Vaccinations in pregnancy: An update for a changing time

Maternal immunization is one of the most effective public health interventions to reduce infectious morbidity and mortality in pregnant women, fetuses, and newborns. Despite robust evidence supporting vaccine safety and effectiveness in pregnancy, global uptake has declined following the COVID-19 pandemic, contributing to resurgent outbreaks of vaccine-preventable diseases. While national immunization schedules vary, there is broad international consensus recommending influenza and tetanus-diphtheria-acellular pertussis (Tdap) vaccination during pregnancy, with increasing adoption of maternal respiratory syncytial virus (RSV) immunization. This review provides an updated, globally relevant summary of recommended vaccines before, during, and after pregnancy, highlights vaccines under development, and discusses implementation challenges. Strengthening maternal immunization requires coordinated action across governments, healthcare systems, industry, and media to improve access, trust, and equity in vaccine delivery.