Vaccinations in pregnancy

Levy M, Koren G. Hepatitis B vaccine in pregnancy maternal and fetal safety. Am J Perinatol 1991 8(3) 227-32. 

Continued surveillance in the USA (data collected through the Vaccine in Pregnancy Registry) has not shown evidence that RA 27/3 rubella vaccine, administered during pregnancy, can cause the congenital rubella syndrome (136). 

Levine MM. Live-virus vaccines in pregnancy. Risks and recommendations. Lancet 1974 2(7871) 34-8. 

Previous studies assessing the safety of seasonal influenza vaccines in pregnancy did not find any safety concerns among... 

Moro PL, Tepper NK, Grohskopf LA, VeUozzi C, Broder K. Safety of seasonal influenza and influenza A (HlNl) 2009 monovalent vaccines in pregnancy. Expert Rev Vaccines 2012 11(8) 911-21. 

Zheteyeva Y, Moro PL, Yue X, Broder K. Safety of meningococcal polysaccharide-protein conjugate vaccine in pregnancy a review of the vaccine adverse event reporting system. Am J Obstet Gynecol 2013 208(6) 478.el-6. 

Although the vaccine has not been associated with congenital rubella syndrome, its use in pregnancy is contraindicated. Women should be counseled not to become pregnant for 4 weeks after vaccination. 

An analysis of the OPV mass campaign in Finland suggested that OPV during early pregnancy had no harmful effects on fetal development (45). There were no significant deviations from the baseline prevalence for all malformations. However, when the vaccine is administered later in pregnancy the prospects may be different. 

Live virus vaccines, such as Varicella, are contraindicated in pregnancy. 

A problem with the vaccine is that administration of a live virus is contraindicated in pregnancy. Indications arc... 

Currently, no data are available regarding the association between anthrax vaccine and chronic disease, snch as infertility or cancer. In addition, no data are available regarding the safety of anthrax vaccine for children under 18 or people over 65 years, nor are there stndies regarding the safety of anthrax vaccine during pregnancy. A recent stndy of the association between anthrax vaccine and congenital anomalies was inconclnsive dne to the limitations in computerized records used in the study (16). 

Less than 50 cases of fetal vaccinia have occurred, usually following primary vaccination of the mother in early pregnancy. Fetal vaccinia generally causes a stillbirth or neonatal death. The vaccine is not associated with congenital anomalies. No cases occurred among the 39,213 civilians receiving vaccination in 2003 (15). 

While the safety of PPV 23 during the first trimester of pregnancy has not been evaluated, no adverse effects have been seen in newborns whose mothers received the vaccine during pregnancy. ... 

A possible solution might be to follow the example of the National Vaccine Injury Act of October 1988, where a trust fund was set up derived from an excise tax imposed on each vaccine. The funds, through an arbitration panel, are used to compensate persons injured by vaccination. It should be noted that a Drugs in Pregnancy Registry has been set up to follow up early embryonic exposure to the anticonvulsants and antiviral drugs... 

D. Use In pregnancy. FDA category C (indetenninate). Tetanus toxoid may be used during pregnancy. Pregnant patients not previously vaccinated should receive the three-dose primary series (see p 405). 

In a study of neurodevelopment in infants at 6 months who had been exposed in utero to thimerosal in tetanus-diphtheria vaccines during pregnancy there were no differences from infants who had not been exposed [4Pf. Although there was a significant correlation between the concentration of mercury in the hair of the mothers and the hair of the neonates, there was no correlation between the degree of in utero exposure to ethylmercury and mercury concentrations in neonatal hair. 

The effects of HPV vaccine on pregnancy outcomes (live births, abortions, fetal deaths, and congenital anomalies) have been analysed using postmarketing data from the USA, France, and Canada [28 ]. Among the 517 prospective reports with known outcomes, 451 (87%) were live births, including three sets of twins. Of 454 neonates, 439 (96.7%) were normal. The overall rate of spontaneous abortions was 6.9 per 100 outcomes. The prevalence of major birth defects was 2.2 per 100 live-born neonates. There were seven fetal deaths (1.5 per 100 outcomes). Rates of spontaneous abortions and major birth defects were not greater than in the unexposed population. 

Although live attenuated influenza vaccines (seasonal or live HlNl vaccines) were not indicated during pregnancy, it is reassuring to know that inadvertent exposure to this vaccine in pregnant women did not result in unexpected reactions. 

Due to a lack of safety data, MCV4 is not recommended in pregnancy. A review of VAERS reports in pregnant women who received MenACWY-D inadvertently between January 2005 and December 2011 did not identify any concerning patterns in maternal, foetal or infant outcomes. The authors comment that their review, while limited, supports the current ACIP recommendations that pregnancy should not preclude MenACWY-D vaccination in women at increased risk for meningococcal disease (e.g. in a disease outbreak) [91 J. 

Oppermaim M, Fritzsche J, Weber-Schoendorfer C, Keller-Stanislawski B, Allignol A, Meister R, et al. A(HlNl)v2009 a controlled observational prospective cohort study on vaccine safety in pregnancy. Vaccine 2012 30(30) 4445-52. 

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