Pregnancy raises the cost of flu, but you can help stop it

ByEmily Bishop

By Jeremy Chu, MD, PGY3 St. Joe’s Family Medicine Residency

Every year flu season returns with disastrous collateral damage: missed work, packed urgent cares, and hospital beds filled with patients whose “just a bad flu” becomes pneumonia, respiratory failure, or worse. Amid this seasonal chaos, one group remains caught in an unnecessary debate: pregnant patients.

During my ICU training, I cared for many pregnant patients who needed respiratory and cardiovascular support stemming from an influenza infection. Sitting with their families in those frightening moments made one truth clear- family physicians have the power to prevent these tragedies before they occur.

If we are to protect moms and babies, we should treat flu vaccination in pregnancy as the default, not a “maybe.”

Pregnancy isn’t an illness, but it makes respiratory infections harder to weather. These changes make influenza more dangerous than it needs to be. Pregnant people with influenza face significantly elevated mortality risk, accounting for approximately 5% of all influenza deaths despite representing only 1% of the U.S. population.1 However, flu vaccination during pregnancy can reduce the risk of hospitalization by about 40%.2 That is why major medical and public health organizations recommend influenza vaccination during any trimester.

Flu vaccination during pregnancy also protects newborns. Babies cannot be vaccinated until six months, but maternal antibodies cross the placenta and help shield infants during this vulnerable window. A study in Jama demonstrated strong protection against infant flu hospitalization in the first six months of life.3

Vaccine hesitancy in pregnancy often isn’t ideological; it’s a protective instinct. Many people hear “limited pregnancy data” and assume “unknown risk.” But for influenza vaccination, we’re not operating in the dark. A 2023 systemic review clearly shows no link between flu vaccination and adverse birth outcomes and serious maternal adverse events.4

Flu Vaccine Counseling in Pregnancy Tips:

  • Recommend it clearly- not “if you want,” but “I recommend it”: Provider recommendation is one of the strongest predictors of uptake.5
  • Use the right product: In pregnancy, stick with inactivated influenza vaccines; the live-attenuated nasal spray is generally avoided.6
  • Frame it as infant protection too: Families want to protect their baby- positively framing the benefit helps motivate action

Pregnancy is full of decisions made for someone not born yet. But this decision is clear- flu vaccination is evidence based and protective for both mother and baby.

I know these conversations are exhausting during a busy clinic day- especially with vaccination resistance on the rise. But in my experience, definitive recommendations can be brief and still make a difference: offer protection clearly and with purpose.

Dr. Jeremy Chu is a third year family medicine resident at Saint Joseph Family Medicine Residency. Article edited by Dr. Stephanie Sandhu.

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References

  1. Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States. JAMA. 2010;303(15):1517–1525. doi:10.1001/jama.2010.479
  2. Committee on Infectious Diseases; Recommendations for Prevention and Control of Influenza in Children, 2025–2026: Technical Report. Pediatrics December 2025; 156 (6): e2025073622. 10.1542/peds.2025-073622
  3. Sahni LC, Olson SM, Halasa NB, et al. Maternal Vaccine Effectiveness Against Influenza-Associated Hospitalizations and Emergency Department Visits in Infants. JAMA Pediatr. 2024;178(2):176–184. doi:10.1001/jamapediatrics.2023.5639
  4. Wolfe DM, Fell D, Garritty C, Hamel C, Butler C, Hersi M, Ahmadzai N, Rice DB, Esmaeilisaraji L, Michaud A, Soobiah C, Ghassemi M, Khan PA, Sinilaite A, Skidmore B, Tricco AC, Moher D, Hutton B. Safety of influenza vaccination during pregnancy: a systematic review. BMJ Open. 2023 Sep 6;13(9):e066182. doi: 10.1136/bmjopen-2022-066182. PMID: 37673449; PMCID: PMC10496691.
  5. Kilich E, Dada S, Francis MR, Tazare J, Chico RM, Paterson P, Larson HJ. Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis. PLoS One. 2020 Jul 9;15(7):e0234827. doi: 10.1371/journal.pone.0234827. PMID: 32645112; PMCID: PMC7347125.
  6. Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK, Morgan RL, Fry AM. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2022-23 Influenza Season. MMWR Recomm Rep. 2022 Aug 26;71(1):1-28. doi: 10.15585/mmwr.rr7101a1. PMID: 36006864; PMCID: PMC9429824.