Is it safe to give vaccinations to pregnant women?
Pregnancy is a condition when we have to prevent disease to the mother as well as the intrauterine fetus. Ideally woman should be vaccinated before she becomes pregnant. Pregnancy should not prevent a woman receiving vaccines which are safe during pregnancy. With rising incidence of communicable diseases and travel abroad by a pregnant woman, it is important to give proper advice along with routine vaccination
CDC’s suggestion:The centers for Disease Control suggests that vaccination is an integral part of pregnancy care as pregnant women and her baby are vulnerable populations.
Why pregnant women are at increased risk?
1. Altered immune response
2. Increased risk of severe infections
3. Increased risk of severe infections outcomes(maternal, fetal or both) of some infections
Why fetus& newborn are at increased risk?
1. Immature immune response
2. Increased risk of some infections
3. Increased risk of severe outcomes of some infections
4. Infection sequelae can result in lifelong disability
What are the Maternal and Fetal outcomes of some infections during pregnancy?
Measles:If the pregnant woman is not immune to measles and becomes infected while she is pregnant, there’s a risk of miscarriage,premature birthor stillbirth and a low birthweight baby
Mumps: Increases the risk of embryonic loss, spontaneous fetal loss, preterm birth and fetal death, especially during the first trimester of pregnancy (reported to be as high as 27%). No association has been found between mumps and congenital anomalies
Chicken pox (Varicella): Mother may have fatal Pneumonia. Baby will have congenital anomaly. When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes:
- Defects of muscle and bone
- Malformed and paralyzed limbs
- Small head size
- Intellectual disability
This syndrome is rare with an infection that occurs after 20 weeks of pregnancy.
Rubella(German measles):Miscarriage and defects of heart, eye and brain.
If a pregnant woman contracts rubella, the consequences for her unborn child may be severe, and in some cases, fatal. Up to 80% of infants born to mothers who had rubella during the first 12 weeks of pregnancy develop congenital rubella syndrome. This syndrome can cause one or more problems, including:
- Growth delays
- Congenital heart defects
- Defects in other organs
- Intellectual disabilities
The highest risk to the foetus is during the first trimester, but exposure later in pregnancy also is dangerous.
H1N1:Pregnant women, especially with co-morbidities, are at higher risk of complications from all forms of influenza virus infection, seasonal, zoonotic as well as pandemic. Influenza in pregnancy is associated with an increased risk of adverse pregnancy outcomes such as, spontaneous abortion, Preterm birth and fetal distress. Pregnant women appear to be 4-5 times more likely to develop serious disease than non-pregnant womenin the general population and the risk is highest in 3rd trimester.
This phenomenon was also observed during the recent outbreak, as pregnant women have had ahigher rate of hospital admission, than the general population. Pregnant women are at a higher risk of acute respiratory distress syndrome.
Covid 19: During pregnancy, pregnant women are at higher risk of serious illness caused by COVID-19. Pregnant women are also at higher risk of delivering the baby prematurely if they contract COVID-19.
Vaccinations schedules during pregnancy
1.FOGSI recommends vaccination counseling as a part of pre-pregnancy counseling. History of occurrence of vaccine preventable diseases, previously administered vaccinations, and allergic reactions to vaccinations must be recorded. Rubella, Hepatitis B, and Varicella vaccination should be given preferably during postmenstrual period. Pregnancy should be deferred for 3 months in case of rubella vaccine.
2.Two doses of Tetanus toxoid injection atleast 28 days apart are to be given to all pregnant mothers commencing from 2nd trimester. If the subsequent pregnancy occurs within 5 years of first child birth, only one booster dose to be given
3.Immunization of pregnant women with a single dose of Tdap during the third trimester (preferred during 27 to 36 weeks gestation)-Indian Academy of Pediatrics-IAP recommendation.
4.H1N1 vaccination-Influenza vaccine: Influenza disease may cause hospitalization and medical complication. If vaccinated against influenza virus, then antibody produced will protect the baby too. There is no vaccine available for baby of < 6 months against influenza. No significant effect was found on major birth defects, preterm birth or fetal growth restriction if vaccinated during pregnancy
5.Rabies vaccination: Purified vero cell rabies vaccine(PVRV) during pregnancy is found to be safe and effective without any adverse effect to the mother and baby.
6.Hepatitis B: Hepatitis B vaccination with an ongoing pregnancy is safe and doesn’t warrant termination.
7.Covid 19 vaccination:Pregnant people are more likely to get severely ill with COVID-19 compared with non-pregnant people. Getting a COVID-19 vaccine during pregnancy can protect the pregnant woman from severe illness from COVID-19 and no safety concerns have been identified
With the new variant (Omicron) in circulation, it is strongly recommended that all pregnant women to have their first and second doses of the COVID-19 vaccine if they have not already done so, to protect themselves and their baby.
Vaccines based on live viruses are avoided in pregnancy as they may harm the unborn baby. However, non-live vaccines are safe in pregnancy (for example, flu and whooping cough).
Which Vaccines should be avoided during pregnancy?
1. Mumps containing vaccine
2. Smallpox vaccine
3. Yellow fever vaccine
5.Oral polio vaccine
6.Influenza live vaccine(Nasal)
Postnatal period is a good window period for giving vaccines such as rubella which can safely be administered.
Live vaccine should be avoided during pregnancy. If not immunized earlier and if the mother is having chance of contracting infection, Woman should be offered vaccination to prevent adverse fetal outcome,.