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Influenza and Tdap Vaccination Rates Among Pregnant Women

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Women who are pregnant should get vaccinated with both the influenza and Tdap vaccines to protect themselves and their babies.

“Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants.”

Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020

These are not new recommendations.

Influenza and Tdap Vaccination for Pregnant Women

Although some vaccines are contraindicated when you are pregnant, it has long been recommended that all pregnant women get:

  • a flu vaccine – any trimester – a recommendation that has been evolving since 1983
  • the Tdap vaccine during each and every pregnancy between 27 and 36 weeks of gestation – a recommendation that has been evolving since 2006

Still, many pregnant women are still not getting vaccinated like they should, leaving themselves and their babies at risk for the flu and pertussis.

Recommendations for Influenza and Tdap Vaccines in Pregnancy

So when did the recommendations for these vaccines in pregnancy start, and how did they evolve?

If we look at the history of flu vaccine recommendations, we can see that the recommendations to vaccinate pregnant women:b

  • began during the 1983-84 flu season, when it was recommended that physicians should evaluate a pregnant woman’s need for influenza vaccination on the same basis used for other persons; i.e., vaccination should be advised for a pregnant woman who has any underlying high-risk condition.
  • evolved during the 1990-91 flu season, when it was recommended that pregnant women who have other medical conditions that increase their risks for complications from influenza should be vaccinated, as the vaccine is considered safe for pregnant women. Administering the vaccine after the first trimester is a reasonable precaution to minimize any concern over the theoretical risk of teratogenicity. However, it is undesirable to delay vaccination of pregnant women who have high-risk conditions and who will still be in the first trimester of pregnancy when the influenza season begins.
  • further evolved during the 1994-95 flu season, when it was recommended that pregnant women who have other medical conditions that increase their risks for complications from influenza should be vaccinated because the vaccine is considered safe for pregnant women — regardless of the stage of pregnancy. Thus, it is undesirable to delay vaccination of pregnant women who have high-risk conditions and who will still be in the first trimester of pregnancy when the influenza season begins.
  • evolved again during the 1995-96 flu season, when additional case reports and limited studies suggest that women in the third trimester of pregnancy and early puerperium, including those women without underlying risk factors, might be at increased risk for serious complications from influenza. Health-care workers who provide care for pregnant women should consider administering influenza vaccine to all women who would be in the third trimester of pregnancy or early puerperium during the influenza season. Pregnant women who have medical conditions that increase their risk for complications from influenza should be vaccinated before the influenza season, regardless of the stage of pregnancy. Administration of influenza vaccine is considered safe at any stage of pregnancy.
  • And finally, for the 1997-98 flu season, the flu vaccine recommendation was updated to what we have now – “Women who will be in the second or third trimester of pregnancy during the influenza season.”

And the Tdap recommendations?

  • began in 2006, when a postpartum dose of Tdap was first recommended
  • evolved in 2008, when a recommendation for a dose of Tdap for pregnant women in special situations was added, especially if they are at a high risk of getting pertussis.
  • evolved again in 2011, when a dose of Tdap was recommended in pregnancy if the women had not previously received a dose of Tdap.
  • evolved again in 2013, when a dose of Tdap was recommended during every pregnancy, ideally during the third trimester to “provide the highest concentration of maternal antibodies to be transferred closer to birth”

Did you get a flu shot and Tdap vaccine when you were pregnant?

How about a COVID vaccine or RSV shot?

Influenza and Tdap Vaccination Rates Among Pregnant Women

While influenza and Tdap vaccination rates in pregnant women are rising, they are still suboptimal, as we can see in a new report from the CDC, Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020.

“Among 1,841 survey respondents who were pregnant anytime during October 2019–January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018–19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018–19 season.”

Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020

Just over half of pregnant moms are getting vaccinated.

And as we have seen in other recent surveys, guess who was most likely to get vaccinated and protected?

“Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%).”

Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020

Not surprisingly, more pregnant women were vaccinated if their providers simply offered flu and Tdap vaccines!

Why is all of this important?

Even though it is known that neither the flu nor Tdap vaccines provide perfect protection, it is well known that they provide very good protection to pregnant mothers and to newborns and younger infants who are too young to get their own vaccines.

“In 2012, the Centers for Disease Control and Prevention received more than 41 000 reports of pertussis infection in the United States (US), with 18 deaths. Most of those who died were unvaccinated infants younger than 3 months of age.”

Tdap vaccination during pregnancy to reduce pertussis infection in young infants

Protection that can keep them from dying from pertussis.

“Infants born to women reporting influenza immunization during pregnancy had risk reductions of 64% for ILI, 70% for laboratory-confirmed influenza, and 81% for influenza hospitalizations in their first 6 months.”

Influenza in Infants Born to Women Vaccinated During Pregnancy

Protection that can keep them from dying from flu too.

“Pandemic influenza virus infection in pregnancy was associated with an increased risk of fetal death. Vaccination during pregnancy reduced the risk of an influenza diagnosis. Vaccination itself was not associated with increased fetal mortality and may have reduced the risk of influenza-related fetal death during the pandemic.”

Risk of Fetal Death after Pandemic Influenza Virus Infection or Vaccination

So don’t skip your flu or Tdap vaccine, especially if you are pregnant.

A flu shot during your pregnancy protects both you and your baby.
A flu shot during your pregnancy protects both you and your baby.

These vaccines in pregnancy are safe, effective, and very necessary.

Did your health care provider recommend that you get a flu and Tdap vaccine when you were pregnant?

Did you get a flu and Tdap vaccine when you were pregnant?

Do you now understand why you should?

More on Influenza and Tdap Vaccines for Pregnant Women

Last Updated on March 11, 2025