Flu Vaccination During Pregnancy: When a Vaccination Is Recommended for Mother and Child

When many people come down with a fever, cough, and body aches in the fall and winter, pregnant women often wonder whether they should get the flu shot. The flu is very different from a common cold and can be more severe during pregnancy. That is why the Standing Committee on Vaccination (STIKO) recommends the seasonal flu vaccine during every pregnancy.

Flu or Cold: What's the Difference?

The flu (influenza) is an acute respiratory illness caused by influenza viruses. The number of annual influenza cases is high; about 10% of the population contracts the illness each year. There are some differences between influenza and the common cold, primarily regarding the severity of the illness caused by the influenza virus.

The differences between the flu and the common cold are summarized in the following table:

Ways the Flu Is Spread

Transmission and infection with the influenza virus (flu) in pregnant women generally occurs in the same way as in non-pregnant individuals, although flu can be caused by various influenza viruses. However, there are some specific considerations and risks that should be taken into account.

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• Droplet transmission: The most common way the flu spreads is through droplets released when a person coughs, sneezes, or speaks. These droplets can be inhaled by others, leading to infection.
• Aerosols: Aerosols—that is, fine particles in the air—can also contain the influenza virus and be carried over long distances.
• Contact transmission: Indirect transmission can occur via hands and surfaces. If an infected person touches their hands and then contaminates a surface, the virus can be picked up by another person who touches that surface and then touches their face (e.g., eyes, nose, mouth), thereby causing a flu infection; good hygiene practices are therefore particularly important, especially with influenza A.

Why Pregnant Women Are at Higher Risk for Severe Cases of the Flu

During pregnancy, the body’s systems change to ensure the well-being of the unborn child. The immune system undergoes physiological adjustments so that the unborn child is not treated as a foreign body. At the same time, the demands on the circulatory and respiratory systems increase. These changes raise the risk of severe influenza.

Risks for Pregnant Women

Pregnant women are at higher risk for serious complications from the flu compared to non-pregnant women. This is because the immune system changes during pregnancy and is therefore less effective at fighting off infections. In addition, chronic conditions such as asthma or diabetes—which are more common in pregnant women—can increase the risk of complications at any stage of pregnancy.

Symptoms of the Flu

The symptoms of influenza in pregnant women are generally the same as in non-pregnant women and include:

• Sudden onset with a high fever
• Headache
• Muscle pain
• Tiredness
• Sore throat
• Cough
• Runny or Stuffy Nose

Complications of an influenza infection

Pregnant women have a significantly increased risk of the following complications:

• Sinusitis and middle ear infections: These are more common in pregnant women and can cause significant discomfort.
• Pneumonia: Influenza can cause bacterial pneumonia, which may require hospitalization. Severe pneumonia can lead to acute respiratory distress syndrome, which should be treated in a hospital.
• Preterm Birth and Low Birth Weight: An influenza infection can cause preterm birth and increases the risk of low birth weight in babies.
• Growth delays in children: In addition, the risk of growth delays in the unborn child increases.

Preventing the Flu (Influenza) During Pregnancy

To minimize the risk of influenza infection during pregnancy, the following measures are important:

• Vaccination: The flu vaccine is strongly recommended for pregnant women. It is safe and can significantly reduce the risk of complications.
• Hygiene: Wash your hands regularly with soap and water, or use an alcohol-based hand sanitizer.
• Avoiding sources of infection: Avoid contact with sick people, especially during flu season.

Pregnant women should follow the protective measures listed above, especially during the cold season and during outbreaks, as they are part of a high-risk group.

Treating the Flu During Pregnancy

If a pregnant woman develops the flu, it is important to see a doctor immediately. Medications should generally only be taken during pregnancy after a doctor has evaluated the situation. Antiviral medications may be prescribed to alleviate symptoms and shorten the duration of the illness. However, it is important to take these medications within 48 hours of the onset of symptoms in order for them to be fully effective.

What does STIKO recommend regarding flu vaccinations during pregnancy?

The vaccination recommendation from the Standing Committee on Vaccination (STIKO) regarding seasonal influenza vaccination is as follows: vaccination of all pregnant women starting in the second trimester, as they are considered a high-risk group within the population.

If there is an increased health risk due to an underlying medical condition, the influenza vaccine should be administered as early as the first trimester of pregnancy. Vaccination should be repeated during each pregnancy and before each flu season.

How safe is the flu vaccine for mothers and their children?

Inactivated influenza vaccines—that is, "killed" vaccines—are generally used for flu vaccinations during pregnancy. They do not contain influenza viruses capable of replicating and therefore cannot cause the flu.

Inactivated vaccines are generally considered safe for use during pregnancy. Common reactions following vaccination include pain at the injection site, fatigue, headache, muscle aches, and a slight fever. These side effects are temporary and usually subside after a short time.

