Vaccination for Maternal-Fetal Protection

January 27, 2015

Vaccination for Maternal-Fetal Protection

  1. Anna Wald, MD, MPH

OB/GYN clinicians are in a unique position to encourage and provide timely immunization of women.

  1. Anna Wald, MD, MPH

Within the past decade, the roles of OB/GYNs and nurse midwives in implementing immunization of women have become more prominent, bolstered by new recommendations to deliver certain vaccines specifically during or after pregnancy.

Vaccines recommended during each pregnancy

  • Influenza vaccine: Inactivated vaccine that prevents influenza (especially severe cases), which disproportionately affects pregnant women. Maternal influenza vaccination may also lower risk for neonatal respiratory infections. The best time to immunize is when the vaccine is first available, regardless of trimester.

  • Tetanus toxoid, diphtheria toxoid, and acellular pertussis (Tdap): Inactivated vaccine that lowers maternal risk for pertussis; also protects newborns (who are too young to be immunized) against pertussis, which can be fatal at this age. Ideally, pregnant women should receive Tdap between 27 and 36 weeks' gestation.

Vaccines recommended immediately postpartum in nonimmune women

  • Measles, mumps, and rubella (MMR) vaccine: Live attenuated vaccine that protects against three childhood viral infections that were previously epidemic in the U.S. Rubella immunity is particularly important for women of childbearing age, as infection during pregnancy is associated with severe congenital abnormalities and miscarriage.

  • Varicella vaccine: Live attenuated vaccine that protects against chickenpox, which can be very severe in pregnancy and may result in congenital malformations.

Because the MMR and varicella vaccines are both live, they are not recommended during pregnancy. However, unintentional administration during pregnancy is not an indication for abortion, as large databases have not shown detrimental fetal effects.

Several other vaccines are recommended for women who may be exposed to certain pathogens (e.g., pneumococcus, meningococcus), or who travel to areas that pose risk for vaccine-preventable diseases (e.g., yellow fever, Japanese encephalitis, typhoid fever).

Comment

Current recommendations for vaccinations during pregnancy or immediately postpartum focus on the new role of OB/GYN clinicians as vaccinators. Does the shoe fit? Despite the logistic challenges of vaccine administration (such as storage and reimbursement), data from the 2012–2013 season suggest that it does: Immunization of pregnant women against influenza exceeded 50% for the first time. Of note, because this year's flu vaccine is a suboptimal match, pregnant women who present with influenza-like syndrome should receive prompt initiation of antiviral therapy prior to laboratory confirmation of infection.

Editor Disclosures at Time of Publication

  • Disclosures for Anna Wald, MD, MPH at time of publication Consultant / Advisory board AiCuris; Eisai Inc. Grant / Research support NIH; NIH / NCI; NIH / NIAID; Agenus Inc.; Genocea Biosciences; Vical; Genentech; Gilead

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