ACOG releases new all-in-one resource on vaccinations in pregnancy

ACOG recently released the new all-in-one resource to help obstetrics care provider ensure that all pregnant women receive the vaccines they need—not only protect themselves but also their unborn child again preventable diseases.

ACOG recommends that all obstetrician should routinely assess the immunization status of their pregnant patients and address their concerns about vaccine safety during prenatal visits.

"Studies consistently demonstrate that when the recommendation and availability of vaccination during pregnancy comes directly from a woman's obstetrician or other obstetric care providers, the odds of vaccine acceptance and receipt are 5-fold to 50-fold higher," write the authors of ACOG committee opinion on vaccination.

During the first prenatal visit, the provider should assess the woman’s immunity status against rubella and varicella. If the woman is not immunized against measles-mumps-rubella (MMR) or varicella, she needs to get these vaccines in the postpartum period, because both the MMR and varicella vaccines are live attenuated vaccines and are contraindicated in pregnancy.

Women who are pregnant during influenza season should receive the flu vaccine during each pregnancy. Other vaccines that are to be given during each pregnancy are tetanus toxoid, reduced diphtheria toxoid and acellular pertussis given as early as possible in the 27 to 36 weeks of gestation window.

All live attenuated vaccines are contraindicated in pregnancy while inactivated virus, bacterial vaccines, or toxoids are entirely safe in pregnancy as indicated by a growing body of research data.

Vaccines that are given in every pregnancy

Inactivated Influenza

Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap)

Maybe given in pregnancy in particular population

Pneumococcal vaccine

Hepatitis A

Meningococcal disease

Hepatitis B

Contraindicated in pregnancy

Measles-mumps-rubella (MMR)

Varicella

Initiated during the postpartum period or when breastfeeding or both

HPV vaccination series

Inactivated Influenza

Tetanus toxoid reduced diphtheria toxoid and acellular pertussis (Tdap)

Pneumococcal vaccine

Hepatitis A

Meningococcal disease

Hepatitis B

Measles-mumps-rubella (MMR)

Varicella

Vaccines in development

Some vaccines that can significantly reduce infectious disease in neonates are in the process of development and are likely to become part of the maternal/newborn arsenal shortly. It includes:

Streptococcus agalactiae, or group B Streptococcus (GBS)

Respiratory syncytial virus (RSV)

ACOG committee opinion

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ACOG committee update on Immunization in Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) has released updated guidelines for Tetanus, Diphtheria, and Pertussis Vaccination (Tdap) in pregnancy.

The Committee Opinion No. 718 was published in September issue of Journal of Obstetrics and Gynecology.

This update is especially important to reduce pertussis infection in newborn through passive immunization. Infants 3 months and younger face high risk of pertussis infection and the earliest possible shot they can receive is at 6 weeks of age, thereby leaving a window when they are vulnerable for infection from close family itself.

Increasing research and study data available since 2013, have shown that if mother receives Tdap during the late second or early third trimester (with at least 2 weeks from the time of vaccination to delivery), it is   highly effective in protecting the infant against neonatal pertussis.

The recommendations state that:

1) All pregnant women should be vaccinated with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap)during each pregnancy between 27–36-weeks-of-gestation period if possible.

2) All pregnant women should be reassured about safety of vaccine during each pregnancy, so that the newborn can be protected against pertussis till he starts with his own vaccination series.

3) All obstetric health care provider should carry the vaccine and administer it to the women during prenatal visits.

4) All family members, caregivers should also be offered the vaccination if not already received. The ideal time for them to receive the vaccine is 2 weeks before the expected arrival of the baby.

5) If not received during pregnancy the women should be vaccinated postpartum, if she has not received Tdap as adolescent, adult or during the previous pregnancy.

6) In certain circumstances, the women can be given the vaccine outside the 27–36 weeks of gestation window like pertussis outbreak in the community or managing a wound.

7) If she receives the vaccine outside the 27–36 weeks of gestation window, she need not be again given a second dose during 27–36 weeks.

Full Text of Committee Opinion.