Vaccinations To Sort Before You Conceive

All ready to start a family, are you? Well, do get yourself screened for these illnesses that can be prevented by vaccine before you get pregnant.

Two of the most important vaccinations for a pregnancy can’t be given during it. That’s the whole reason this needs doing beforehand.

MMR and chickenpox vaccines are live vaccines, and live vaccines are avoided in pregnancy.

Which means: if you aren’t immune to rubella or chickenpox, the window to fix it closes the moment you conceive, and you should avoid becoming pregnant for one month after either vaccination.

So sort this out at least three months before you start trying, not when you see a positive test.

What to check before you try

Rubella (German measles)

A mild illness in an adult and a serious one for a foetus. Infection in the first trimester brings a high risk of passing to the baby, and can cause deafness, cataracts, heart defects and developmental problems: congenital rubella syndrome.

A blood test tells you whether you’re immune. Don’t assume childhood vaccination covered it; immunity can wane, and records are often lost.
If you’re not immune, the MMR vaccine, then wait a month before trying.
If you find out you aren’t immune while already pregnant, you can’t be vaccinated then. Avoid anyone with a rash illness, and get vaccinated after delivery.

Chickenpox (varicella)

Most adults who grew up here have had it, but not all, and it’s more dangerous in pregnancy than most people realise. It can cause severe pneumonia in the mother, and infection at certain points in pregnancy can affect the baby.

If you’re unsure whether you had it, get the blood test. Recollection is unreliable.
If you’re not immune, the vaccine is two doses, so start early, and wait a month after the second before trying.
If you’re exposed while pregnant and not immune, contact your doctor the same day. There’s treatment that can reduce the risk, and it’s time-sensitive.

Hepatitis B

Different from the other two: this is about screening as well as vaccination.

Screening comes first. If you carry hepatitis B, transmission to the baby is largely preventable: the newborn is given immunoglobulin plus the vaccine at birth. Knowing beforehand is what makes that happen reliably.
The vaccine isn’t live, so it can be given in pregnancy if needed. But three doses over six months is easier before.
Carrier rates in this region make it better to check than to assume.

Vaccines given during pregnancy

These are often confused with the above, and they run the other way.

Whooping cough (pertussis). Given in pregnancy, usually in the second or third trimester, so that antibodies cross to the baby and protect them in the first weeks before their own vaccinations start. Newborns are the group most at risk of dying from whooping cough, so the timing is important.
Influenza. Recommended in pregnancy, and safe. Pregnancy increases the risk of severe illness from flu.
COVID-19, per current national guidance. Check what’s advised at the time.

Ask your obstetrician about these at your booking appointment rather than assuming they’ll be offered.

Other things to sort out before conceiving

Pre-pregnancy is the right moment for several other things that are harder later:

Folic acid, 400mcg daily, started at least a month before conceiving. The neural tube closes by about day 28, so starting after a positive test is often too late for its main purpose.
Thalassaemia screening for both partners. Carrier rates are significant in Singapore, and if both partners are carriers, that’s a conversation to have before a pregnancy, not during one.
Review your regular medications with a doctor. Some need changing before conception, not at eight weeks. This includes acne treatments, certain anti-epileptics and some blood pressure medications.
A dental check. Gum disease is common in pregnancy and treatment is simpler beforehand.
Chronic conditions optimised, diabetes control in particular, where pre-conception control measurably affects outcomes.
Stop smoking, reduce alcohol, both partners.
Cervical screening if it’s due.

Where to get it done

A GP or polyclinic can order the immunity blood tests and give the vaccinations. Singapore has a National Adult Immunisation Schedule, and MediSave can be used for the vaccines on it at participating clinics and polyclinics. Ask about it, since many people pay cash without knowing.

Ask specifically for a pre-pregnancy check instead of a general health screen; it’s a recognised consultation and the doctor will know what to include.

Frequently asked questions

Which vaccinations should I have before pregnancy?

Check immunity to rubella and chickenpox, and get screened for hepatitis B. MMR and chickenpox vaccines are live and can’t be given during pregnancy, so if you aren’t immune the window closes once you conceive.

How long before trying should I be vaccinated?

Avoid becoming pregnant for one month after MMR or the chickenpox vaccine. Since chickenpox needs two doses, allow at least three months before you start trying, and longer if you also need hepatitis B, which is a three-dose course over six months.

I was vaccinated as a child. Do I still need a blood test?

Yes. Immunity can wane, records are frequently lost, and recollection about chickenpox in particular is unreliable. The blood test is straightforward and it’s the only way to know.

What if I’m already pregnant and not immune to rubella?

You can’t be vaccinated during the pregnancy. Avoid contact with anyone who has a rash illness, tell your obstetrician, and get vaccinated after delivery so that future pregnancies are protected.

Which vaccines are given during pregnancy?

Whooping cough, usually in the second or third trimester, so antibodies cross to the baby and protect them before their own vaccinations begin. Newborns are the group most at risk of dying from it. Influenza is also recommended and safe, and COVID-19 vaccination per current guidance. Ask at your booking appointment instead of waiting to be offered.

What else should I do before conceiving?

Start folic acid at least a month beforehand, get thalassaemia screening for both partners, review regular medications with a doctor since some need changing before conception, have a dental check, optimise any chronic condition, and stop smoking.

Can I use MediSave for these vaccinations?

MediSave can be used for vaccines on the National Adult Immunisation Schedule at participating clinics and polyclinics. Many people pay cash without realising, so ask.

The main points

Get blood tests for rubella and chickenpox immunity, and screening for hepatitis B: three months before you start trying, not after.

MMR and chickenpox vaccines can’t be given in pregnancy, and you need to wait a month after either before conceiving. That’s the whole reason for the lead time.

While you’re there: folic acid, thalassaemia screening for both of you, and a medication review.