Should I give the flu shot to my pregnant patients?

Influenza vaccine has been shown to decrease the risk of influenza illness among pregnant women and their infants.¹ Beginning as early as 1960, influenza vaccination was recommended for pregnant women to prevent influenza virus infection and its complications.² Since 2004, the US Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), the American College of Obstetricians and Gynecologists (ACOG), and other professional organizations have recommended that all pregnant women receive the inactivated vaccine, regardless of pregnancy trimester, to avoid missed opportunities for vaccination.³

Risks and benefits of vaccination

Pregnant women with influenza are at substantial risk for morbidity and mortality related to influenza. The increased severity of influenza in pregnant women is thought to be related to physiologic changes that occur during pregnancy: heart rate and oxygen consumption increase, lung capacity decreases, and there is a shift away from cell-mediated immunity. One only needs to recall the 2009 influenza A H1N1 pandemic to recount the reports of maternal ICU admission and death in pregnant women.⁴ Newborn infants born to mothers with influenza during pregnancy, especially mothers with severe illness, are also at increased risk of adverse outcomes due to exposure and lack of immunity.⁵ Vaccination against influenza may reduce the risk of flu-associated acute respiratory infection in pregnant women by up to one-half.⁶  Infants born to women who received an influenza vaccine during pregnancy are protected from influenza infection for their first several months of life; this is critical because infants under 6 months of age are dependent on the antibodies conferred in utero and the vaccine is not approved for use in infants younger than 6 months.^7,8

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