Dr Mannan Gupta
Medically Reviewed by Dr. Mannan Gupta On May 22, 2026
In India, the Tetanus Toxoid (TT) vaccine — or its newer replacement, the Td vaccine — is the only vaccine mandated under the government’s national antenatal care programme, but several additional vaccines are strongly recommended based on your individual health history, trimester, and risk factors.
Knowing exactly which vaccines you need, when to get them, and why they matter is one of the most straightforward ways to protect both yourself and your newborn before birth even happens.
At Dr. Mannan IVF Centre, New Delhi, Dr. Mannan Gupta, IVF and High-Risk Pregnancy Specialist, integrates vaccination counselling into every antenatal care plan from the first trimester.
As a trusted pregnancy vaccination clinic in New Delhi, we ensure no expectant mother leaves her prenatal appointments uncertain about what she has received, why she received it, or what comes next.
Key Takeaways
- Tetanus Toxoid (TT) / Td vaccine is the only government-mandated vaccine in India’s national antenatal programme
- The Tdap vaccine (Tetanus, Diphtheria, Pertussis) is strongly recommended between 27–36 weeks to protect the newborn from whooping cough
- Influenza vaccine is recommended during pregnancy — particularly in the second and third trimester
- Live vaccines including MMR and chickenpox are strictly contraindicated during pregnancy
- Vaccination timing matters — some are trimester-specific for maximum foetal protection
- Your vaccination history before pregnancy affects which doses you need during pregnancy
Why Do Pregnant Women Need Vaccines in the First Place?
This is a question worth answering clearly, because vaccine hesitancy during pregnancy is real — and understandable, given how carefully most mothers monitor everything that enters their body.
The rationale for antenatal vaccination is twofold. First, pregnancy suppresses the maternal immune system, making certain infections more severe and harder to recover from.
Second — and more importantly — the antibodies a mother generates in response to vaccination cross the placenta and provide the newborn with passive immunity during the critical first weeks of life, before the baby’s own immune system is mature enough to respond to vaccines.
This is called passive transfer of maternal antibodies, and it is one of the most elegant mechanisms in perinatal medicine. Vaccinating the mother is, in effect, vaccinating the newborn before birth.
What Is the Government-Mandated Vaccine Under India's Antenatal Programme?
Under India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) programme, the Tetanus Toxoid (TT) vaccine has been the cornerstone of mandatory antenatal immunisation for decades.
Source: Ministry of Health and Family Welfare, Government of India — National Immunisation Schedule
The schedule for TT vaccination in pregnancy depends on prior immunisation history:
- If previously vaccinated (within the last 3 years): One booster dose of TT, ideally before 36 weeks
- If not previously vaccinated or status unknown: Two doses of TT — the first at the earliest antenatal visit, the second at least 4 weeks later, and no later than 4 weeks before the expected delivery date
In recent years, the government has increasingly transitioned toward the Td vaccine (Tetanus and Diphtheria combined), which offers broader protection at the same schedule.
Many private facilities have further moved to Tdap, which additionally covers Pertussis (whooping cough).
The TT injection in pregnancy prevents neonatal tetanus — a potentially fatal condition in newborns caused by Clostridium tetani infection through the umbilical stump. India has made significant progress in eliminating neonatal tetanus, largely through consistent antenatal TT coverage.
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What Is the Tdap Vaccine and Why Is It Recommended in Pregnancy?
Tdap stands for Tetanus, Diphtheria, and acellular Pertussis — and it is one of the most important vaccines recommended during every pregnancy, ideally between 27 and 36 weeks of gestation.
Pertussis (whooping cough) is the reason Tdap matters so urgently in pregnancy. Newborns cannot receive their own pertussis vaccine until they are 6 weeks old.
In the weeks between birth and their first vaccination, they are completely unprotected — and whooping cough in a newborn is a potentially fatal illness, characterised by severe coughing spells that can cause breathing to stop entirely.
When a mother receives Tdap between 27–36 weeks, she generates high levels of anti-pertussis antibodies.
These cross the placenta in the final trimester, directly protecting the newborn from birth. Studies show that maternal Tdap vaccination reduces pertussis hospitalisation in infants under 2 months by up to 91%.
Tdap is recommended in every pregnancy — not just the first. Antibody levels wane between pregnancies, so each new pregnancy warrants a fresh dose in the third trimester.
What Are the Recommended — But Not Mandated — Vaccines During Pregnancy?
Beyond the government-mandated schedule, several vaccines during pregnancy are strongly recommended based on clinical evidence and international guidelines.
Influenza (Flu) Vaccine
Pregnant women are at significantly higher risk of severe influenza complications — including pneumonia, preterm labour, and ICU admission — compared to non-pregnant adults.
The inactivated influenza vaccine is safe in all trimesters and is recommended annually. It also provides some protection to the newborn through maternal antibody transfer.
Hepatitis B Vaccine
If a woman is Hepatitis B surface antigen negative and has not previously completed the Hepatitis B vaccine series, vaccination during pregnancy is considered safe and appropriate — particularly for women at higher risk of exposure.
Vertical transmission of Hepatitis B from mother to child during delivery is a significant concern, and maternal immunity reduces this risk.
COVID-19 Vaccine
Based on current evidence and guidelines from ACOG, WHO, and India’s NTAGI (National Technical Advisory Group on Immunisation), COVID-19 vaccination is recommended during pregnancy.
Pregnant women who contract COVID-19 are at higher risk of preterm birth and ICU admission. Both mRNA vaccines and the Covishield platform have been studied in pregnancy with reassuring safety data.
