Pregnancy and Flu Vaccination

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 Osteopathic Association (AOA), 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.

Pregnant women should receive seasonal influenza vaccine.

  1. 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.
  2. Risk of premature labor and delivery is increased in pregnant women with influenza.
  3. 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.
  4. 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.

Influenza vaccine is safe.

  1. 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.
  2. Influenza vaccine can be given to pregnant women in any trimester.
  3. Pregnant women should receive inactivated vaccine (flu shot) but should NOT receive the live attenuated vaccine (nasal spray).
  4. Postpartum women, even if they are breastfeeding, can receive either type of vaccine. 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: Free patient education resources (including for pregnant or postpartum patients) are available at

Lori J. Heim, M.D.
American Academy of Family Physicians

Judith S. Palfrey, MD, FAAP
American Academy of Pediatrics

Holly Powell Kennedy, CNM, PhD, FACNM, FAAN
The American College of Nurse-Midwives

Ralph W. Hale, MD, FACOG
Executive Vice President
The American College of Obstetricians and Gynecologists

Michael D. Maves, MD, MBA
Executive Vice President/Chief Executive Officer
American Medical Association

Marla Weston, PhD, RN
Chief Executive Officer
American Nurses Association

Karen J. Nichols, DO
American Osteopathic 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