Immunization during pregnancy
Immunization during pregnancy, that is the administration of a vaccine to a pregnant woman, is not a routine event as it is generally preferred to administer vaccines either prior to conception or in the postpartum period. When widespread vaccination is used, the risk for an unvaccinated pregnant patient to be exposed to a related infection is low, allowing for postponement, in general, of routine vaccinations to the postpartum period. Nevertheless, immunization during pregnancy may occur either inadvertently, or be indicated in a special situation, when it appears prudent to reduce the risk of a specific disease for a potentially exposed pregnant woman or her fetus.
As a rule of thumb the vaccination with live virus or bacteria is contraindicated in pregnancy.
Live attenuated bacterial vaccine
BCG vaccine is used against tuberculosis and is contraindicated in pregnancy.
Inactivated bacterial vaccine
Inactivated bacterial vaccine is used during pregnancy for women who have a specific risk of exposure and disease. Vaccination against pneumococcus or meningococcus infections, or typhoid fever show no confirmed side effects regarding the fetus, however data are limited. Data regarding anthrax vaccination during pregnancy are very limited but show no confirmed effect on the fetus.
Toxoids
Tetanus toxoids appear safe during pregnancy and are administered in many countries of the world to prevent neonatal tetanus. The World Health Organization(WHO) states more than 180,000 newborns die and over 30,000 women die each year from tetanus. It is recommended by the American Congress of Obstetrics and Gynecologists(ACOG) the following schedule for pregnant women to receive the vaccine--
- Schedule if never immunized: three doses in 0, 4, and 6-12 months
- Schedule if unknown immunization: at least two doses** in the late second or third trimester. The National Business Group on Health (NBGH) states an analysis of pregnant women who received at least two doses had 98% effectiveness of the tetanus vaccine(NBGH, 2011).
- Not administered in pregnancy: a dose in postpartum period
- One of the doses during pregnancy should be the Tdap** (ACOG, 2012).
References: American College of Obstetricians and Gynecologists (ACOG),Committee Opinion (2012). Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. 521(119), 690–1. Retrieved from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_ Obstetric_Practice/Update_on_Immunization_and_Pregnancy_Tetanus_Diphtheria_and_ Pertussis_Vaccination
National Business Group on Health.(2011). Tetanus(Immunization)for Pregnant Women. Retrieved from http://www.businessgrouphealth.org/preventive/topics/tetanus.cfm#9
Department of Making Pregnancy Safer, World Health Organization.(2007), Standards of Maternal and Neonatal Care. Retrieved from http://whqlibdoc.who.int/hq/2007/a91272.pdf
Immune globulins
Immune globulins are used for post exposure prophylaxis and not associated with reports that harm is done to the fetus. Such agents are considered in pregnant women exposed to hepatitis B, rabies, tetanus, varicella, and hepatitis A.
Up-to-date information about vaccination and pregnancy can be obtained from the CDC.
References
- ACOG Committee Opinion, Number 282, January 2003 (Obstet Gynecol 2003;101:207-12)
- CDC information
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