Flu Vaccine and Pregnancy

  September 15, 2010

Dear Colleague:

Advice from a healthcare provider plays an important role in a pregnant and postpartum woman’s decision to get vaccinated against seasonal influenza. The American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Nurse-Midwives (ACNM), American College of Obstetricians and Gynecologists (The College), American Medical Association (AMA), American Nurses Association (ANA), American Pharmacists Association (APhA), Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), March of Dimes, and Centers for Disease Control and Prevention (CDC) are asking for your help in urging your pregnant and postpartum patients to get vaccinated against seasonal influenza.

The Advisory Committee on Immunization Practices (ACIP) recommends that pregnant and postpartum women receive the seasonal influenza vaccine this year, even if they received 2009 H1N1 or seasonal influenza vaccine last year. Lack of awareness of the benefits of vaccination and concerns about vaccine safety are common barriers to influenza vaccination of pregnant and postpartum women. To overcome these barriers, some key points have been provided below.

1. Pregnant women should receive seasonal influenza vaccine.

a. Influenza is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women more prone to severe illness from influenza.
b. Risk of premature labor and delivery is increased in pregnant women with influenza.

c. Vaccination during pregnancy has been shown to protect both the mother and her infant (up to 6 months old) from lab-confirmed influenza. Influenza hospitalization rates in infants <6 months of age are more than 10 times that of older children.

d. Pregnant women represented 5% of 2009 H1N1 influenza deaths in the U.S., while only about 1% of the population was pregnant. Severe illness in postpartum women was also documented. 2009 H1N1 is expected to continue to circulate this influenza season and is included in the seasonal trivalent influenza vaccine this year.


2. Influenza vaccine is safe.

a. Influenza vaccines have been given to millions of pregnant women over the last decade and have not been shown to cause harm to women or their infants.

b. Influenza vaccine can be given to pregnant women in any trimester.

c. Pregnant women should receive inactivated vaccine (flu shot) but should NOT receive the live attenuated vaccine (nasal spray).d. Postpartum women, even if they are breastfeeding, can receive either type of vaccine.http://www.cdc.gov/flu/professionals/vaccination/. Free patient education resources (including for pregnant or postpartum patients) are available at www.cdc.gov/flu.
Please encourage your pregnant and postpartum patients to get vaccinated against influenza. If you do not offer influenza vaccination, please find out who offers the vaccine in your community and send your pregnant and postpartum patients there. You play a crucial role in helping to prevent influenza in your patients and their infants, which can save their lives. More information can be found at:


Sincerely, Lori J. Heim, M.D.


American Academy of Family Physicians

Judith S. Palfrey, MD, FAAP

President American Academy of Pediatrics

Holly Powell Kennedy, CNM, PhD,



The American College of Nurse-Midwives

Ralph W. Hale, MD, FACOG

Executive Vice President

The American College of Obstetricians and


Michael D. Maves, MD, MBA

Executive Vice President/Chief Executive


American Medical Association

Marla Weston, PhD, RN

Chief Executive Officer

American Nurses Association

Thomas E. Meninghan, Pharmacist, BS

Pharm, MBA, ScD, FAPhA

Executive Vice President and CEO

American Pharmacists Association

Karen Peddicord, RNC, PhD

Chief Executive Officer

Association of Women’s Health, Obstetric

and Neonatal Nurses

Jennifer L. Howse, PhD


March of Dimes

Anne Schuchat, MD

RADM, United States Public Health Service

Assistant Surgeon General

Director, National Center for Immunization

and Respiratory Diseases