Vaccination in Pregnancy

Summary

Vaccination during pregnancy is a critical component of prenatal care, aimed at protecting both the mother and fetus from preventable infectious diseases. Ideally, vaccinations should be administered according to the recommended adult immunization schedule before conception.

Preconception Immunization

• Optimal Timing: The best practice is to ensure that patients are vaccinated against preventable diseases prevalent in their environment before conception. This approach helps in avoiding the use of certain vaccines during pregnancy that are contraindicated due to potential risks to the fetus.
• Critical Vaccines: It's essential to confirm immunity against measles, mumps, rubella (MMR), and varicella in susceptible individuals of childbearing age. These vaccines are live and contraindicated during pregnancy and for a defined period before conception due to theoretical risks to the fetus. Infections from these diseases in nonimmune pregnant patients can lead to adverse pregnancy outcomes.

Vaccination During Pregnancy

• Screening for Pregnancy: Before administering any vaccine, healthcare providers should inquire if the patient is pregnant or could become pregnant in the next four weeks.
• Routine Pregnancy Testing: It is not necessary to conduct routine pregnancy testing before vaccine administration, provided pregnancy can be reasonably excluded based on the patient's history.
• Live Vaccines: Live vaccines are generally avoided during pregnancy. Patients are advised to avoid pregnancy for 28 days following the administration of a live vaccine. However, if pregnancy occurs within one month of immunization with live vaccines such as MMR, varicella, yellow fever vaccine, or oral polio vaccine, there has been no reported teratogenesis. Thus, termination of pregnancy solely due to exposure to these vaccines is not recommended.

Minimizing Risks of Infection Exposure

• Pregnant patients should take measures to minimize their risk of exposure to infections. This includes avoiding travel to areas with a high prevalence of certain diseases (e.g., yellow fever), ensuring household members are up-to-date with standard immunization schedules, and maintaining good hygiene practices.

Immunizations that may be administered before, during, and after pregnancy

COVID-19 – All individuals who are pregnant or might be pregnant should receive a coronavirus disease 2019 (COVID-19) vaccine. Vaccination reduces the risk of developing COVID-19 and reduces the severity of disease if a breakthrough infection occurs.

Avoid contraindicated immunizations.

• Live attenuated vaccines are contraindicated as they carry a theoretical risk of fetal infection (e.g., congenital rubella syndrome ; , congenital varicella syndrome).
• Vaccines lacking safety data in pregnant individuals: HPV vaccine, RZV, certain HepB vaccines (i.e., Heplisav-B and PreHevbrio)
  

  Note
  MMR vaccine, varicella vaccine, HPV vaccine, and live attenuated influenza vaccine are not recommended during pregnancy.	ملاحظة