Immunizations are a widely available and safe method of preventing many diseases. Although immunization against vaccine-preventable disease is recommended by public health agencies as a vital aspect of primary care and preventative health maintenance, vaccination rates in the United States fall behind the goal (American College of Obstetricians and Gynecologists [ACOG], 2016). Reasons are varied, but there continues to be a concern about the safety of vaccines among some individuals. Many studies have shown a strong and direct recommendation from a healthcare provider can have a major influence of acceptance of immunizations (ACOG, 2016). It is important that obstetric care providers routinely assess the vaccination status of their pregnant patients, have a focused conversation to encourage any indicated immunizations, and the ability to administer them whenever possible (ACOG, 2016, 2018). If a woman declines, best practice includes a conversation to explore her hesitation or unwillingness, documentation of her declination and the conversation, and a reassessment at future visits (ACOG, 2016).

The Tdap vaccination against tetanus, diphtheria, and pertussis can protect the fetus into the neonatal period by providing passive transfer of protective antibodies across the placenta when administered during 27 to 36 weeks gestation. Therefore, Tdap is recommended in every pregnancy to boost maternal immune response and maximize placental antibody transfer as early as possible to maximize effect (ACOG, 2018). If a patient declines Tdap in pregnancy, she should be offered and given a dose if accepted during postpartum if she has never been given the vaccine or is due for a booster (ACOG, 2018). Outside of pregnancy, Tdap is recommended at 11 to 12 years of age, with a booster every 10 years after (Kim, Riley, & Hunter, 2018).

Influenza vaccination in its inactivated form is also recommended in pregnancy. Pregnant women who contract influenza can have severe morbidity or mortality depending on the strain. The vaccine can be safely administered in any trimester and should be given as soon as available each influenza season (ACOG, 2018). For women who decline during pregnancy, the influenza vaccine can also be safely given in the immediate postpartum period.

Several vaccines may be offered to women of a high-risk group based on age, risk factors, underlying disease comorbidities, and/or prior immunization history. Immunizations safe to be administered in pregnancy, but may not be necessary for all women, include pneumococcal vaccines, meningococcal vaccines, hepatitis A, and hepatitis B (ACOG, 2018). Disease comorbidities that may indicate need for additional immunizations and warrant further investigation include, but are not limited to, HIV, pregestational diabetes, sickle cell disease, heart or lung disease, substance use disorder especially with intravenous drug use, or chronic liver disease (ACOG, 2018).

The human papillomavirus (HPV) vaccination is not indicated in pregnancy but should be offered after giving birth, even if still breastfeeding, to those women less than 27 years old who have not been previously vaccinated (ACOG, 2018). However, inadvertent vaccination against HPV during pregnancy has not been associated with adverse fetal or maternal events (ACOG, 2018). The measles, mumps, rubella or varicella vaccine is contraindicated in pregnancy but safe in the postpartum period even if breastfeeding (ACOG, 2018).

Vaccination is a safe and cost-effective method of preventing many avoidable complications and public health concerns both in pregnancy and throughout the lifespan and can even have fetal and neonatal benefits. Ensuring vaccinations are appropriate and up-to-date requires healthcare providers to inform patients and enable access. Preconception counseling visits may be an opportunity to assess that vaccinations are current and if not, safely administer (or refer her to primary care for administration) before she is pregnant for those vaccines that are contraindicated in pregnancy. Additional information on vaccines and implementing vaccination into your setting is available at the following ACOG Web sites: http://www.acog.org/More-Info/MaternalImmunization or http://www.immunizationforwomen.org.

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