Vaccination During Pregnancy - An Overview

Introduction:

Vaccinations help in keeping the mother and the fetus safe. The various immunological changes during pregnancy result in susceptibility to certain infections and diseases that result in complications during pregnancy and childbirth. Administering vaccination to pregnant women protects the mother against certain infectious diseases that can be preventable with vaccinations and protects the fetus. Vaccine-preventable conditions cause morbidity and mortality in mothers, neonates, and young infants.

Is Vaccination Safe During Pregnancy?

All the vaccines recommended for use during pregnancy are tested for safety, purity, and potency and approved by Food and Drug Administration (FDA) and by the Centers for Disease Control and Prevention (also called CDC):

• The benefits of vaccinating women during pregnancy outweigh the potential risks when the possibility of exposure to infectious diseases resulting in severe complications is high, which would likely harm the mother and the growing fetus.

• The pregnant woman will be at greater risk of maternal morbidity, mortality, and fetal morbidity if the recommended vaccine is not taken during pregnancy.

• Some inactivated vaccines are considered safe to be administered during pregnancy.

• Live vaccines are not recommended during pregnancy as they might risk the developing fetus.

Why Are Vaccinations During Pregnancy So Important?

• Vaccination during pregnancy provides direct protection to the fetus and neonate via the transfer of antibodies from the mother to the fetus. Thus, it improves the health outcomes of both mother and child.

• Vaccines strengthen the immune systems of the body.

• Vaccination protects mothers from serious diseases that could affect future pregnancies as well.

• Certain vaccines are safe and recommended for pregnant women before, during, and after pregnancy to help keep them and their babies healthy.

• The risk of not taking the recommended vaccinations during pregnancy may also result in congenital anomalies, miscarriages, spontaneous abortion, preterm birth labor, and low birth weight of the baby.

What Vaccines Are Unsafe During Pregnancy?

Live attenuated virus is unsafe during pregnancy as the virus crosses the placenta and results in viral infection in the fetus.

Examples of live attenuated vaccines that contain live viruses and are not recommended during pregnancy are:

• Chickenpox (varicella) vaccine.

• Measles, mumps, and rubella (MMR) vaccine.

• Varicella vaccine.

• Meningococcal vaccine.

• Human Papillomavirus (HPV) vaccine.

• Pneumococcal polysaccharide vaccine.

• Oral polio vaccine (OPV).

• Inactivated Polio Vaccine (IPV).

• Typhoid vaccine.

• Cholera vaccine.

• Plague vaccine.

• Japanese encephalitis vaccine.

What Are the Most Common Vaccines Given During Pregnancy?

The most common vaccines administered during pregnancy are:

• Influenza Vaccine: The influenza vaccine is recommended for pregnant women during the flu season. The influenza vaccine is a type of inactivated vaccine, and thus, it is safe and efficacious for both mother and the growing fetus. Avoiding the influenza nasal spray vaccine - made from a live virus is recommended. Influenza infection during pregnancy has potential risk factors for unborn babies, including premature labor and delivery. The changes in the immune system in pregnant women make them more prone to serious influenza infections and hospitalizations. Thus, the influenza vaccine is given during pregnancy to prevent morbidity and mortality. It is essential to know that a live attenuated influenza nasal spray vaccine is not recommended in pregnancy. Ideally, it is recommended to get vaccinated by the end of October.

• Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine: Receiving the Tdap vaccine during pregnancy helps protect the newborn from whooping cough or pertussis. Ideally, the Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine should be given between 27 and 36 weeks of pregnancy. The Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine help protect the baby from pertussis in the first few months of life until the baby is administered this vaccine.

• Hepatitis A Vaccine: Hepatitis A is transmitted through the fecal-oral route by ingesting contaminated food or water. Hepatitis A infection is fatal, resulting in death.

• Meningitis vaccine.

• Pneumonia vaccine.

• Hepatitis B vaccine.

• Hepatitis A vaccine.

• COVID-19 Vaccine: According to the Centers for Disease Control and Prevention (also called CDC), the American College of Obstetricians and Gynecologists (ACOG), the Advisory Committee on Immunization Practices (ACIP), and the Society for Maternal-Fetal Medicine (SMFM) COVID-19 vaccine can be given during pregnancy and in breastfeeding mothers.

If a pregnant woman is traveling outside the United States of America, then the health care provider may recommend taking the following vaccines for safety reasons:

• Vaccine for Anthrax: A rare disease caused by gram-positive and rod-shaped bacteria. It is naturally found in soil and affects domestic and wild animals. People can get very sick when they come in contact with animals infected with anthrax or contaminated animal products. It is not contagious.

• Japanese Encephalitis Vaccine: Japanese encephalitis virus is caused by a bite from an infected mosquito, resulting in fatal brain swelling. Pregnant women at risk of acquiring Japanese encephalitis should receive the Japanese encephalitis vaccine during the 1st and 2nd trimesters.

• Polio Vaccine: Polio is a disease caused by a virus that infects the central nervous system, including the brain and spinal cord, and results in lifelong disabilities. Oral polio or inactivated polio vaccine can be given to pregnant women if there is an increased risk of polio infection.

What Are the Side Effects of Vaccination in Pregnancy?

The side effects of the vaccines considered safe during pregnancy can result in the following:

• Soreness at the injection site.

• Redness at the injection site.

• Discomfort at the injection site.

• Fever.

• Pain and stiffness of joints for one to two weeks.

• Rash.

• Swelling at the injection site.

• Headache.

• Fatigue.

• Severe allergic reactions in rare cases.

What Are the Limitations of Administering Vaccines During Pregnancy?

• Lack of awareness regarding the benefits and advantages of vaccines.

• Lack of concerns about vaccine safety.

• In developing countries like India, vaccines should be given by the government at the community level for cost-effectiveness.

Conclusion:

Vaccinations during pregnancy demonstrate disease prevention in women and their newborns. It is a simple and effective way to have a safe pregnancy and healthy childbirth. Vaccinations during pregnancy improve pregnancy outcomes as maternal vaccination provides health benefits to the mother and the growing fetus.