Vaccine hesitancy in pregnancy is common in India — and understandable. The idea of introducing any medication or vaccine during pregnancy raises instinctive caution. But the risk calculation is clear: several vaccine-preventable infections are significantly more dangerous in pregnancy than in the general population, and some vaccines provide protection to the newborn through maternal antibody transfer. In most cases, the risk of the disease is substantially higher than any risk from the vaccine.

Dr. Shachi Singh, consultant obstetrician at Prakash Hospital, Sector 33, Noida, explains.

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Vaccines Recommended in Pregnancy

Tetanus-Diphtheria-Pertussis (Tdap)

Pertussis (whooping cough) is life-threatening in newborns — the most at-risk group — who cannot receive their own pertussis vaccine until 6 weeks of age. Maternal Tdap vaccination in the third trimester (ideally 27 to 36 weeks) transfers protective anti-pertussis antibodies to the fetus through the placenta, giving the newborn some protection from birth.

In India: The maternal immunisation programme includes tetanus toxoid (TT) or Td vaccines — given twice in the first pregnancy (first dose at 16 weeks, second 4 weeks later) and once in subsequent pregnancies. Where Tdap is available, it is preferred over TT alone because of the added pertussis protection.

Tetanus vaccination in pregnancy prevents neonatal tetanus — still a cause of newborn deaths in areas with poor access to clean delivery facilities.

Safety: Tdap and TT have an excellent safety record in pregnancy. No evidence of harm to the fetus.

Influenza (Flu) Vaccine

Influenza in pregnancy causes significantly more severe illness than in non-pregnant women — higher rates of hospitalisation, pneumonia, and ICU admission. The 2009 H1N1 pandemic disproportionately killed pregnant women globally.

Maternal influenza vaccination:

• Reduces severe influenza in the pregnant woman
• Reduces influenza in the infant in the first 6 months of life (antibody transfer)
• Reduces preterm birth and low birth weight associated with maternal influenza infection

When to get it: Ideally at the start of influenza season (October to December in North India). Can be given at any trimester.

Type of vaccine: Inactivated influenza vaccine (injection) — safe in any trimester. Live attenuated influenza vaccine (nasal spray) — not recommended in pregnancy.

Safety: Well-established. No evidence of harm. A large body of data from millions of vaccinated pregnant women globally confirms safety.

Hepatitis B Vaccine

If a pregnant woman is not already immune (anti-HBs positive) and not infected, hepatitis B vaccination series can be started in pregnancy — it is safe during pregnancy. More commonly, screening for hepatitis B surface antigen (HBsAg) is done at booking — HBsAg-positive mothers require specific management to prevent vertical transmission to the baby at delivery.

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Vaccines That Are Routinely Given Around Pregnancy

Hepatitis B at Birth for the Newborn

All newborns should receive hepatitis B vaccine within 24 hours of birth — particularly important if the mother is HBsAg positive. This is part of India's National Immunisation Schedule.

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Vaccines to Avoid in Pregnancy

Live Attenuated Vaccines

Live vaccines contain weakened but live organisms — theoretically capable of causing infection in the immunocompromised environment of pregnancy, or in the developing fetus. The following are contraindicated in pregnancy:

• MMR (measles, mumps, rubella): Avoid in pregnancy. If needed (e.g., rubella non-immune woman), vaccinate postpartum and wait 1 month before conceiving.
• Varicella (chickenpox): Avoid in pregnancy. Chickenpox infection in pregnancy carries serious risks (pneumonia, neonatal varicella) — ideally women are vaccinated before pregnancy.
• BCG (tuberculosis): Avoid in pregnancy.
• Yellow fever: Avoid unless travel to a high-risk endemic area makes the infection risk greater than the vaccine risk.
• Typhoid oral vaccine (Ty21a live oral form): Avoid in pregnancy. Injectable typhoid polysaccharide vaccine is considered safe.

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HPV Vaccine: Not in Pregnancy, But Before Is Ideal

The HPV vaccine series (Cervarix, Gardasil) should not be started during pregnancy — not because of proven harm, but because the data in pregnant women is limited. If a woman discovers she is pregnant mid-series, the remaining doses are deferred until after delivery.

Ideally, HPV vaccination is completed before pregnancy — or postpartum if not previously done.

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COVID-19 Vaccination and Pregnancy

COVID-19 infection in pregnancy is associated with significantly higher rates of ICU admission, preterm birth, and maternal and fetal mortality. Multiple large registry studies and national data from the UK, USA, and Australia confirm:

• mRNA vaccines (Covishield, Covaxin in India) are safe in pregnancy
• Vaccination reduces severe COVID-19 illness and its obstetric consequences
• No evidence of increased miscarriage, preterm birth, or fetal harm from COVID-19 vaccination

International bodies including WHO, ACOG, and the UK RCOG recommend COVID-19 vaccination in pregnancy. In India, vaccination in pregnancy is recommended and available.

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Obstetric Care in Noida and Greater Noida

Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, provides comprehensive antenatal care including vaccination counselling for pregnant women across Noida and Greater Noida.

To book a consultation, call: +91 97023 46853

Clinic Hours: Monday to Saturday, 9 AM – 6 PM | Sunday, 10 AM – 2 PM

Address: D-12A, 12B, Sector-33, G.B. Nagar, Noida, UP 201301

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This blog is for educational purposes only. Discuss specific vaccination decisions with Dr. Shachi Singh at your antenatal appointment.