For decades, pregnancy and vaccination have shared an uneasy relationship in the public imagination. Many expecting mothers still associate vaccines with risk rather than protection, worried that anything injected during pregnancy could somehow harm the baby.

Doctors say this fear, while understandable, often works against the very outcome it is trying to protect: a healthy mother and a healthy newborn.

The science behind the shot

The evidence tells a different story. A comprehensive review published in Best Practice & Research Clinical Obstetrics & Gynaecology lays out a fairly clear roadmap. Vaccination during pregnancy serves two purposes at once. It builds active immunity in the mother against infections that could otherwise turn dangerous during pregnancy, and it passes on passive immunity to the baby, protection the newborn would otherwise have to wait months to develop on its own.

The review draws a useful distinction that often gets lost in dinner-table conversations about vaccine safety. Live vaccines, which contain a weakened version of the actual virus or bacteria, are generally avoided during pregnancy because of the theoretical risk of the infection passing to the fetus. Inactivated vaccines, which use killed pathogens or fragments of them, carry no such risk and are considered safe.

This is why tetanus toxoid, the Tdap vaccine (which also covers diphtheria and whooping cough), and the flu shot sit at the centre of pregnancy vaccination guidelines almost everywhere, including in India.

The clinical review is unambiguous on why inactivated vaccines form the backbone of this list, noting simply that “inactivated vaccines are generally safe.” The review recommends that all pregnant women receive Tdap and tetanus toxoid vaccination in the third trimester, timed so that the antibodies the mother develops have enough time to cross the placenta before delivery.

The flu vaccine, on the other hand, can be given at any point during pregnancy, and if a woman misses it while pregnant, she can still receive it after delivery.

Who needs which vaccine and when

The review is specific about which vaccines fall outside the routine list. It states that vaccines “should be offered to women if at high risk of exposure” for a defined set of diseases, namely hepatitis A and B, pneumococcal and meningococcal infections, yellow fever, Japanese encephalitis, polio, typhoid and cholera, depending on where a woman lives, travels, or works.

A separate category exists for vaccines used only after exposure has already occurred. According to the review, vaccines “to be given only for post-exposure prophylaxis (PEP) are smallpox, rabies, and anthrax,” reserved strictly for emergency use rather than routine immunisation during pregnancy.

The review also addresses the period right after childbirth. It states plainly that “postpartum women should be offered human papillomavirus (HPV) vaccination,” and that those not immunised earlier “should be offered MMR, Tdap, and Flu vaccines.” In other words, the review treats the months after delivery as a continuation of a woman’s vaccination record, not a separate, lower-priority phase.

What the newer research adds

A more recent systematic review, published in Cureus in January this year, adds weight to these recommendations by pulling together data from studies conducted between 2018 and 2024. After screening research from PubMed, Scopus and Web of Science, the reviewers settled on eight studies examining five vaccines: influenza, DTaP, RSV, Group B Streptococcus and COVID-19.

Across the board, the pattern held. These vaccines produced strong immune responses in pregnant women, and just as importantly, the antibodies they generated were efficiently transferred across the placenta to the baby.

The side effects reported were mostly mild to moderate, comparable to what non-pregnant people experience after the same vaccines. The reviewers were direct about the bottom line, concluding that “no significant increase in adverse pregnancy or neonatal outcomes was associated with maternal vaccination.” That finding directly addresses the anxiety many expecting mothers carry.

The review does flag one persistent obstacle, though: vaccine hesitancy.

Despite the safety data, many women remain reluctant, which the authors argue points to a communication gap between healthcare providers and pregnant women rather than a genuine safety concern. That same gap, doctors say, plays out just as visibly in Indian clinics as it does in the research literature.

The Indian picture

That gap becomes easier to understand when you look at real-world data from India, where research on this subject has historically been thin. A prospective cohort study published in the Indian Journal of Medical Research followed 430 pregnant women across two primary health centres in Chandigarh through 2021 and 2022, during the country’s COVID-19 vaccination drive. Of these women, 295, or roughly 69 per cent, chose to get vaccinated against COVID-19 while pregnant.

The findings offer some of the most India-specific reassurance available so far. Vaccinated women showed no worse outcomes than unvaccinated women across most measures the study tracked, including the type of delivery, birth weight and rates of intrauterine growth restriction.

In fact, one outcome moved in a distinctly positive direction: babies born to vaccinated mothers needed neonatal intensive care far less often than those born to unvaccinated mothers. For a country where NICU admissions strain both family finances and hospital capacity, that single finding carries weight beyond the study itself.

The researchers themselves were measured in how they framed it, writing only that “vaccination in pregnant women in India might be safe,” a cautious phrasing that reflects the study’s scope rather than any hedging on the data. What that single finding hints at in numbers, doctors treating pregnant women every day can explain in plainer terms.

What doctors are seeing in the clinic

Doctors on the ground echoed much of what the research points to, while adding nuance that data alone cannot capture.

Dr Meenakshi Ahuja, principal director, obstetrics & gynaecology at Fortis LaFemme, Delhi, explained why inactivated vaccines get a free pass in pregnancy. “Since pregnancy is an immune-deprived state, we can’t give live vaccines,” she noted, adding that inactivated vaccines contain no infectious material at all.

She elaborated on the third-trimester timing too, observing that antibodies formed close to delivery pass on to the newborn before the baby receives its own first shots. “We are actually immunising two instead of one at that point,” she remarked.

Dr Ahuja offered a straightforward clinical explanation of the Chandigarh study’s finding of fewer NICU admissions among vaccinated mothers. Unvaccinated mothers who fall ill are more likely to go into premature labour, she said, while a vaccinated mother’s baby also carries some of her immunity at birth.

Interestingly, she pushed back on the idea that hesitancy remains widespread among her own patients, insisting that “everyone understands the value of immunisation” today. She did, however, agree that doctors themselves often underplay preventive counselling, admitting candidly, “we are failing in our duty.”

Dr Abha Majumdar, advisor and emeritus consultant at the Centre of IVF and Human Reproduction, Sir Ganga Ram Hospital, agreed that the problem lies less with expecting mothers and more with how doctors themselves approach the conversation. She attributed it to what she called doctors’ “tubular vision,” where clinicians treat only the presenting complaint and skip broader preventive counselling altogether.

She also addressed vaccine myths directly, recalling how COVID-era scepticism cost lives. “Vaccination doesn’t harm us, it protects us,” she stressed, cautioning that rare side effects should never overshadow population-wide benefit.

For hesitant patients, she said she leans on comparison rather than reassurance alone, pointing out that an actual infection during pregnancy is often far riskier than the vaccine meant to prevent it.

Taken together, the research and the clinical experience arrive at the same conclusion from different directions: the science on maternal vaccination is settled, and what remains is largely a matter of conversation, timing and trust between doctor and patient.

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