Vaccinations during pregnancy

Why flu vaccination is important?

Flu vaccination is important because, while flu is unpleasant for most people, it can be dangerous and even life threatening for some people, particularly those who are pregnant or living with certain health conditions.

The best time to have your flu vaccine is in the autumn or early winter before flu starts spreading. But you can get your vaccine later.

Why are pregnant women advised to have the flu vaccine?

A flu jab will help protect both you and your baby.

There is good evidence that pregnant women have a higher chance of developing complications if they get flu, particularly in the later stages of pregnancy.

Pregnancy changes how the body responds to infections such as flu. Having flu increases the chances of pregnant women and their babies needing intensive care.

One of the most common complications of flu is bronchitis, a chest infection that can become serious and develop into pneumonia.

If you have flu while you’re pregnant, it could cause your baby to be born prematurely or have a low birthweight, and may even lead to stillbirth or death.

Is the flu vaccine safe in pregnancy?

Yes. Studies have shown that it’s safe to have a flu vaccine during any stage of pregnancy, from the first few weeks up to your expected due date.

Women who have had a flu vaccine while pregnant also pass some protection on to their babies, which lasts for the first few months of their lives.

It’s safe for women who are breastfeeding to have a flu vaccine if they’re eligible (for example, because of a long-term health condition).

Flu vaccine side effects

Flu vaccines are very safe. All adult flu vaccines are given by injection into the muscle of the upper arm.

Most side effects are mild and only last for a day or so, such as:

• a slightly raised temperature
• muscle aches
• sore arm where the needle went in

Try these tips to help reduce the discomfort:

• continue to move your arm regularly
• take a painkiller, such as paracetamol or ibuprofen – some people, including those who are pregnant, should not take ibuprofen unless a doctor recommends it

When should I have the flu jab?

The best time to have a flu vaccine is in the autumn, before flu starts circulating.

If you’ve missed this time, you can be vaccinated later in the winter although it’s better to get it earlier.

Do not worry if you find that you’re pregnant later in the flu season – you can have the vaccine then if you have not already had it.

How do I get the flu vaccine?

To get a flu vaccine you can:

• contact your GP surgery to book an appointment
• find a pharmacy that offers NHS flu vaccination (if you’re aged 18 or over)
• book a flu vaccination appointment online or in the NHS App (if you’re aged 18 or over)
• contact your midwife – in some areas you may be able to get a flu vaccine through a maternity service.

How effective is the flu vaccine?

Vaccination gives the best protection against flu.

Flu vaccines help protect against the main types of flu viruses, although there’s still a chance you might get flu.

If you do get flu after vaccination, it’s likely to be milder and not last as long.

Having a flu vaccine may help stop you spreading flu to other people who could be more at risk of serious problems from flu.

It can take 10 to 14 days for the flu vaccine to work.

If I had the flu jab last year, do I need to have it again now?

Yes, because the viruses that cause flu change every year. This means the flu strains the vaccines are designed to prevent this year may be different from last year. The protection from a flu vaccine also goes down with time.

If you had the flu vaccine during the last flu season because you were pregnant (same pregnancy or a previous pregnancy), or because you’re in a vulnerable group, you need to have it again this year.

Will the flu jab give me flu?

No. Injected flu vaccines do not contain any live viruses, and cannot cause flu. Some people get a slightly raised temperature and aching muscles for a couple of days afterwards, and you may feel sore at the injection site.

Can I have the flu jab at the same time as the whooping cough vaccine?

Yes, you can have a flu vaccine at the same time as the whooping cough vaccine, but do not delay your flu jab so you can have both at the same time.

Pregnant women are at risk of severe illness from flu at any stage of pregnancy, so you need to have a flu vaccine as soon as possible.

The best time to get vaccinated against whooping cough is from 16 weeks up to 32 weeks of pregnancy.

If you miss having the vaccine for any reason, you can still have it up until you go into labour.

Find out more about the whooping cough vaccine in pregnancy.

Are pregnant women still eligible for the vaccine once they have delivered?

They would only be eligible if they are under another at-risk category otherwise no longer eligible once they have had the baby.

Are there specific precautions regarding pregnant women and the nasal flu vaccine?

