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It can sometimes get complicated, and books, the internet and social media are full of voices with opinions on the topic. Being aware of the options recommended by experts in infectious disease as it relates to pregnancy — and working closely with your healthcare team — can help you navigate the process, keeping yourself and your baby as healthy as possible.
Vaccines before pregnancy
For anyone, it’s important to stay up to date on recommended vaccines. Some vaccines should be avoided in pregnancy. This takes on increased significance if pregnancy has any chance of happening in your future. Steps you can take to meet pre-pregnancy vaccine recommendations include:
- Get up to date. Because unintended pregnancies happen, it’s good to be up to date on all vaccine recommendations. This includes staying current with ongoing seasonal vaccines, such as flu and COVID-19 vaccines. Your healthcare team can help you sort out what you need to do to get current. Other vaccines for which adults are due also include the chickenpox (varicella) vaccine, the human papillomavirus (HPV) vaccine, the hepatitis B vaccine, the measles-mumps-rubella (MMR) vaccine, and the tetanus-diphtheria vaccine.
- Plan ahead. If you’re able to time your pregnancy, visit your healthcare team at least one month before trying to get pregnant to discuss any specific vaccine recommendations. Your healthcare team may recommend getting ahead on certain vaccine needs, as some vaccines will be put on pause while you are pregnant.
- See a healthcare professional promptly if there’s a surprise. If you are not fully up to date on vaccines and become pregnant, your healthcare team can help you get on track in a way that is safe for you and your baby.
- Consider special circumstances. In some cases, doctors may recommend other vaccines such as the pneumococcal vaccine, the hepatitis A vaccine, the poliovirus vaccine, or the meningococcal vaccine. These depend on your current risk and past history. In several of these cases — such as pneumococcal pneumonia — getting a vaccine is meant to protect you and not the baby. According to Dr. Jacobson, “some vaccines do not impact the baby other than keeping the mother well and uninfected.”
Vaccines during pregnancy
Vaccines that are recommended for the mother during pregnancy play two key roles. One is to help the mother stay healthy during pregnancy. In addition, these vaccines help protect the baby from infectious disease in the first few months of life. This is crucial, as the immune system of a newborn is not fully developed, and newborns are unable to receive certain vaccines for several months to a year.
Vaccines help your body create antibodies, which are proteins that help your immune system more swiftly identify — and fight off — infectious diseases. When a mother receives a vaccine during pregnancy, antibodies developed in the mother are then transferred to the fetus. Antibodies develop at different times for each vaccine. For this reason, timing may vary for when vaccination is recommended.
Vaccines that are typically recommended to get while pregnant include:
- Tetanus, diphtheria and acellular pertussis (Tdap). According to the Centers for Disease Control and Prevention (CDC), the Tdap vaccination should be done once during every pregnancy between 27 and 36 weeks. It will protect your baby against pertussis (whooping cough) for the first six months of life. During that time your baby will be getting the three priming vaccine doses of DTaP (the child form of the Tdap) to protect the baby. Pertussis is a life-threatening infection for babies under 1 year old. Babies cannot safely get the DTaP vaccine until 6 weeks of age and again, it will take three doses over four months or more to get effective immunity. The Tdap vaccine is given for the exclusive benefit of the newborn and will not affect or have benefits for the mother.
- COVID-19. Being pregnant creates a higher risk of developing complications from a COVID-19 infection for the mother. The risk of complications is five times as high during pregnancy. Having COVID-19 while pregnant also can create complications for the mother and baby. In addition, the vaccine will help protect your baby from COVID-19 for their first six months of life, after which they can receive the vaccine on their own. This vaccine can be done at any point during pregnancy and should be received as soon as the vaccine is available.
- Influenza. Being pregnant also means a higher risk of developing complications from an influenza infection for the mother. As a bonus, the antibodies that your body creates from the flu vaccine will help protect your baby in the first few months of life. There are no flu vaccines for newborns, so the only protection they can get is from a vaccinated mother. The flu vaccine recommended for pregnant women is the version given by injection, which contains nonlive (inactivated) virus. The nasal spray vaccine, which contains weakened but still live virus (live-attenuated), is not recommended for pregnant women. While most people get the flu vaccine in September or October, the CDC recommends early vaccination in July and August for anyone in the third trimester of pregnancy during those months.
- Respiratory syncytial virus (RSV). Getting the RSV vaccination between weeks 32 and 36 of pregnancy during the two months preceding the RSV season or during the months of the actual RSV season can protect an infant from this infection for the first three months of life. In most of the United States, the season runs from November through March. Thus, pregnant individuals start getting the RSV vaccine in September if the pregnancy they are carrying has reached the qualifying gestational age. If a pregnant woman is not vaccinated at least two weeks before giving birth, it is typically recommended that the infant get immunized postpartum with a special infant nonvaccine immunization for RSV.
