Vaccinations in Pregnancy and Lactation
Pregnancy and lactation can be a common time for patients to have questions about vaccinations. Every pregnant person needs two vaccines during each pregnancy: Flu and Tdap.
Are Tdap and the Flu Shots Safe for Pregnant Patients and Babies?
Yes. Both vaccines are safe. Information from millions of pregnant people show no increased risk of pregnancy problems or birth defects with either vaccine. In fact, vaccination with these during pregnancy decreases the risks of complications for both pregnant people and their infants.
Tdap Vaccination
What is the Tdap Vaccine?
- Tdap is a combination vaccine that protects against three potentially life-threatening bacterial diseases: tetanus, diphtheria, and pertussis (whooping cough).
- TETANUS (T) causes painful stiffening of the muscles. Tetanus can lead to serious health problems, including being unable to open the mouth, having trouble swallowing and breathing, or death.
- DIPHTHERIA (D) can lead to difficulty breathing, heart failure, paralysis, or death.
- PERTUSSIS (aP), also known as "whooping cough," can cause uncontrollable, violent coughing which makes it hard to breathe, eat, or drink. Pertussis can be extremely serious in babies and young children, causing pneumonia, convulsions, brain damage, or death. In teens and adults, it can cause weight loss, loss of bladder control, passing out, and rib fractures from severe coughing.
Also see the CDC's TDAP Vaccine Information Statement.
Why Does the CDC Recommend Tdap in Pregnancy?
The CDC recommends that ALL pregnant people should get a dose of Tdap during every pregnancy, to protect the newborn from pertussis. Infants are most at risk for severe, life-threatening complications from pertussis. In babies, pertussis can be very serious. One-half of babies who get pertussis end up in the hospital. This especially true if your infant is expected to have other challenges (prematurity, heart disease) or to need to go to the Neonatal Intensive Care Unit (NICU) after birth.
When Should I Get the Tdap Vaccine? When Will My Baby Get Their First Tdap?
There is a vaccine for pertussis, but babies can’t get it until they are 2 months old. You can protect your newborn by getting vaccinated with the pertussis vaccine (Tdap) when you are pregnant. To give your baby the best protection, you need to get Tdap during each pregnancy. The ideal time is between 27 and 36 weeks of pregnancy, but if you are expected to deliver early, you may be offered it slightly earlier in the pregnancy. If you don’t get vaccinated during pregnancy for some reason, we will offer you this booster after delivery.
How Does Getting Vaccinated Protect My Baby?
Vaccinating in pregnancy protects the baby in several ways. First, the antibody (protection) crosses the placenta providing "passive" immunity (meaning immunity from another person). Secondly, boosting your immunity decreases the likelihood of you getting pertussis from the community and bringing it home to baby. Thirdly, antibodies also pass through the breastmilk can provide continued passive immunity and protection.
Flu Vaccination
What is the Flu Shot?
- A flu shot is a vaccination the influenza virus.
- Because the flu changes from year to year, the vaccine for the flu is updated each year.
- A flu shot protects your health by reducing your risk of getting the flu. It can also protect your baby from the flu for a few months after birth.
- Influenza vaccine does not cause flu.
- Influenza vaccine may be given at the same time as other vaccines.
Why Does the CDC Recommend the Flu Shot in Pregnancy?
The CDC recommends that all pregnant people should get a flu shot during pregnancy, to protect themselves and their newborn from flu. Infants and young children, people 65 years of age and older, pregnant women, and people with certain health conditions or a weakened immune system are at greatest risk of flu complications. Getting vaccinated against the flu reduces the risk of respiratory illnesses in pregnant people by half.
Also see the CDC's Flu Shot Vaccine Information Statement.
What Happens if I Get the Flu While I Am Pregnant?
Pregnant people are much more likely to have complications from the flu that those that are not pregnant, and are more likely to develop complications like pneumonia, or to be hospitalized. Pregnant people and people within 2 weeks after delivery who have symptoms should call their doctor right away to get anti-viral medication (called oseltamivir (Tamiflu)) to help reduce the severity of flu symptoms and shorten the course of the illness. Even you get the flu, having been vaccinated will generally help your illness be less severe, and reduce the risk of hospitalization by 40%.
When Should I Get the Flu Shot? When Will My Baby Get Their Flu Shot?
You need to get the flu shot during each pregnancy. You should get it as soon as it becomes available in the fall. Infants cannot get a flu shot until they are 6 months old.
How Does Getting Vaccinated Protect My Baby?
Vaccinating in pregnancy protects the baby in several ways. First, the antibody (protection) crosses the placenta providing "passive" immunity (meaning immunity from another person). Secondly, boosting your immunity decreases the likelihood of you getting pertussis from the community and bringing it home to baby. Thirdly, antibodies also pass through the breastmilk can provide continued passive immunity and protection.
Infants are most at risk for severe, life-threatening complications from flu. In babies, flu can be very serious. This is especially true if your infant is expected to have other challenges (prematurity, heart disease) or to need to go to the Neonatal Intensive Care Unit (NICU) after birth.
What is the COVID Vaccination?
- A COVID shot is a vaccination to the COVID-19 virus.
- These are new vaccines, and there are several different versions.
- Vaccination represents the most promising strategy for combatting COVID-19.
- These vaccines DO NOT contain live virus.
- You CANNOT get COVID from the vaccination.
- You can view the full patient information sheet for the COVID Pfizer-BioNTech vaccine here.
I Am Being Offered the COVID Vaccine Because of Where I work. Should I Get the COVID Vaccination in While I Am Pregnant?
Pregnancy is a high-risk condition for developing a severe form of COVID-19 disease, with an increased risk for hospitalization, complications and death. More than half of pregnant individuals also fall into another high-priority category, including frontline workers and those with underlying medical conditions. If you get COVID-19 in pregnancy, and develop severe symptoms, you may need to be admitted and/or delivered early.
There is currently no evidence of HARM from these vaccines in pregnancy, and evidence so far “raises no concerns for safety in pregnancy.”
Since the theoretical risk of fetal harm from mRNA vaccines is very low, the benefits from vaccination greatly outweigh these risks in anyone exposed to COVID-19 at work or at home.
The Society for Maternal-Fetal Medicine recommends that healthcare and other workers who are considered prioritized for vaccination, such as high-risk workers in health facilities or first responders, be offered the vaccine even if they pregnant. The American college of Obstetrics and Gynecology similarly recommends that for pregnant individuals, the decision to vaccinate must be left to each patient in consult with their trusted clinician, as well as notes the high risk nature of COVID infection in pregnancy. The CDC also has more information on their website as well.
There is no information about the safety of the new COVID-19 vaccines during breastfeeding. Based upon the limited information that we have; we believe it will be safe for use during breastfeeding. The URMC lactation service has more information about COVID and lactation here.
These decisions are complicated, and we understand that you may wish to speak to someone about them directly. Please talk to your obstetrical provider if you would like more information or help with making this decision. The MotherToBaby service also has more information and is happy to speak with you as well, by text chat or phone.