Vaccination in Pregnancy

1. See Also
   1. Adult Vaccination
   2. Pediatric Vaccination
   3. Immunization Status Unknown
   4. Immunizations in HIV
   5. Antiviral Medications in Pregnancy
2. Class C: Small risk in controlled animal studies
   1. Tdap (Tetanus Diptheria Acellular Pertussis Vaccine)
      1. Give Tdap at 27-36 weeks gestation in each pregnancy
      2. Allows time for maternal Pertussis antibodies to transfer to the newborn (passive Immunity)
      3. (2013) Ann Intern Med 158(3):191-9 [PubMed]
   2. Hepatitis A Vaccine
      1. Give if travel to endemic area or IVDA in pregnancy
   3. Hepatitis B Vaccine
      1. Administer in all pregnant patients if not previously immunized
   4. Influenza Vaccine
      1. Indicated if pregnant in Influenza season
      2. Immunize after first trimester
   5. Meningococcal Vaccine
      1. Standard indications (dormitory, barracks, travel)
   6. Plague Vaccine
   7. Polyvalent pneumococcal Vaccine
      1. Vaccinate high risk women before pregnancy
      2. ACIP recommends avoiding during pregnancy
   8. Polio Vaccine (live and inactivated)
      1. Avoid during pregnancy in most cases
      2. Use IPV in pregnancy if high risk Polio exposure
   9. Rabies Vaccine
   10. TularemiaVaccine
   11. Typhoid Vaccine
3. Class D: Strong evidence of risk to the human fetus
   1. Yellow Fever Vaccine
4. Class X: Very high risk to the human fetus
   1. BCG vaccine (Bacille Calmette-Guerin Vaccine)
   2. MMR Vaccine (MeaslesVaccine, Mumps Vaccine, RubellaVaccine)
      1. Give MMR dose immediately post-delivery if Rubella non-immune
   3. Small PoxVaccine
   4. TC-83 Venezuelan Equine EncephalitisVaccine
   5. Varicella Vaccine (Varivax)
      1. Risk if vaccinated within 4 weeks of conception
      2. Theoretic risk only; not an indication for EAB
5. Resources
   1. CDC Guidelines for vaccinating pregnant women
      1. http://www.cdc.gov/nip/publications/preg_guide.htm
6. References
   1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
   2. Black (2003) Am Fam Physician 67(12):2517-24 [PubMed]
   3. Larimore (2000) Prim Care 27(1):35-53 [PubMed]
   4. Sur (2003) Am Fam Physician 68(2):299-304 [PubMed]