COVID-19, Flu Shots Coadministered Are Well-Tolerated in Pregnancy

COVID-19 vaccination during pregnancy was safe and well tolerated when administered concurrently with influenza immunization, according to a new survey study in Vaccine.¹ The most common reactions were injection site pain, redness or swelling, plus fatigue and muscle aches, while no survey participants needed medical attention.

“Both COVID-19 and influenza infections during pregnancy, without vaccination, present a heightened risk of developing severe disease, resulting in increased maternal mortality, morbidity, and adverse perinatal outcomes,” wrote authors of the study. “Despite consistent evidence of safety and efficacy, vaccine hesitancy in the pregnant population remains widespread.”

To evaluate these reactogenicity patterns, researchers with the Canadian COVID-19 Vaccine Registry for Pregnant Women and Pregnant People analyzed survey responses from hundreds of pregnant participants across Canada.¹

READ MORE: No Added Adverse Event Risk in Pfizer-BioNTech COVID-19 Vaccine

Examining the Clinical Safety and Reactogenicity Findings

Out of 344 individuals vaccinated against COVID-19 during pregnancy, 85 received a same-day influenza immunization. Local injection site symptoms such as pain, redness, or swelling were the most frequent post-vaccination reactions, reported by 48.3% of the overall vaccinated cohort.

Participants receiving coadministered shots experienced higher rates of local injection site reactions at 67.1% compared with 42.1% among those receiving the COVID-19 vaccine alone. Systemic symptoms were similarly mild, with fatigue reported by 40.4% of participants and muscle aches in 39.2%.¹

Chills were noted in 18.8% of coadministered recipients versus 8.5% in the single-vaccine group. Adverse reactions were self-limiting and no significant health events requiring emergency medical attention or hospitalization occurred following dual administration.

Navigating Guidance Shifts and Community Pharmacy Access

These safety findings arrive alongside evolving regulatory policies and clinical guidance that expand administration channels for pregnant individuals. In the US, updated recommendations from the Advisory Committee on Immunization Practices (ACIP) established that adults, including pregnant patients, can receive COVID-19 vaccines through shared clinical decision-making between patients and providers. This regulatory decision ensures insurance coverage and allows community pharmacies to directly dispense and administer vaccines to pregnant women.^2,3

Meanwhile, updated guidance from the American College of Obstetricians and Gynecologists (ACOG) firmly supports routine COVID-19 vaccination alongside influenza, Tdap, and respiratory syncytial virus (RSV) immunizations during pregnancy.³

Although federal guidance emphasizes individualized discussion, major clinical organizations frame maternal vaccination as standard preventive care that should be administered at the earliest clinical opportunity.

Empowering Pharmacists as Trusted Immunization Counselors

For community and health-system pharmacists, these aligned insights provide powerful evidence when addressing patient concerns regarding vaccine safety. Research demonstrates that direct recommendations from health care professionals significantly improve vaccine acceptance, and coadministering vaccines during a single visit dramatically increases overall uptake.^3,4

When vaccines are stocked and offered at the point of care during patient consultations, acceptance rates rise between 5 and 50 times. Pharmacists can reassure expectant patients that coadministration does not compromise immunogenic protection or increase the risk of severe adverse events.^1,4

Furthermore, vaccinating during pregnancy facilitates the passive transfer of maternal antibodies across the placenta, conferring vital protection for infants against respiratory hospitalizations during their first 6 months of life.^4,5

By offering coadministration services, pharmacists play a central role in protecting maternal and neonatal health.⁴

“COVID-19 vaccination in pregnancy, with or without influenza coadministration, was safe and well tolerated by survey respondents,” concluded authors of the current study.¹ “As strains of the SARS-CoV-2 virus are expected to persist in circulation and continue to pose a heightened risk of disease severity for both those pregnant and in utero, immunization against COVID-19 remains an important point of discussion in prenatal care.”

READ MORE: COVID-19 Resource Center

REFERENCES

1. Tran S, McClymont E, Blitz S, et al. Self-reported reactogenicity after COVID-19 vaccination with and without influenza vaccine coadministration during pregnancy in Canada. Vaccine. 2026;92:129122. doi:10.1016/j.vaccine.2026.129122

2. CDC reverses RFK Jr.’s restrictions on COVID vaccine for pregnant women. KFF Health News. October 9, 2025. Accessed October 27, 2026. https://kffhealthnews.org/morning-breakout/cdc-reverses-rfk-jr-s-restrictions-on-covid-vaccine-for-pregnant-women/

3. New pregnancy vaccine guidance backs COVID shot, despite CDC shift. Epocrates. June 12, 2026. Accessed October 27, 2026. https://www.epocrates.com/online/article/new-pregnancy-vaccine-guidance-backs-covid-shot-despite-cdc-shift

4. Fitch J. ACOG's 2026-27 respiratory virus immunization recommendations in pregnancy, postpartum. Contemporary OB/GYN. September 2, 2026. Accessed October 27, 2026. https://www.contemporaryobgyn.net/view/acog-2026-27-respiratory-virus-immunization-recommendations-pregnancy

5. Are COVID-19 vaccines recommended during pregnancy? Immunize.org. October 23, 2026. Accessed October 27, 2026. https://www.immunize.org/ask-experts/are-covid-19-vaccines-recommended-during-pregnancy/