WRITE UPS - MISCELLANEOUS: (OB) - Immunization in Pregnancy

Infections in pregnancy can have far reaching consequences. Prevention is desirable. It is therefore desirable to have a good knowledge of immunization. Pregnant mothers are at an equal risk of contracting any infection as her non-pregnant counterpart, if not more. Also, in pregnancy there are situations where extra protection is desirable. In pregnancy, the immunization demanding situations are

–   Grave risk to mother and fetus due to infection.

–   Exposure of the mother or other family members to the diseases in pregnancy.

–   Epidemic

–   Voluntary prophylaxis.

Infections can have a far-reaching effect on the fetus too. These include teratogenic effects, organ/tissue damage, placental infection, persistent neonatal jaundice, hydrocephalus, microcephaly congenital vascular diseases, congenital deafness and others. The obstetric effects of infections include abortions, preterm delivery, IUGR, birth asphyxia, sick and morbid newborn. It is therefore understandable to prevent any maternal infections from causing devastation. Immunization in pregnancy is one such measure.

Different types of vaccines available include attenuated live vaccines, inactivated vaccines, immunoglobulins, and new technology-based vaccines. The therapeutic vaccines include tetanus, gas gangrene, diphtheria, anti-snake venom, botulism and others. Inactivated Vaccines are generally safe in pregnancy. Vaccines against bacterial infections are usually of these types.

Attenuated live vaccines: They give active immunity. However the small near theoretical risk of transferring infection remains. But the benefits should be weighed against the risk involved. They are thus best avoided in first 12 weeks and last month of pregnancy. Common vaccines used for prophylaxis in pregnancy are tetanus toxoid, Cholera and Typhoid during epidemics.

Two most influential vaccines that have affected positively are 1) Tetanus and 2) Anti- D Vaccine. These two have given a spectacular result in their respective areas of protection.

Tetanus Toxoid: The schedule currently recommended is:

§   In first pregnancy two doses, four to six weeks apart.

§   In next pregnancy is within two years one booster dose is enough.

§  If more than two years have passed before the next pregnancy, two doses are recommended.

Undoubtedly, tetanus toxoid has changed the face of maternal and neonatal tetanus. Amidst, a fear of increased ABO in compatibility due to tetanus toxoid was expressed. However the risk is reduced with more pure preparations. Also, the benefits far outweigh the risks in favour of administration.

Hepatitis B: It is recommended for pregnant woman coming in contract of affected person or endemic areas. Recombinant Hepatitis B surface antigen is to be given in 3 doses of 1 ml IM (20 mg). First and second dose is to be given one-month apart and third six months after. Prophylactic gamma globulin (16.5% 0.04ml/kg) is also recommended for administration for exposure to HAV infections and HBIg for HB vaccine administered for HBV exposure. These are having a significant protective effect.

For subjects who are  “pregnant to be”, Rubella and Hepatitis vaccines are recommended. Rubella: Primary active immunization of pre school children and vaccination of “pregnant to be”. Live attenuated vaccine confers long lasting immunity in about 95% receivers. Rubella vaccine is not recommended for a pregnant lady. However in case of an inadvertent exposure to the vaccine, termination is not recommended.

Anti-rabies vaccine is recommended even in pregnancy as benefits outweigh the risks and so should be given.

Summary of recommendations of immunization during pregnancy:


Live virus vaccine:

Measles: C.I.

Mumps: C.I

Polio: Not routine

Yellow Fever: On travel

Inactive virus vaccine:

Influenza: Voluntary

Rabies: same as non-pregnant.

Hepatitis B At high risk and –ve for BAg

Inactivated Bacterial Vaccines:

Pneumococcal pneumonia: same as non –pregnant    

Typhoid: Travel

Plague: Selective vaccination of exposed persons.

Hyper immunoglobulin:

Hepatitis B: Post exposure prophylaxis along with HB vaccine initially and then vaccine alone at1 and 6 months.

Rabies: Post exposure prophylaxis

Tetanus: Post exposure prophylaxis



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