Abstract
CME Educational Objectives
| 1. | Discuss the current recommendations for vaccination during pregnancy in the United States. |
||||
| 2. | Determine the benefits of maternal immunization for the newborn and infant. |
||||
| 3. | Outline future developments for maternal vaccination and potential benefits for the fetus and newborn. |
||||
The immunization of women during pregnancy can protect both the mother and her infant against serious infectious diseases. The prevention of infection through maternal immunization reduces the risk of exposure to the baby, results in higher concentrations of transplacentally transferred pathogen-specific maternal antibodies to the newborn, and provides protection to the infant during a period of vulnerability. The benefits of vaccinating pregnant women outweigh any theoretic risk when there is a risk of exposure to an infectious disease that threatens the mother or the newborn’s health.
Toxoids and inactivated virus or bacterial vaccines are safe and cause no harm to the mother or fetus. Live vaccines, viral or bacterial, are contraindicated during pregnancy as a precaution because of the theoretic risk of infection of the fetus. However, there has been no evidence to date of direct fetal injury after the administration of live viral vaccines to pregnant women. The administration of immune globulin preparations to pregnant women results in no known risks to the fetus.
In the United States, vaccines recommended in pregnancy include the seasonal influenza vaccine, tetanus toxoid, and the pertussis vaccine as a combined tetanus-diphtheria toxoid and acellular pertussis vaccine (Tdap). Pregnant women who travel or who have unavoidable exposures to vaccine-preventable diseases should be immunized. Breast-feeding is not a contraindication to the vaccination of mothers with inactivated and most live vaccines. Women who are not immune to rubella should be immunized after delivery. Similarly, the influenza and Tdap vaccinations may be administered postpartum in women who were not vaccinated during pregnancy.
- 1.Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through 18 Years and Adults Aged 19 Years and Older — United States, 2013. MMWR Surveil Summ. 2013; 62(Suppl. 1):1–19.
10.1016/S0735-1097(02)01886-7 > CrossrefGoogle Scholar - 2.Glezen WP. Maternal immunization for the prevention of infections in late pregnancy and early infancy. Infect Med. 1999; 16(9):585.
10.1016/0190-9622(92)70239-C > CrossrefGoogle Scholar - 3.The American College of Obstetricians and Gynecologists. Immunization for Women. Available at: www.immunizationforwomen.org. Accessed June 26, 2013.
10.1002/9781444311822 > CrossrefGoogle Scholar - 4.Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Immunizations for Pregnant Women. Available at: www.cdc.gov/vaccines/parents/pregnant.html. Accessed June 26, 2013.
10.1111/j.1750-2659.2010.00166.x > CrossrefGoogle Scholar - 5.Wilson E, Goss MA, Marin M, Varicella vaccine exposure during pregnancy: data from 10 years of the pregnancy registry. J Infect Dis. 2008; 197(Suppl 2):S178–S184.
10.1086/522136 > Crossref MedlineGoogle Scholar - 6.Ryan MA, Gumbs GR, Conlin AM, Evaluation of preterm births and birth defects in live born infants of U.S. military women who received smallpox vaccine. Birth Defects Res A Clin Mol Teratol. 2008; 82(7):533–539.
10.1002/bdra.20470 > Crossref MedlineGoogle Scholar - 7.Cetron MS, Marfin AA, Julian KG, Yellow fever vaccine recommendations of the ACIP, 2002. MMWR Recomm Rep. 2002; 51(RR-17):1–10.
10.1016/j.vaccine.2010.05.036 > Crossref MedlineGoogle Scholar - 8.Moro PL, Broder K, Zheteyeva Y, Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, 1990–2009. Am J Obstet Gynecol. 2011; 204(2):146.
10.1016/j.ajog.2010.08.050 > Crossref MedlineGoogle Scholar - 9.Hartert TV, Neuzil KM, Shintani AK, Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season. Am J Obstet Gynecol. 2003; 189(6):1705–1712.
