In This Article
- Obtaining a thorough preconception immunization history as part of routine care is an important step to prevent harm during pregnancy
- Obstetrical providers should be knowledgeable on vaccine safety and efficacy during and after pregnancy
- Ilona Goldfarb, MD, PhD, provides counseling tips and evidence-based guidance on vaccines before, during and after pregnancy
Given the rise of vaccine-preventable diseases in the U.S., protecting pregnant women through timely and effective vaccinations in crucial. Obtaining a thorough preconception immunization history as part of routine care is an important step to prevent harm during pregnancy. In Contemporary OB/GYN, Ilona Goldfarb, MD, PhD, maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Massachusetts General Hospital, and former OB/GYN department member Laura E. Riley, MD, provide counseling tips and evidence-based guidance on vaccines before, during and after pregnancy.
Assessing a patient's immunization history before conception and administering any necessary vaccinations can ensure a healthier pregnancy. Live vaccines should not be administered to women who may be pregnant, and it is generally advised for women to wait four weeks after receiving a live vaccine before attempting pregnancy. Influenza infection during pregnancy, for example, can pose a risk of severe maternal illness, pregnancy loss and preterm birth. The trivalent or quadrivalent, inactivated influenza vaccine should be given to all individuals older than 6 months, including women considering pregnancy, as opposed to live versions of the vaccine (e.g., LAIV, Flumist).
Other vaccines will not pose harm if a woman becomes pregnant during the four-week period. The vaccines for Hepatitis B (HBV) and hepatitis A (HAV), for example, are inactivated and can be given either as pre- or post-exposure prophylaxis. These vaccines are recombinant and have not been associated with any adverse fetal outcomes. Also, vaccines for measles, mumps and rubella (MMR), varicella zoster virus (VZV) and human papillomavirus (HPV) show no reports of fetal harm if pregnancy occurs inadvertently during the 4-week period.
Routine vaccine administration during prenatal care is vital to protecting women and their children from vaccine-preventable diseases. Some vaccines, like the Influenza vaccine during flu season and Tdap, should be given to all women during pregnancy. Other vaccines should only be considered during pregnancy if a woman has high-risk comorbidities or is in the process of completing a vaccine series. In order to increase vaccine uptake during pregnancy, it is important for obstetrical providers to be knowledgeable on vaccine safety and efficacy.
Vaccines for rubella, measles or VZV should be administered postpartum if a woman has not received them prior to her pregnancy. These live-attenuated virus vaccines do not pose any issues with lactation. If a postpartum woman has certain risk factors for HPV, HAV, HBV or pneumococcus, the appropriate vaccines should be administered as well.
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