Vaccinations in Pregnancy

Midwife and client with baby discuss vaccination

Vaccination recommendations and guidelines are constantly changing. Pregnant people are at greater risk than non-pregnant people for more severe illness from exposure to some vaccine-preventable diseases. Accordingly, midwives need to be aware of current guidelines for vaccinations that can be offered to pregnant people. 

This table provides information on the most current Canadian vaccination guideline recommendations as of October 2018 based on guidelines from the SOGC, PHAC, and NACI. Download the AOM’s RM Rx App for more information on the proper dosing, warnings and precautions, for each of these vaccines.

 

Common Exposed Illnesses and their Recommended Course of Action
Illness Recommended Course of Action
Influenza The influenza vaccine should be offered to all pregnant people at any stage of pregnancy to protect against influenza-related morbidity and mortality. (1, 2)
Tdap (Tetanus, Diphtheria, Pertussis)

Tdap vaccination should be offered to all pregnant people in every pregnancy, regardless of previous Tdap vaccination history, as a means of protecting the infant from pertussis. (2, 3)

The National Advisory Council on Immunizations recommends vaccination between 27 and 32 weeks (3); the SOGC recommends Tdap between 21 and 32 weeks. (2)

Tdap vaccination in pregnancy is generally not covered by OHIP and is outside midwifery's scope of practice, necessitating a referral to a physician. The cost is covered by OHIP only when a client has not received a Tdap vaccine as an adult

Rubella

Immunity to rubella can be assumed if there is documentation of an individual having received one fose of a rubella vaccine (e.g. MMR) after 12 months of age, laboratory-confirmed disease, or laboratory evidence of immunity. (2) No additional rubella vaccine is required postpartum for clients who meet the above criteria, even when there is no rubella IgG detectable by conventional assays.

If vaccination after 12 months cannot be confirmed by documentation and there is no serologic evidence of immunity or laboratory-confirmed disease, a booster of the rubella vaccine in the postpartum period is considered best practice. The SOGC advises delaying rubella vaccination if the client received Rh-immune globulin or other blood products. (2)

Hepatitis B

The SOGC (2018) recommends that pregnant people at high risk for acquiring hepatitis B infection during pregnancy be offered recombinant hepatitis B vaccine series, which is not contraindicated in pregnancy. Pregnant people at high risk are:

  • those with more than one sex partner within the last six months
  • those being evaluated or treated for an STI
  • those with recent or current injection drug use
  • those having exposure to a partner with a known hepatitis B infection
  • health care workers
  • household contacts of hepatitis B-infected individuals
  • those who are susceptible to hepatitis B infection (hepatitis B surface antigen and antibody negative)
Hepatitis A Vaccinating pregnant people for hepatitis A to protect against liver failure is indicated when the person is travelling to an endemic area for post-exposure or when there has been close contact to a person with a known hepatitis A diagnosis.
Travel Recommendations around vaccinating pregnant travelers are dependent on a number of factors, including the destination, duration of travel, risk of contracting the disease, and the severity of the effect of the disease and/or the vaccine on the pregnant person and/or fetus. For information on travel vaccinations, refer to Public Health Agency of Canada's Statement on Pregnancy and Travel.

 

References

1. Government of Canada (2016). Canadian Immunization Guide Chapter on Influenza and Statement on the Seasonal Influenza Vaccine for 2016-2017. Retrieved September 12 2018.

2. The Society of Obstetricians and Gynaecologists of Canada (2018). Immunization Clinical Practice Guideline: No. 357 - Immunization in Pregnancy. Retrieved July 2018.

3. Government of Canada (2018). Update on immunization in pregnancy with Tdap vaccine. Retrieved March 2018.