Immunization in Pregnancy

Whenever possible, pregnant women should be immune to the diseases that pose the greatest and most common risks during pregnancy and for which there are effective vaccines. Women of childbearing age in the United States should already be immune to measles, mumps, rubella, tetanus, diphtheria, and poliomyelitis -- if we haven’t had a natural infection then we have usually been immunized. Many adults don’t realize they should get immunized against diseases, however, and so they are not up to date. During your pregnancy your obstetrician can help determine which vaccines are necessary and whether you should get them before or after delivery.

INFLUENZA
Pregnant women stand to benefit as much as adults with high-risk conditions from the protection the ‘flu shot offers, but not enough pregnant women take advantage of it. Influenza, which strikes during the winter months, is serious enough to put a pregnant woman in the hospital. The shot changes each year to provide protection from the changing strains of influenza; it typically becomes available in October or November. If you will be in the 2nd or 3rd trimester during ‘flu season you should get a ‘flu shot (if you have a serious medical condition you need one whatever the stage of pregnancy).

TETANUS, DIPHTHERIA, POLIO
Among the vaccinations that are recommended for routine administration during pregnancy are tetanus and diphtheria toxoids (Td). The booster for this combination is supposed to be given every 10 years. On the other hand, if you are an adult who is not immune to polio, you do not need to be vaccinated because the risk of getting polio in the U.S. is extremely low.

RUBELLA, MEASLES, MUMPS
Measles, mumps, and rubella (MMR) vaccine should be given to women at least 3 months before pregnancy or in the immediate postpartum period. A rubella infection in pregnancy can cause birth defects; a measles infection during pregnancy raises the risk of miscarriage and preterm birth as well as of complications for the mother. The varicella vaccine used to prevent chickenpox is one of our newer agents. It should be given at least one month before pregnancy or postpartum.

HEPATITIS A and B
A hepatitis B infection is always very serious for newborns and for pregnant mothers. For this reason we follow the Centers for Disease Control guidelines and screen our patients early in the course of prenatal care. The hepatitis B vaccine series can be given to pregnant women who are at high risk and who test negative for the virus to protect them and their infants from infection during and after pregnancy. The hepatitis A vaccine is another relatively new product. Since there is no research available about its use in pregnancy the series should be completed well before getting pregnant or it should be given afterward.

PNEUMOCOCCAL VACCINE
Only those people under the age of 65 who have chronic illness or other high risk factors will need to have a pneumococcal vaccine; you will usually already know who you are.

WHEN DISEASE SEEMS UNAVOIDABLE
Immune globulin (IgG) usually will prevent measles infection if given within 6 days after exposure and can be given to pregnant women. However, immune globulin has not been shown to prevent infection to rubella or mumps. IgG or a specific immune globulin can be given following exposure to measles, hepatitis A or B, tetanus, chickenpox, or rabies.

It rarely happens, but sometime a pregnant woman can’t avoid traveling to areas where she may be exposed to very high risk diseases. In this situation, it is a good idea to obtain immune globulin or vaccination against poliomyelitis, yellow fever, typhoid, or hepatitis B .

References:

FOR MORE INFORMATION
American College of Obstetrics and Gynecology
www.acog.org
Centers for Disease Control
www.cdc.gov
Immunization Action Coalition
www.immunize.org