When new infectious diseases, such as Ebola or Zika, make it to the news, we all get a bit nervous. Our conversations, at home and in public, focus on wanting a treatment or a cure for this new and worrisome illness. We also talk about wanting a vaccine, and when the new disease is particularly dangerous in pregnancy, there is much emphasis on vaccine research and development. It makes good sense to us to prevent an infection rather than risk the harm when there is a new disease that scares us.
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But when infectious diseases are more familiar to us, we sometimes lose perspective about just how much illness we can prevent with vaccination. In pregnancy this is doubly important; vaccination in pregnancy is protecting both the mother and the unborn child, and immunity created in the pregnant woman also protects the infant in the first few months of life.
The antibodies that are created when a pregnant woman is vaccinated can be shared with her infant in two ways. First, the antibodies can cross the placenta, and the infant can get antibody protection from within the womb. Second, if the mother chooses to breastfeed, antibodies can be shared in that way as well.
What are the recommended vaccines for pregnant women? The most timely is the seasonal influenza vaccine. National agencies and groups, such as the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists, recommend that all pregnant women receive the inactivated influenza vaccine. If someone is already pregnant at the start of the flu season, they should take the vaccine as soon as it is available. If the pregnancy starts in the middle of the flu season, then once the woman establishes her prenatal care, she should be vaccinated at that first visit.
Why is there such a push to ensure that all pregnant women are vaccinated against influenza? Women who are infected with flu are at higher risk for pregnancy complications, like needing to be in the hospital, respiratory complications and premature birth. Getting vaccinated can lower the risk of these complications.
The flu vaccine is not perfect. Each year a slightly different version of the flu virus is spread from person to person, and so the vaccine is not always a perfect match. Being vaccinated therefore does not mean that the routine ways of preventing the spread of infection can be ignored. Good influenza virus prevention can include avoiding people who are sick, washing hands frequently, and making sure that all people who will come in contact with you and your new baby have also been vaccinated against influenza. If a pregnant woman does get infected with influenza, she should contact her obstetrics provider immediately, as timely diagnosis and management are incredibly important.
The other vaccination that is routinely recommended in pregnancy is called Tdap. It protects against three different types of infectious diseases: tetanus, pertussis and diptheria. The major emphasis in this vaccine is protecting the infant from pertussis, a respiratory infection that can make breathing difficult or cause violent coughing. Our immunity to pertussis fades over time, which is why the recommendation is to have every pregnant woman get vaccinated in the third trimester (weeks 27 through 36) of every pregnancy. We can’t rely on any blood test to know if a pregnant woman is immune to pertussis. If you are pregnant three times, you should be vaccinated with each pregnancy.
Pertussis can be dangerous for anyone, but for infants, breathing issues can be so severe that the baby can die. As with prevention of flu, if the pregnant woman is vaccinated in the third trimester of pregnancy, immunity is passed to the pregnancy while in the womb, and protects the baby after delivery. Breastfeeding can also help protect the infant. For extra protection, it is important to make sure that anyone who will be in contact with your new baby is up to date on their own vaccinations.
What is the role of the care team in vaccination during pregnancy? Your doctor or midwife should be routinely recommending these vaccines to you in every pregnancy. They may have the vaccine in their office, or send you to a pharmacy to receive the vaccine. If your care team is not talking to you about these vaccines, then speak up and make sure they are doing their best to protect your growing family.
New infectious diseases will continue to appear and threaten our health and the health of babies. As we work to find vaccines and cures for the newest infections, it is important to reap the benefits of disease prevention for illnesses that already can be prevented via vaccination.
Christine L. Curry, M.D., Ph.D., is assistant professor of obstetrics and gynecology at the University of Miami Health System.