All Pregnant Women Should Get Influenza Vaccine, ACOG Says

Lara C. Pullen, PhD

August 20, 2014

Pregnant women should receive influenza vaccination, according to an updated opinion of the Committee on Obstetric Practice and Immunization Expert Work Group of the American College of Obstetricians and Gynecologists (ACOG), published in the September issue of Obstetrics & Gynecology. The committee emphasizes that obstetrician-gynecologists, other healthcare providers, healthcare organizations, and public health officials should work to improve the rate of influenza vaccination among pregnant women.

Recent data continue to show that the vaccine is safe for pregnant women and their newborns, which should be reassuring to patients and clinicians alike, the committee notes. Moreover, other studies have shown that newer quadrivalent vaccines are safe and appropriate for use in pregnant women as well.

Pregnant women are at increased risk for serious illness from seasonal and pandemic influenza because the immune system changes during pregnancy. These changes appear to place women at increased risk for illness and influenza-related complications. It is therefore critical that women receive influenza vaccination during pregnancy.

At this time, approximately 50% of pregnant women are immunized against influenza. Pregnant women who receive a recommendation for the influenza vaccine from their obstetrician or obstetric provider are 5-fold to 50-fold more likely to be immunized. Thus, it is incumbent on providers to recommend influenza vaccination and to make it available in the office.

"The flu virus is highly infectious and can be particularly dangerous to pregnant women, as it can cause pneumonia, premature labor, and other complications," Laura Riley, MD, chair of the College's Immunization Expert Work Group, which developed the Committee Opinion in conjunction with the College's Committee on Obstetric Practice, said in an ACOG news release. "Vaccination every year, early in the season and regardless of the stage of pregnancy, is the best line of defense."

Influenza prevention is also important during preconception and during both prenatal and postpartum care. The inactivated influenza vaccine can be given to women at any stage of pregnancy. However, the live attenuated vaccine is not recommended for pregnant women but can be used safely during the postnatal period. The ACOG recommendations are consistent with those of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, which recommend that all adults be given an annual influenza vaccine. The ACOG committee explains that the influenza vaccines are as effective in pregnant women as they are in the general adult population.

The recommendation includes vaccines with thimerosal as well as vaccines without thimerosal.

The committee opinion is consistent with ACOG's longstanding support of the Advisory Committee on Immunization Practices' recommendations that all pregnant women receive the inactivated influenza vaccine. The updated recommendation reflects the newest research on influenza and represents a strengthening of the recommendation that pregnant women receive the influenza vaccine. For more information, see ACOG's Web site.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2014;124:648-651. Full text

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