Not sure which vaccines you need and when during your pregnancy? Get a personalised antenatal vaccination plan from Dr. Mannan Gupta at Dr. Mannan IVF Centre, New Delhi. Visit drmannanivfcentre.com
Which Vaccines Are Strictly Contraindicated During Pregnancy?
This is equally important — knowing what to avoid prevents well-intentioned but harmful decisions.
Live attenuated vaccines are contraindicated during pregnancy because they contain weakened but viable virus or bacteria that carry a theoretical — and in some cases documented — risk of foetal infection.
Vaccines to avoid during pregnancy:
- MMR (Measles, Mumps, Rubella) — avoid during pregnancy; ideally given at least one month before conception if immunity is lacking
- Varicella (Chickenpox) — strictly contraindicated; congenital varicella syndrome is a serious foetal risk
- BCG — not given during pregnancy
- Yellow Fever — avoid unless travel to a high-risk area makes the risk-benefit calculation shift
- Live attenuated influenza vaccine (nasal spray) — the injected inactivated form is safe; the nasal spray version is not recommended in pregnancy
If you discover you received a live vaccine before you knew you were pregnant, inform your doctor immediately — most accidental exposures do not result in adverse outcomes, but the pregnancy should be monitored appropriately.
What Is the Right Vaccination Schedule to Follow Trimester by Trimester?
A clear trimester-based framework helps patients and families plan without confusion.
Trimester | Recommended Vaccines |
First (Weeks 1–12) | TT/Td dose 1 (if unvaccinated); Flu vaccine (safe from any trimester); Hepatitis B (if indicated) |
Second (Weeks 13–26) | TT/Td dose 2 (if first given in first trimester); Flu vaccine (if not already given) |
Third (Weeks 27–36) | Tdap — most important window; COVID-19 booster (if due); Flu vaccine (if not given earlier) |
This schedule is a general guide. Individual timing may vary based on your prior vaccination history, underlying conditions, and your doctor’s clinical assessment.
Women seeking maternal vaccination in New Delhi support should bring their vaccination records — however incomplete — to their first antenatal visit so gaps can be identified and addressed.
Should You Get Vaccinated If You Conceived Through IVF?
Yes — and this group of patients often has additional considerations.
Women who conceive through assisted reproduction — including IVF — may have had their antenatal vaccination history overlooked during the fertility treatment phase.
Additionally, some high-risk pregnancy conditions associated with IVF pregnancies, such as multiple gestation or preterm labour risk, make influenza and pertussis protection even more clinically important.
For women managing their pregnancies through a prenatal care clinic in Noida or in South Delhi following IVF, a full vaccination review at the first obstetric appointment is standard practice at our centre.
Conclusion
Vaccination during pregnancy is not a separate or optional component of antenatal care — it is a fundamental part of it. The Td or TT injection protects against neonatal tetanus.
Tdap protects your newborn against whooping cough in their most vulnerable weeks. Influenza vaccination protects you from a disproportionately severe infection risk. Together, these form a protective layer that begins before your baby takes their first breath.
At Dr. Mannan IVF Centre, every antenatal patient receives a vaccination review at their first visit and updated guidance at each subsequent trimester.
We believe that a protected mother and a protected newborn are not accidental outcomes — they are the result of informed, timely, and evidence-based care.
If you are pregnant or planning to conceive and are uncertain about your vaccination status, come speak with us. A few injections at the right time can prevent outcomes no family should ever have to face.
Frequently Asked Questions
1. Is it safe to get the Tdap vaccine in every pregnancy, or just the first?
Yes — Tdap is recommended in every pregnancy, ideally between 27–36 weeks each time. Maternal antibody levels wane between pregnancies, so a new dose with each pregnancy ensures the newborn receives adequate passive protection from birth. This is the current recommendation from ACOG, WHO, and most national immunisation bodies.
2. I missed my TT injection in my first trimester. Can I still get it in the third trimester?
Yes — it is better late than not at all. The final dose should ideally be given at least 4 weeks before the expected delivery date to allow adequate antibody development and transfer to the baby. If you are already beyond 36 weeks, discuss the timing with your doctor — a single dose may still be given with meaningful benefit.
3. Can vaccines cause miscarriage or preterm labour?
Inactivated and toxoid vaccines — including TT, Td, Tdap, inactivated flu, and Hepatitis B — do not cause miscarriage or preterm labour. This has been studied extensively. Live vaccines carry different considerations and are contraindicated as noted above. Vaccine hesitancy in pregnancy based on miscarriage fears, while understandable, is not supported by the available clinical evidence.
4. My doctor says I do not need the flu vaccine because it is not in the government schedule. Is this correct?
The government’s national antenatal programme primarily mandates TT/Td due to resource and implementation priorities at a population level. The absence of influenza vaccine from the mandatory schedule does not mean it is not recommended — it is strongly recommended by ACOG, WHO, and the Indian Academy of Paediatrics for all pregnant women, particularly during influenza season. Discuss it with your doctor and do not decline it on the basis of it not appearing in the government booklet.
5. If I was vaccinated against tetanus before pregnancy, do I still need the TT injection during pregnancy?
It depends on how long ago you were vaccinated. If you received a full tetanus immunisation within the last 3 years, a single booster during pregnancy is typically sufficient. If your last dose was more than 3 years ago, or if your vaccination history is uncertain, a two-dose schedule is recommended. Always bring whatever records you have to your antenatal appointments — even partial records help your doctor make the right decision.
