Prenatal screening
Women who
are planning to become pregnant should make sure that they are up to date on
their immunizations. This will protect them and the unborn child from many
diseases.
The measles,
mumps, rubella, and chickenpox (varicella) vaccines are particularly important
for women of childbearing age, as these cannot be given when pregnant. If a
woman is infected with any of this in pregnancy, particularly first trimester,
it results in adverse pregnancy outcome.
Patients
should check with their physician, who can request a blood test to see the
blood levels of antibodies against these viruses, because of prior vaccination
or prior history of disease itself.
MMR- If you need to get the vaccine for Rubella, avoid
getting pregnant for at least a month after receiving the MMR.
Varicella- Similarly, if you are not immune to
chickenpox, get vaccinated at least a month before getting pregnant.
HPV Vaccine- The human papillomavirus (HPV)
vaccine is recommended for nonpregnant girls and women 9 to 26 years of age. It
is contraindicated during pregnancy, although evidence suggests it is safe if
pregnant women receive it inadvertently.
Hepatitis B- A woman should get tested for anti-HBs
before she is pregnant to see whether the vaccine was well taken and she is
immune to infection.
Vaccines during pregnancy
The tetanus,
diphtheria, acellular pertussis (Tdap)
vaccine is recommended for every pregnant woman during each pregnancy. It should be given as early as possible between 27
and 36 weeks of gestation, to facilitate the passive transfer of maternal
antibodies. Infants exposed in utero to Tdap vaccine were better protected
against pertussis during the first year of life than infants not exposed in
utero.
Influenza (flu)- Every pregnant woman who is pregnant
around the influenza season should be vaccinated against the seasonal flu as she
is at high risk for developing flu complications. The vaccine has no adverse
effect on fetus, on the contrary the unborn baby is protected against flu for
first 6 months of life, till the baby is eligible to receive the vaccine.
The nasal
spray influenza vaccine is contraindicated as it is made of live virus.
Vaccines for special circumstances
Hepatitis A- Pregnant woman who is at risk for
developing Hepatitis A should receive the vaccine as the virus can be passed on
to fetus.
Hepatitis B- It is only recommended for pregnant
women who are at high risk for developing the infection like unimmunized women
who live with someone infected with hepatitis B and for completing the series
if started before becoming pregnant.
Poliomyelitis- Although polio has been eradicated
from most developed and some developing countries, polio vaccine is usually not
given in pregnancy unless travel to an area where polio is prevalent is
unavoidable. In such circumstances, she may receive the inactivated polio
vaccine (IPV).
Pneumococcus- Ideally the vaccine is given before
pregnancy, but if woman is at high risk
for pneumococcal infection, the vaccine appears to be safe if given in second
and third trimester.
Varicella- Because the effects of the varicella
virus on the fetus are unknown, it is contraindicated in pregnant women.
Vaccines for travel
Yellow fever- May be given if benefit outweigh
risk.
BCG- contraindicated
Typhoid- Inadequate data to make any
recommendations
Rabies – Pregnancy is not considered a
contraindication for post-exposure prophylaxis. If risk of exposure is
substantially high, pre-exposure prophylaxis could be considered.
Passive Immunization during pregnancy
No known
risk exists for the fetus from passive immunization of pregnant women with
immune globulin preparations.
Prenatal screening
Every
Pregnant woman should be tested for immunity to rubella and varicella and be
tested for the presence of HBsAg during every pregnancy. Women who are found
susceptible to rubella and varicella should be vaccinated immediately after
delivery.
If a woman
is found to be HBsAg positive, the infant should receive HBIG and begins the
hepatitis B vaccine series no later than 12 hours after birth.
Breastfeeding and vaccines.
Inactivated and
live-virus vaccines are not contraindicated in pregnant woman, although the
virus can replicate in mother, it is not excreted in human milk.
Small pox
and yellow fever vaccines are contraindicated in lactating mother, although if
travel to an area where Yellow fever is endemic is imminent, it can be given.