There are no specific precautions regarding pregnant women who are exposed to children who have been vaccinated with LAIV as the likelihood of onward transmission is considered very low.

Does the flu vaccine contain gelatine?

LAIV contains a highly processed form of gelatine (derived from pigs) as one of its additives. Gelatine is commonly used in a range of pharmaceutical products, including many capsules and some vaccines. The gelatine in LAIV is used as a stabiliser to protect the live viruses from the effects of temperature.

Is the flu vaccine suitable for vegetarians and vegans?

Please refer to the relevant SPC (Summary of Product Characteristics) which provides the composition for each vaccine Home – electronic medicines compendium (emc).

Where it is known that there are animal derivatives/excipients etc, then it is a personal choice.

I’m pregnant and think I have flu. What should I do?

Talk to a GP as soon as possible. If you do have flu, there’s a prescribed medicine you can take that might help, or reduce your risk of complications, but it needs to be taken very soon after symptoms appear.

How to get the flu vaccine

If you’re eligible for an NHS flu vaccine, you can:

• contact your GP surgery to book an appointment
• find a pharmacy that offers NHS flu vaccination (if you’re aged 18 or over)
• book a flu vaccination appointment online or in the NHS App (if you’re aged 18 or over)

Some people may be able to get vaccinated through their maternity service, care home or their employer if they are a frontline health or social care worker.

You may receive an invitation to get vaccinated, but you do not have to wait for this before booking an appointment.

When is it safe to have COVID-19 vaccines during pregnancy?

It’s safe to have the vaccine during any stage of pregnancy, from the first few weeks up to your expected due date. You do not need to delay vaccination until after you have given birth.

Are there any risks to my baby for having COVID-19 vaccines?

Getting vaccinated against COVID-19 reduces the risk of having a stillbirth. There’s no evidence COVID-19 vaccination increases the risk of having a miscarriage, pre-term birth or other complications in your pregnancy. The COVID-19 vaccines do not contain any live viruses and cannot give you or your baby COVID-19. They have been widely used during pregnancy in other countries and there have been no safety concerns.

Is it safe to get COVID-19 vaccines if I am breastfeeding?

It’s safe to get the COVID-19 vaccine if you are breastfeeding. You cannot catch COVID-19 from the vaccines and cannot pass it to your baby through your breast milk.

Why are pregnant women in a higher risk group?

Pregnant women have been identified as being at higher risk of becoming seriously unwell from respiratory infections, including COVID-19. This is because, in a small proportion of women, pregnancy can alter how your body handles severe viral infections and some viral infections, such as flu, are known to be worse in pregnant women. Among pregnant women, the highest risk of becoming severely unwell (should you contract the virus) appears to be for those who are 28 weeks pregnant or beyond. This is something that midwives and obstetricians have known for many years in relation to other similar infections (such as flu) and they are used to caring for pregnant women in this situation.

Evidence suggests that hospital admission may be more common in pregnant women with COVID-19 than in non-pregnant women of the same age, however this is partly because pregnant women are also admitted to hospital for reasons unrelated to COVID-19. In the UKOSS study, which examined women with COVID-19 in pregnancy between March and September 2020, the majority of pregnant women with COVID-19 admitted to hospital were in the third trimester of pregnancy. This evidence supports the remaining UK government recommendation that all pregnant women should pay particular attention to social distancing measures and good hygiene and this is particularly important at 28 weeks pregnant and beyond. It also strongly encourages pregnant women to be vaccinated against COVID-19.

What effect does COVID-19 have on pregnant women?

Evidence suggests that pregnant women are no more likely to get COVID-19 than other healthy adults but, if they are unvaccinated or not fully vaccinated, they are at increased risk of becoming severely unwell if they catch COVID-19 which can lead to admission to intensive care and premature birth of the baby. Roughly three-quarters of pregnant women with COVID-19 have no symptoms at all (also known as being asymptomatic). Most pregnant women who do have symptoms only have mild cold or flu-like symptoms.

Studies have shown there are higher rates of admission to intensive care units for pregnant women with COVID-19 than for non-pregnant women with COVID-19. It is important to note this may be because clinicians are more likely to take a more cautious approach when deciding the best place to care for an unwell pregnant woman with COVID-19.