Safety of vaccines during pregnancy
What do all of these vaccines have in common? They are inactivated (nonlive) vaccines. This means that the germ fragments used to make the vaccine cannot cause an infection. These contrast with live vaccines. Live vaccines contain a weakened, but still live, form of the bacteria or virus used to generate immunity. While inactivated vaccines may not provide immunity that’s as long-lasting as activated vaccines, they are safer for weaker immune systems and cause less risk to pregnancy in general. For this reason, live vaccines such as the measles-mumps-rubella (MMR) vaccine, the varicella vaccine and the live attenuated flu vaccine (LAIV) are not recommended during pregnancy.
The main risk of getting a live vaccine during pregnancy is that the bacteria or virus may cause an infection in the mother, threatening the pregnancy or the fetus itself. This is why live vaccines are not recommended for pregnant people.
Vaccines for special circumstances during pregnancy
Depending on your situation, your healthcare team may recommend one or more additional vaccines. These may include:
- Hepatitis A. This inactivated vaccine may be recommended for anyone at increased exposure to this bloodborne virus. Increased exposure risk can occur due to travel plans, substance use and several other concerns.
- Hepatitis B. Anyone who is due or in the process of completing a hepatitis B immunization series can continue throughout pregnancy. This inactivated vaccine is safe during all stages of pregnancy and has become routine for babies and children to get as well.
- Meningococcal ACWY and B vaccines. The meningococcal bacteria can cause severe, life-threatening infections by either infecting the lining of the spinal cord and brain or the bloodstream. This inactivated vaccine may be recommended for anyone at higher risk of infection, which includes young adults or anyone with a weakened immune system.
- Pneumococcal. A mother at increased risk of invasive pneumococcal disease will be recommended to get this vaccine. Risks for pneumococcal pneumonia include alcohol use disorder, chronic heart, liver and lung disease, chronic renal failure, cigarette smoking, having a cochlear implant, congenital or acquired asplenia, congenital and acquired immunodeficiencies, cerebral spinal fluid leak, diabetes mellitus, cancer, HIV infection, Hodgkin disease, iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease or other conditions affecting hemoglobin, and having had a solid organ transplant. Pneumococcal vaccines are inactivated and, according to Dr. Jacobson, “they are safe and effective in pregnancies when needed.”
- Vaccines for travel (these can vary). In general, it is not recommended to travel when pregnant to an area where there is a high risk of exposure to infection. For example, exposure to yellow fever — a mosquito-borne infection in tropical regions of South America and Sub-Saharan Africa — will likely result in the mother needing to take a live vaccine to protect herself due to the infection’s high fatality rate. Other examples of infections that could be encountered when traveling to certain locations include rabies, poliovirus, malaria, Zika virus, Ebola and typhoid fever. If travel is unavoidable, appropriate vaccines may be considered. In addition, take any precautions and steps possible to avoid infection during travel such as avoiding mosquitoes, maintaining personal hygiene, and avoiding risk of food or waterborne illness.
In general, make sure to talk to your healthcare team about the benefits and risks within each situation. In some situations, taking a vaccine may not seem ideal, but is highly recommended due to the risks of not doing so.
Vaccines after pregnancy
After giving birth and before leaving the hospital there may be vaccines that are recommended. This is referred to as postpartum vaccination. Vaccines given postpartum are typically live vaccines that the mother was not able to receive while pregnant. They can include MMR and varicella as well as inactivated vaccines not well studied in pregnant individuals such as the HPV vaccine.
Receiving a live vaccine will not harm your baby after birth. This includes people who plan to breastfeed. It is important that parents remain healthy during their baby’s newborn stage due to the baby’s developing immune system. The best way to achieve this is to stay up to date on all recommended vaccines.
Who should be vaccinated around your newborn
Likely, you will have a flood of people wanting to see your newborn. Grandparents, aunts, uncles, siblings, cousins, neighbors and friends. But don’t open the floodgates just yet!
As mentioned earlier, the importance of parents being healthy around their newborn is critical, but that goes for everyone. Anyone spending time with a newborn baby should be up to date on their vaccinations. That doesn’t mean additional vaccines for them. Just the ones they are due for is what they need. That’s because newborns do not have fully developed immune systems. Newborns are at much higher risk for contracting illness, and they are not able to fight illness off as well as adults.
Remember that people can carry infections without showing any symptoms, so don’t let just anyone hold or touch your newborn.
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