10.1016/S0002-9378(03)00857-3 > Crossref MedlineGoogle Scholar - 10.Jamieson DJ, Rasmussen SA, Uyeki TM, Weinbaum C. Pandemic influenza and pregnancy revisited: lessons learned from the 2009 pandemic influenza A (H1N1). Am J Obstet Gynecol. 2011; 204(6 Suppl 1):S1–3.
10.1016/j.ajog.2011.04.010 > Crossref MedlineGoogle Scholar - 11.Siston AM, Rasmussen SA, Honein MA, Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. JAMA. 2010; 303(15):1517–25.
10.1001/jama.2010.479 > Crossref MedlineGoogle Scholar - 12.Louie JK, Acosta M, Jamieson DJ, Honein MACalifornia Pandemic (H1N1) Working Group. Severe 2009 H1n1 influenza in pregnant and postpartum women in California. N Eng J Med. 2010; 362(1):27–35
10.1056/NEJMoa0910444 > Crossref MedlineGoogle Scholar - 13.American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 468: Influenza vaccination during pregnancy. Obstet Gynecol. 2010; 116(4):1006–1007.
10.1067/mpd.2003.87 > Crossref MedlineGoogle Scholar - 14.WHO Global Advisory Committee on Vaccine Safety. Influenza vaccination of women during pregnancy. Wkly Epidemiol Rec. 2004; 79(3):17.
10.1111/j.1651-2227.2012.02687.x > CrossrefGoogle Scholar - 15.Experts advise WHO on vaccine policies and strategies, Pandemic (H1N1) 2009 briefing note 14. Strategic Advisory Group of Experts (SAGE), Global Alert and Response. 2009. Available at: www.who.int/csr/disease/swineflu/notes/briefing_20091030/en/. Accessed June 26, 2013.
10.1177/000992280003900902 > CrossrefGoogle Scholar - 16.Zaman K, Roy E, Arifeen SE, Effectiveness of maternal influenza immunization in mothers and infants. [Published erratum appears in N Engl J Med. 2009;360(6):648]. N Engl J Med2008; 359(15):1555–1564
10.1056/NEJMoa0708630 > Crossref MedlineGoogle Scholar - 17.Eick AA, Uyeki TM, Klimov A, Maternal influenza vaccination and effect of influenza virus infection in young infants. Arch Pediatr Adolesc Med. 2011; 65(2):104–111.
10.1001/archpediatrics.2010.192 > CrossrefGoogle Scholar - 18.Maternal and Neonatal Tetanus (MNT) elimination. World Health Organization, Immunization surveillance, assessment and monitoring. Available at: www.who.int/immunization_monitoring/diseases/MNTE_initiative/en/. Accessed June 26, 2013.
10.1017/S0266462307070304 > CrossrefGoogle Scholar - 19.World Health Organization. Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec. 2010; 40(85):385–400.
10.1161/CIRCULATIONAHA.109.192576 > CrossrefGoogle Scholar - 20.Provisional Pertussis Surveillance Report for 2012. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Available at: www.cdc.gov/pertussis/surv-reporting.html. Accessed June 26, 2013.
10.1016/j.pcl.2004.03.003 > CrossrefGoogle Scholar - 21.Murphy TV, Slade BA, Broder KR, Prevention of Pertussis, Tetanus, and Diphtheria among Pregnant and Postpartum Women and their Infants: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008; 57(RR-4):1–51.
10.1056/NEJMra1110265 > Crossref MedlineGoogle Scholar - 22.Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged Less than 12 Months — Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011; 60(41):1424–1426. > MedlineGoogle Scholar
- 23.Committee on Obstetric Practice. ACOG Committee Opinion No. 521: Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Obstet Gynecol. 2012; 119(3):690–691. > Crossref MedlineGoogle Scholar
- 24.Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep. 2013; 62(07):131–135.
10.3201/eid1804.110968 > Crossref MedlineGoogle Scholar - 25.Gall SA, Myers J, Pichichero M. Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels. Am J Obstet Gynecol. 2011; 204(4):334.
10.1016/j.ajog.2010.11.024 > Crossref MedlineGoogle Scholar