In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity. Several international studies have also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high. The actual number of stillbirths in the UK however, remains low.

UKOSS studies and more recent publications have found that pregnant women from Black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for COVID-19. Pregnant women over the age of 35, those who had a BMI of 25 kg/m2 or more, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness and requiring admission to hospital. Living in areas or households with greater social and economic disadvantages is also known to increase risk of developing severe illness.

What effect will COVID-19 have on my baby if I am diagnosed with the infection?

Evidence suggests that if you have the virus it is unlikely to cause problems with your baby’s development, and there have been no reports of this so far. There has also been no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage.

Transmission of COVID-19 from a woman to her baby during pregnancy or childbirth (which is known as vertical transmission) seems to be uncommon. Whether or not a newborn baby gets COVID-19 is not affected by mode of birth (i.e. vaginal birth or caesarean), feeding choice, or whether the woman and baby stay together. It is important to emphasise that, in most of the reported cases of newborn babies developing COVID-19 very soon after birth, the babies remained well.

Studies have shown that there is a two- to three-times increased risk of giving birth prematurely for pregnant women who become very unwell with COVID-19. Women who tested positive for COVID-19 but had no symptoms were not more likely to give birth prematurely.  In most cases these preterm births were recommended for the benefit of the women’s health and to enable them to recover. Babies born before full term (before 37 weeks) are vulnerable to problems associated with being born premature – the earlier in the pregnancy a baby is born, the more vulnerable they are. Babies of women with COVID-19 may be more likely to be admitted to the neonatal intensive care unit (NICU), but almost all do well.

Does COVID-19 vaccines effect fertility?

There’s no evidence the COVID-19 vaccines have any effect on your chances of becoming pregnant. There’s no need to avoid getting pregnant after being vaccinated.

There’s also no evidence that the COVID-19 vaccines have any effect on male fertility.

Can I get the whooping cough vaccination after 32 weeks?

You are recommended to have the vaccine between 16 and 32 weeks, as the peak of the antibody takes two weeks. However, although there is no guarantee we can protect the baby, you will be protected and less likely to give it to your baby. You can also get vaccinated up to two months after delivery for this reason, until the baby has their first primary immunisation.

Can I have the whooping cough vaccine at the same time as the flu jab?

Yes, you can have the whooping cough vaccine when you get the flu vaccine, but do not delay your flu jab so that you can have both at the same time.

What are the side effects from having the vaccine whilst pregnant?

You may have some mild side effects from the vaccine that are common, such as swelling, redness or tenderness where the vaccine is given. Serious side effects are extremely rare, especially in adults. There are no safety concerns specific to having the vaccine during pregnancy.

I was vaccinated for whooping cough as a child, do I still need it again?

Yes. Also you still need to have the vaccination again, even if you have contracted whooping cough. The vaccine provides a booster to your antibody production and therefore protects your baby.

I had the vaccine for a previous baby, do I need another for this pregnancy?

It is recommended that you are vaccinated every pregnancy, even if a previous pregnancy didn’t go to full term.

Is there a whooping cough-only vaccine? I don’t want the dtp (diphtheria, tetanus and poliomyelitis)

There is no whooping cough-only vaccine, the vaccine you’ll be given also protects against polio, diphtheria and tetanus. The vaccine is called Boostrix IPV. Boostrix IPV is similar to the 4-in-1 vaccine – the pre-school booster that’s routinely given to children before they start school. There isn’t an alternative to having the vaccine to protect your unborn from whooping cough.

How long will the vaccine protect my baby for?

The vaccine will provide enough protection for your baby until their first immunisations at 8 weeks.

I am expecting twins, do I only need one vaccine?

Yes, one vaccine is enough for multiple pregnancies.

How can whooping cough effect my baby?

Whooping cough is a serious disease that can lead to pneumonia and permanent brain damage. Most young babies with whooping cough will be admitted to hospital and they are at risk of dying from the disease.

Young babies are particularly at risk of serious disease and they remain vulnerable until they can be vaccinated against whooping cough from 2 months of age. You can help protect your unborn baby against whooping cough in its first weeks by having the whooping cough vaccination while you are pregnant. You should have the vaccination even if you’ve been vaccinated before or have had whooping cough yourself.