suspension (see label).
IXCHIQ: lyophilized powder for solution (see label).
DailyMed
VIMKUNYA | IXCHIQ
Pregnancy recommendation
Pregnancy is generally a precaution (limited data). In general, defer vaccination until after delivery unless exposure risk is high and cannot be avoided; discuss maternal exposure risk, gestational age, and potential fetal/neonatal risks. [13,14]
Important (IXCHIQ) FDA communications in 2025 describe pauses/restrictions and a license suspension for IXCHIQ; consult current CDC/FDA updates before use. [13,15]

Cholera — Vaxchora®

Travel For certain travelers to cholera-affected areas.

Type of vaccine
Live attenuated cholera vaccine (oral).
Administration
Oral (single dose) after reconstitution per label.
How supplied
Oral kit (powder components) requiring mixing/reconstitution; see label for exact contents and preparation.
DailyMed
VAXCHORA
Pregnancy recommendation
Not routinely recommended during pregnancy because safety data are limited; consider only if travel/exposure risk is substantial and unavoidable. [10,11]

Japanese Encephalitis — Ixiaro®

Travel Consider for travel/residence in higher-risk settings (season, rural exposure, duration, activities).

Type of vaccine
Inactivated Japanese encephalitis vaccine (adsorbed).
Administration
IM; schedule per label and age/risk.
How supplied
Injection suspension (often prefilled syringe presentation; see label).
DailyMed
IXIARO
Pregnancy recommendation
Limited data; defer if possible, but may be administered if risk of exposure is high and travel is unavoidable. [10,12]

Meningococcal (MenACWY) — Menveo® (example)

Travel / risk-based Indicated for certain destinations (e.g., meningitis belt, Hajj/Umrah) or medical risk.

Type of vaccine
Meningococcal conjugate vaccine (serogroups A, C, W, Y).
Administration
IM.
How supplied
Manufacturer-specific kit/solution presentations; may require preparation/reconstitution per label.
DailyMed
MENVEO
Pregnancy recommendation
Pregnancy should not preclude MenACWY vaccination when indicated (including pregnant travelers). MenB vaccination is generally deferred unless the pregnant patient is at increased risk. [10,11,12]

Polio (IPV) — IPOL®

Travel / outbreak For travelers to polio-affected areas if not up to date; booster may be indicated for adults.

Type of vaccine
Inactivated poliovirus vaccine (IPV).
Administration
IM or SC (per label).
How supplied
Sterile injection suspension (see label).
DailyMed
IPOL
Pregnancy recommendation
Generally avoid if not needed; may be administered if immediate protection is required due to increased exposure risk (e.g., travel to polio-affected area). [10,12]

Rabies — RabAvert® (example)

Post-exposure is urgent Rabies PEP should not be delayed because of pregnancy.

Type of vaccine
Inactivated rabies vaccine.
Administration
IM; pre-exposure and post-exposure schedules per CDC/ACIP.
How supplied
Requires preparation per label (vaccine presentation varies by product/packaging).
DailyMed
RabAvert
Pregnancy recommendation
Pregnancy is not a contraindication to rabies post-exposure prophylaxis; do not delay PEP when indicated. [10,12]

Tick-borne Encephalitis — TICOVAC™

Travel / outdoor exposure Consider for endemic regions when exposure risk is substantial.

Type of vaccine
Inactivated tick-borne encephalitis vaccine.
Administration
IM.
How supplied
Injection presentation per label (see storage/handling).
DailyMed
TICOVAC
Pregnancy recommendation
Limited data; defer if possible, but may be administered if risk of exposure is high and unavoidable. [10,12]

Typhoid

Travel Prefer injectable inactivated vaccine in pregnancy when vaccination is necessary.

Type of vaccine
Typhim Vi: Vi capsular polysaccharide (inactivated).
Vivotif: live attenuated oral Ty21a.
Administration
Typhim Vi: IM (single dose, booster per risk).
Vivotif: Oral capsules (multi-dose regimen).
How supplied
Typhim Vi: injection solution (often single-dose syringe/vial; see label).
Vivotif: oral capsules (see label).
DailyMed
TYPHIM VI | VIVOTIF
Pregnancy recommendation
If typhoid vaccination is needed in pregnancy, use the inactivated Vi polysaccharide option; avoid live oral Ty21a during pregnancy. [10,12]

Yellow Fever — YF-VAX®

Live vaccine Generally contraindicated; may be considered if travel is unavoidable and exposure risk is high.

Type of vaccine
Live attenuated yellow fever virus vaccine (17D-derived).
Administration
SC.
How supplied
Lyophilized powder with separate diluent vial for reconstitution (see label).
DailyMed
YF-VAX
Pregnancy recommendation
Yellow fever vaccine is generally avoided in pregnancy; if travel to an area with yellow fever risk is unavoidable, vaccination may be considered after individualized risk/benefit counseling. If vaccination is not given, consider a medical waiver and strict mosquito avoidance. [10,12,16]

UPDATED 12/15/2025

References (CDC/ACOG/Yellow Book + DailyMed labels)

1. CDC. Congenital Rubella Syndrome (CRS) — Surveillance Manual / guidance. CDC link

2. ACOG Practice Advisory: Maternal RSV Vaccination (updated guidance as posted by ACOG). ACOG link

3. CDC. Maternal RSV vaccination guidance for pregnant people. CDC link

4. CDC. COVID-19 vaccination for pregnant or breastfeeding people. CDC link

5. ACOG. COVID-19 Vaccines and Pregnancy (clinical guidance / updates). ACOG link

6. CDC. Influenza vaccine recommendations (ACIP). CDC link

7. ACOG. Influenza vaccination during pregnancy (clinical guidance). ACOG link

8. CDC. Tdap vaccination during pregnancy. CDC link

9. ACOG. Tdap vaccination in pregnancy (committee guidance / immunization resources). ACOG link

10. CDC. Guidelines for Vaccinating Pregnant Women/Persons (includes routine + special situation vaccine guidance, including anthrax notes). CDC link [ARCHIVED FILE]

11. CDC Yellow Book. Pregnant Travelers (pre-travel counseling + vaccine considerations). CDC link

12. CDC Yellow Book (destination- and disease-specific chapters used for travel-vaccine decisions): Chikungunya | Meningococcal disease

13. CDC. Chikungunya vaccines (public page; includes updates regarding IXCHIQ and availability). CDC link

14. SMFM. Chikungunya clinical considerations (including pregnancy). SMFM link

15. FDA. IXCHIQ page (safety/availability communications and license actions). FDA link

16. CDC Yellow Book. Yellow fever vaccine considerations in pregnancy are addressed in Yellow Book guidance and the Pregnant Travelers chapter. Yellow fever (Yellow Book)

17. CDC ACIP. Anthrax vaccine recommendations and supporting resources. CDC link

18. CDC. Guidelines for the Prevention and Treatment of Anthrax, 2023 (MMWR Recommendations and Reports). CDC MMWR link

DailyMed / package inserts referenced on this page (selected):