Vaccinations and Pregnancy

September 2013

Technically Speaking

Monthly Column by Deborah Wexler, MD

Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.

Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.

TECHNICALLY SPEAKING

Vaccinations and Pregnancy

Published September 2013

Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit www.immunize.org/acip/acip_vax.asp.

Twenty-five years ago, vaccines generally were not recommended for pregnant women. My, how things have changed! Although certain vaccines should not be given during pregnancy, two vaccines are specifically recommended during this time, and a few additional vaccines are recommended for pregnant women when indicated because of certain risk conditions.

So how do you keep these variations straight? This column provides an overview of the immunization recommendations for pregnant women and gives links to helpful resources, including a new handout, “Vaccinations for Pregnant Women,” created collaboratively by the American College of Obstetricians and Gynecologists (ACOG) and the Immunization Action Coalition (IAC). This great handout was designed to share with pregnant women to remind them about the vaccines they need.

Vaccines recommended during pregnancy

Two vaccines — inactivated influenza vaccine and Tdap (tetanus-diphtheria-acellular pertussis) — are specifically recommended for pregnant women.

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Influenza vaccine has been recommended for almost a decade for all women who are pregnant or will be pregnant during influenza season. The use of this vaccine is critical because influenza is more likely to cause serious illness and complications in pregnant women than in non-pregnant women. As an important side benefit, influenza vaccine administered to the mother also will help protect the newborn infant from influenza. Only injectable inactivated influenza vaccine (i.e., not live nasal spray vaccine) is recommended for use during pregnancy.

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Tdap vaccine is recommended for pregnant women during each pregnancy, regardless of the woman’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, the optimal timing for Tdap administration is between 27 and 36 weeks’ gestation. However, Tdap may be administered at any time during the pregnancy. Women with no history of Tdap vaccination and to whom the vaccine was not administered during pregnancy should receive Tdap immediately postpartum.

Vaccines that should be administered during pregnancy when indicated

Several inactivated vaccines fall into a middle ground. Although they are not recommended for all pregnant women, they should be given if the woman has a particular risk condition — health, occupational, or other — indicating a need for a particular vaccine. These vaccines include hepatitis A, hepatitis B, meningococcal, and pneumococcal (PCV13 and PPSV23), all of which are safe to administer during pregnancy.

Vaccines that should not be administered during pregnancy

The vaccines that should not be given to pregnant women include

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Live vaccines — MMR (measles-mumps-rubella), MMRV (measles-mumps-rubella-varicella), Var (varicella), and LAIV (nasal spray, live attenuated influenza vaccine) — are contraindicated in pregnancy because of theoretical concerns for the fetus. However, there have been no documented cases of injury to any infant when these vaccines were inadvertently administered during pregnancy.

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Human papillomavirus (HPV) vaccine — this inactivated vaccine is not recommended during pregnancy.

Healthcare professionals should try to ensure all women of childbearing age are up to date with their recommended vaccines before they try to conceive.

General resources about vaccination during pregnancy

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Vaccinations for Pregnant Women (ACOG/IAC patient handout)

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Immunization Resources for Obstetrician-Gynecologists: A Comprehensive Toolkit (ACOG)

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Guidelines for Vaccinating Pregnant Women (CDC web page)

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Summary of Recommendations for Adult Immunization (IAC 4-page summary for healthcare professionals)

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Cocooning Protects Babies—Everyone in a baby’s life needs to get vaccinated against whooping cough and flu! (IAC parent handout)

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