I received this wonderful question from a mom the other day, so I wanted to share it with you!

I am currently 33 weeks pregnant with my third child. My other kids are 4 and almost 3. My 4 year old goes to preschool 3 times a week in the mornings. My OB/GYN office highly recommends I get the whooping cough vaccine now. I do vaccinate my children. I do not get the flu shot. I am not against vaccines. I was never asked to get it with my other 2 pregnancies, so I was caught off guard. My non-scientific brain can’t seem to make sense why I would give an under developed fetus a live vaccine when a doctors office wouldn’t give a child the vaccine until at least 6 months.  I was told by another friend that she got the vaccine for herself in the hospital after her child was born. I’m definitely comfortable with that.  My concern is why I should do it now? Do you have any advice? Thanks so much.

Let’s talk about TDaP during pregnancy! Vaccines can be confusing, so let’s start by clearing up some misconceptions:

  • TDaP contains protection against tetanus, diphtheria, and pertussis (aka whooping cough). Right now, the protection against pertussis is especially important due to the increased number of cases across the nation. In 2012, almost 50,000 cases of pertussis were reported to the CDC.
  • TDaP is NOT a live vaccine. It is an inactivated vaccine. Live vaccines are contraindicated (not recommended) during pregnancy. For example, MMR is not recommended during pregnancy because it is a live attenuated vaccine, but TDaP and influenza vaccines are recommended because they are inactivated vaccines and they provide important protection for your baby.
  • Pertussis outbreaks are most common during the fall and winter months, but it is important to remember that pertussis can spread from community to community at anytime of the year. It doesn’t matter what time your baby is due, he or she is still at risk.
  • We give infants their own protection against pertussis at 2, 4, and 6 months through the DTaP vaccine. The recommendations for pregnant women have changed to protect infants younger than 2 months.
  • In 2011, the recommendation was to vaccinate a mother for TDaP only if she had not previously received the vaccine. That is probably why you hadn’t heard about it during your previous pregnancies. Because of the increase of pertussis in the past 5 years, the recommendations for TDaP during pregnancy changed slightly in 2012. The Advisory Committee on Immunization Practices (ACIP) now recommends that mothers receive a TDaP vaccine during every pregnancy in between 27-36 weeks gestation. This recommendation is supported by the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives. Most OB/GYNs and midwives strongly advocate for this vaccine. From my perspective working in pediatrics, I do as well. Here’s why:
    • The risk of catching pertussis is highest for infants before the age of 2 months. Newborns have very delicate immune systems that are highly susceptible to infection after birth. 2 months is the first time an infant can receive their own dose of DTaP to start building their own antibodies.
    • Pertussis is very contagious. An estimated 90% of unvaccinated children living with someone who has pertussis will get the disease. Again, babies are not vaccinated until 2 months, so the first 2 months of life is a critical time of susceptibility.
    • About 30-40% of babies who get pertussis get it from their mother. It’s important to protect yourself and your child from pertussis. This statistic reinforces the critical role mothers play in embracing immunity for their child before they even get here!
    • 90% of pertussis-associated deaths are among babies less than a year old. Stories of newborns dying from pertussis like this one, are still far too common.
  • The TDaP vaccine during the 3rd trimester of pregnancy is safe for you and your baby. Many studies have been done on this topic, but I especially like this one. Over 20,000 pregnant women were given TDaP during their 3rd trimester and the researchers found that there was no increase of any adverse events related to pregnancy.

What’s the benefit of receiving a TDaP during pregnancy vs. after your delivery?

  • After receiving the TDaP vaccine during pregnancy, your body will create antibodies to protect you and your baby. It takes about 2 weeks for your body to create these important antibodies. If you receive the TDaP during your 3rd trimester, the antibodies will transfer through the placenta and help protect your baby at the time of birth.
  • Antibodies can also transfer through your breastmilk. If you receive a TDaP vaccine during your pregnancy, you can share those antibodies with your baby as soon as your milk supply develops.
  • If you have never received a TDaP vaccine and you do not receive one during your pregnancy, it is still important to receive one before you leave the hospital. However, it will still take 2 weeks to develop your own antibodies against pertussis. At that point, you cannot transfer antibodies to your child through the placenta, and it will take at least 2 weeks to give your infant your antibodies through breastmilk. The first 2 weeks of life will inevitably be a high period of exposure to your newborn. He or she will be in the hospital for a period of time and then of course being introduced to family and friends. It is a wonderful, joyous time to welcome your new little one. But, the bottom-line is, it is more beneficial to protect your baby before he or she is here by vaccinating during pregnancy instead of waiting until after delivery.
  • Antibodies from TDaP fade over time. That is one of the reasons TDaP is now recommended during every pregnancy. We want your antibodies against pertussis to be at their highest during delivery at each pregnancy to protect all of your children.
  • Whether you vaccinate for TDaP during pregnancy or not, it is important to practice something we call “cocooning.” That is simply the practice of making sure that everyone who comes in contact with your baby (family, friends, everyone!) has received their pertussis vaccine.

I really hope that adds more understanding to why your OB/GYN or midwife recommended that you get a TDaP during your pregnancy. From the pediatric side of things, I really hope you do as well!

 

Did you vaccinate during your pregnancy? Why or why not? Leave me a comment below!