- Immunization during pregnancy
Immunization during pregnancy, that is the administration of a
vaccineto a pregnant woman, is not a routine event as it is generally preferred to administer vaccines either prior to conception or in the postpartumperiod. When widespread vaccination is used, the risk for an unvaccinated pregnant patient to be exposed to a related infection is low, allowing for postponement, in general, of routine vaccinations to the postpartum period. Nevertheless, immunizationduring pregnancymay occur either inadvertently, or be indicated in a special situation, when it appears prudent to reduce the risk of a specific disease for a potentially exposed pregnant woman or her fetus.
rule of thumbthe vaccination with live virus or bacteria is contraindicated in pregnancy.
Live attenuated virus vaccine
In general, the administration of live attenuated virus vaccines are contraindicated during pregnancy, this includes vaccines against
measles, mumps, poliomyelitis, rubella, yellow fever, and varicella. It should be noted, that cases of fetal damage due to the inadvertent administration of these vaccines has not been confirmed. Also, no case of congenital rubella syndromehas been reported when rubella vaccine was given inadvertently during a pregnancy. MMR vaccination can be given during lactationand does not affect the baby.
The CDC recommends that non-pregnant women who receive the
MMR vaccineor varicella vaccination should wait four weeks before getting pregnant.
Inactivated or assembled virus vaccine
In situations where inactivated virus or parts of a virus are administered, in general, there is no contraindication to immunization during pregnancy. Thus influenza vaccination is given to pregnant women at risk, as are vaccinations against
hepatitis Aand B. In the case of rabiesvaccination, information is very limited. HPV vaccinewas introduced in 2006. It is not to be used during pregnancy. It is a pregnancy categoryB agent and no adverse effects upon the fetus have been reported with inadvertent use, however, the experience is limited and accidental administration during pregnancy needs to be reported to the pregnancy registryof the manufacturer or the CDC.
Live attenuated bacterial vaccine
BCG vaccine is used against
tuberculosisand is contraindicated in pregnancy.
Inactivated bacterial vaccine
Inactivated bacterial vaccine is used during pregnancy for women who have a specific risk of exposure and disease. Vaccination against
pneumococcusor meningococcusinfections, or typhoid fevershow no confirmed side effects regarding the fetus, however data are limited. Data regarding anthraxvaccination during pregnancy are very limited but show no confirmed effect on the fetus.
Tetanus toxoids appear safe during pregnancy.
Immune globulins are used for post exposure prophyllaxis and not associated with reports that harm is done to the fetus. Such agents are considered in pregnant women exposed to
hepatitis B, rabies, tetanus, varicella, and hepatitis A.
Up-to-date information about vaccination and pregnancy can be obtained from the CDC. [http://www.cdc.gov/nip]
# ACOG Committee Opinion, Number 282, January 2003 (Obstet Gynecol 2003;101:207-12)
# [http://www.cdc.gov/nip/home-hcp.htm CDC information]
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