SUPERStudy: Vaccinations During Pregnancy

Purpose: Vaccinations during pregnancy aim to protect both the mother and the baby from serious infectious diseases. Maternal vaccination not only prevents complications during pregnancy but also provides passive immunity to the newborn through the placenta and breastmilk.

• Vaccinations are reviewed at the first prenatal visit. Ideally, a patient will be up to date on expected vaccines prior to the initiation of pregnancy. 
• At least 1 month prior to pregnancy, the measles, mumps, rubella (MMR) vaccine should be completed. Initial blood work will include rubella titers to confirm immune status.

Recommended Vaccinations During Pregnancy:

1.Influenza Vaccine (Inactivated): During the flu season, all pregnant patients without a contraindication to the flu vaccine should be immunized with the current influenza vaccine strain regardless of trimester. Pregnant women are at increased risk for severe complications of influenza. 

• Timing: Any trimester
• Purpose: Protects the mother and baby from complications of influenza, such as preterm labor, pneumonia, and severe illness.
• Form: Only the inactivated (injectable) form is safe; live attenuated (nasal spray) is contraindicated.

2.Tdap (Tetanus, Diphtheria, Pertussis):

• Timing: Between 27-36 weeks of gestation (ideal timing).
• Purpose: Protects the baby from pertussis (whooping cough) in the first few months of life, when they are most vulnerable. It also reduces risk of maternal pertussis in the postpartum period. 
• Notes: Recommended in every pregnancy, regardless of prior vaccination status. Fathers-to-be and others who will have close contact with the infant after delivery should be encouraged to be immunized with Tdap as well.

Contraindicated Vaccinations During Pregnancy:

1.Live Vaccines: MMR (Measles, Mumps, Rubella), Varicella (Chickenpox), Rotavirus, Oral polio vaccine, yellow fever, shingles, BCG, Live Influenza (nasal spray).

MMR: Patients not immune to rubella will need to be identified to ensure that they receive this attenuated live virus vaccine postpartum, as this vaccine is contraindicated in pregnancy.

• Risk: Potential for fetal infection, as live vaccines contain weakened pathogens.
• Timing (if needed): Administer at least one month before conception or postpartum.

Vaccines Based on Risk Factors:

1.Hepatitis B:

• For women at high risk (e.g., multiple sexual partners, hepatitis B positive partner).
• Protects the mother and prevents vertical transmission to the baby.

2.Hepatitis A: For women with chronic liver disease or at risk of infection.

3.Meningococcal Vaccine: For women at high risk (e.g., outbreaks or specific medical conditions).

4.Pneumococcal Vaccine: For women with chronic illnesses like diabetes, heart disease, or immunocompromised states.

5.COVID-19 Vaccine:

• Timing: Any trimester.
• Purpose: Protects against severe illness in the mother and provides some immunity to the baby.

General Guidelines:

• Safety: Most inactivated vaccines are considered safe during pregnancy.
• Benefits vs. Risks: Weigh the risks of infection against vaccine side effects when considering vaccinations.
• Breastfeeding: Most vaccines are safe postpartum and during breastfeeding.

Key Learning Points:

• The influenza and Tdap vaccines are universally recommended for pregnant women.
• Avoid live vaccines during pregnancy due to teratogenic risks.
• Vaccines protect both mother and baby, with maternal antibodies providing early passive immunity to the newborn.

SUPERFormula 

References: 

CURRENT Diagnosis & Treatment: Family Medicine, 5e > Prenatal Care

Jeannette E. South-Paul, Samuel C. Matheny, Evelyn L. Lewis