The available recommendations and reviews conclude that inactivated vaccines are safe during pregnancy. The vaccination recommended by STIKO does not pose any risks during pregnancy beyond those associated with typical vaccine reactions.

Nest Protection: How Vaccination Can Help the Baby After Birth

Maternal immunity is a temporary form of protection for the newborn provided by the mother’s antibodies. Antibodies produced by the mother after vaccination can pass to the child through the placenta during pregnancy and provide protection during the first stage of life. Breastfeeding can supplement this protection after birth, but it does not replace vaccinations for the child. Especially once maternal protection no longer applies to toddlers, vaccinations are important for preventing serious illnesses.

When should you get vaccinated?

The ideal time to get a flu shot is well before the start of flu season, which typically occurs in Germany during the fall and winter. The STIKO recommendation primarily takes into account a precautionary assessment during the first trimester of pregnancy, but this does not mean that an inactivated vaccine is inherently unsafe during the first trimester.

• Pregnancy Starting in the Second Trimester During Fall/Winter: Discuss Vaccination Promptly
• First trimester with no specific risk factors: In general, schedule the vaccination for the second trimester
• First Trimester with an Underlying Medical Condition: Prompt Medical Consultation Regarding Vaccination
• Pregnancy doesn't begin until after flu season: Schedule an appointment with the doctor's office on an individual basis

Getting vaccinated can also be a good idea during the flu season. The ideal time to get vaccinated should not be used as an excuse to skip vaccination later on simply because an earlier opportunity was missed.

Here's how the vaccination appointment works

A vaccination appointment at the gynecologist's office usually proceeds as follows:

• Medical History and Patient Education
• Checking vaccination status, week of pregnancy, and current symptoms
• Assessment of Possible Contraindications
• Injection into the upper arm
• Brief Observations and Tips for the Time Ahead

In the event of an acute, severe illness accompanied by a fever, the appointment may be temporarily rescheduled. Some medical practices also allow you to combine your vaccination appointment with a routine checkup.

Flu Vaccine and COVID-19 Vaccine: What Should You Know During Pregnancy?

Influenza and COVID-19 are caused by different viruses; therefore, the vaccines protect against different diseases. There is no single recommendation that applies to all pregnant women.

The influenza vaccine is a standard STIKO recommendation for every pregnancy. As of 2026, there is no longer a general recommendation for COVID-19 vaccination to establish basic immunity in healthy pregnant women. Vaccination based on medical indications remains relevant for pregnant women with underlying medical conditions or pregnancy-related complications, generally starting in the second trimester.

Flu Vaccination While Breastfeeding

A flu shot can also be beneficial after childbirth. It protects the mother herself; when breastfeeding, antibodies can also be passed on through breast milk. This additional protection is valuable, but it does not replace the childhood vaccinations recommended later on.

Domestic help during pregnancy

A housekeeper can provide support in various ways during pregnancy. Here are some of the tasks and benefits:

• Household Chores: A housekeeper can help with everyday tasks such as cleaning, doing laundry, and grocery shopping, which is especially important for taking it easy on the expectant mother.
• Cooking and Meal Preparation: A home health aide can prepare healthy meals tailored specifically to the needs of a pregnant woman.
• Help with Childcare: If you already have children in your household, a housekeeper can help with their care and thus take some of the burden off you.
• Transportation and Accompaniment: A housekeeper can accompany the expectant mother to doctor's appointments or other important engagements.
• Organization and Planning: Help with scheduling appointments, managing medications, or preparing for the new family member.

Financing by the health insurance company

In Germany, pregnant women may be eligible for domestic help through their health insurance under certain conditions. Here is the basic information:

• Preventive Care Services: Health insurance plans offer various preventive care services for pregnant women, including help with household chores.
• Household Assistance Under Section 38 of SGB V: If a pregnant woman is unable to manage her household due to health problems, she may apply for household assistance. The health insurance provider covers the costs of appropriate household assistance.
• Medical Certificate: A medical certificate is required to prove the need for domestic help. The doctor must confirm that the pregnant woman is unable to manage the household on her own.
• Applying: Applications for home care assistance are typically submitted through your health insurance provider. It is advisable to contact your health insurance provider early and prepare all necessary documents.

Conclusion: Flu Vaccination During Pregnancy at a Glance

During pregnancy, the flu can be more severe than usual. For this reason, STIKO recommends that all pregnant women receive a seasonal flu vaccine starting in the second trimester. However, if you are at higher risk, you should get vaccinated earlier. Discuss the appropriate vaccination date and any individual considerations with your obstetrician’s office or primary care provider well in advance.

Note: This article provides general information and is not a substitute for personalized medical advice. Especially if you have pre-existing conditions, have had previous reactions to vaccines, are currently ill, or are unsure about the best time to get vaccinated, you should discuss your decision with your gynecologist or primary care physician.