Vaccinations During Pregnancy: Recommendations and Current Evidence

There are two vaccines (well, now 3 really!) that are commonly recommended during pregnancy in North America. I know that there is a lot of vaccine hesitancy out there right now in regards to the COVID vaccine, and sometimes that hesitancy can carry over to other vaccines. I find that pregnant women often experience hesitancy because (naturally) we are concerned for the well being of our unborn child. I just want to start off by saying – it is totally okay and normal to feed hesitant about this, and many other things when you are carrying a baby or even after they are born. You are no longer making decisions just for you, but for someone else and it is normal to wonder how that might affect them.

I wanted to share the current recommendations on the vaccines that are recommended during pregnancy and some current data to perhaps help to provide some information for the Googling mother (don’t worry ladies, I’m right there with you half the time). As a reminder – your best source for health information is your primary care provider, if you have one, or an MD you trust. This goes for your own health, your maternal-fetal health, and beyond.

Disclaimer: this is not medical advice. This blog is for informational purposes only. Please direct health question to your trusted, licensed care provider.

Let’s start with the hot topic of the year or more: the COVID vaccine

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I actually recently had Dr. Theresa Patton, OBGYN on the podcast to talk about the vaccine during pregnancy/breastfeeding – so I highly recommend that if you’re looking for information to listen to that episode here (it is available on all major podcast platforms under Elephant in the Womb).

This post will strictly be talking about pregnancy – however, if you listen to the podcast episode as I mentioned above, Dr. Patton also talks about the evidence with breastfeeding (hint: it’s beneficial!). Many of the sources I share will also have information on breastfeeding and safety for the COVID vaccination. As always, I encourage you to reach out to your healthcare provider with any specific questions or concerns.

There are currently many studies on the go studying the safety, efficacy and every little thing about the COVID vaccinations. That alone is incredibly reassuring – vaccines go through a rigorous process for approval, but they don’t always get the intensity and funding that the COVID vaccination has received to continue to research, develop, and improve. If you’re curious about how clinical trials and approval works, I wrote a post about that earlier in the pandemic which can be found here.

Is the vaccine recommended and safe in pregnancy?

Yes. In Canada and the USA (and many other places), the COVID vaccination is currently recommended for administration to pregnant populations (Canada, USA).

These recommendations are made based on studies – a good resource for current information about studies around pregnancy/breastfeeding and the COVID vaccine is the Pandemic Pregnancy Guide. It is often how I stay up to date (with Twitter, of course) and is run by a fantastic team of experts in Canada! I cannot share every study ever done in this post but if you check out their IG page, they share pretty much every time there is a new study. It’s a good resource to stay on top of current information, as well as recommendations.

But yes – the short of it, is these recommendations are not made lightly, yet they have been uniformly made across the CDC and Health Canada. The goal of the vaccine is firstly to protect us – the pregnant people. It is known that in pregnancy, COVID infection can cause severe impact and even death. So we obviously want to protect ourselves (and therefore also our babies of course). However, there also is increasing evidence that there are benefits for our womb-mate as well. Check out this recent post summarizing information on antibody transfer (keep in mind, it was a small study but did replicate data from another study).

One question I even had was – is there a better time to get it? First, second or third trimester?

Reading about antibody transfer probably has some people wondering if they should time their vaccine specifically – right now, neither the evidence or the recommendations point to that. The recommendation in Canada remains to receive it during any trimester. For now – you should be asking your maternal or primary care provider about it, and following their lead which should be in line with current guidance/recommendations from their governing bodies. As I mentioned, the goal is firstly to protect you – so this is a part of this consideration.

Concerns are often around two topics with first trimester vaccination: fever and miscarriage. Dr. Patton does speak to the fever aspect in the podcast episode. The CDC recommends Tylenol (whoever administers your vaccine should be speaking to you about this or you will receive a handout with COVID-19 vaccination after care instructions) if you do present with fever, due to the risk for adverse outcomes. A study completed in June of this year found that fever was not a common effect of the vaccine in the large pregnant population they studied, however it is certainly still a reported potential outcome. The most common effect was pain at injection site. Here is some info about fevers during pregnancy.

If you’re concerned about fever during first trimester, please speak to your healthcare provider. This goes for general timing questions too – don’t be afraid to ask questions/voices your concerns, because what you worry and care about matters.

Notably, the vaccine has not been found to be associated with any increased risk when it comes to birth, stillbirth, or neonatal death (meaning -the risk appears to remain the same for pre-pandemic/non-COVID vaccinated pregnant populations and pregnant women who receive the COVID vaccine).

If you have concerns, please speak to your healthcare provider!

The TDAP Vaccine

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The tetanus combination vaccine (Tdap) helps to prevent not only tetanus, but importantly diphtheria and pertussis (which you may know as whooping cough). This vaccine is not only recommended for pregnant women between week 27 and 36, but also for the general population every 10 years.

You’re probably thinking – why do I care about these things? Do they happen that often? Am I really at risk?

For pregnancy – the main reason this vaccine is recommended is for the whooping cough protection. Whooping cough in babies is no joke. It may seem relatively benign for people as they get older, but infants are at the highest risk for complications. These complications can include (on top of the symptoms of the illness which is a distinct whooping cough and vomiting, or periods of no breathing) pneumonia, seizures, and death. Although the overall occurrence may appear low in North America, getting vaccinated offers your infant protection that they otherwise would not have until at least 2 months when they can start to receive their recommended vaccinations. Here is a recent study on occurrence in infants under 2 months in Canada.

I’ve administered a countless number of Tdap vaccines – it’s the most common thing I think I’ve given to both adults and children. In terms of side effects, I’d say it’s at least from my *anecdotal* experience the least problematic vaccine out there. It causes a sore arm in adults, that is the most commonly reported issue I saw post-Tdap vaccination (in both pregnant and non-pregnant populations). This is also the most commonly listed side effect as reported by the SOGC.

Here is some information (if you click Recommendations) on the safety data for the vaccination during the different trimesters. The best data of course remains within the recommended interval, but please speak to your healthcare provider in regards to your particular circumstances.

But I just got my regular Tdap last year! Do I need to get it again?

Regardless of the last interval of admission, the vaccine is still recommended within the timeframe above during pregnancy for the pertussis aspect.

Note: there may be some flexibility on the timing of your vaccine, so please speak to your HCP. The SOGC actually recommends vaccination any time after 21 weeks (and to delivery) to protect those babies who may be born premature. Timing may also be a consideration if you receive your COVID vaccine (which is to be spaced out from other vaccinations) in third trimester for example. This is a great handout with information on safety and efficacy of the vaccine during and beyond pregnancy.

I know some people worry about this one in pregnancy for whatever reason – but if you plan to vaccinate your kids or have already vaccinated some, they received a version of the Tdap combination vaccine too! Several times in the first year. Just a good thing to know if you’re concerned.

And finally – the flu shot

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The other commonly recommended vaccine during pregnancy is the annual influenza vaccine. Similar to COVID infection, influenza can cause complications and increased severity of illness in pregnant women. So the goal of the vaccine is to avoid that – but there are also added benefits from your baby who will receive some protection as well.

The inactivated flu shot is considered safe during pregnancy for both you and your baby. The CDC reports no increased risk of miscarriage – and their information comes from 3 years worth of data. If you click the link prior, you can also read other studies that report this.

If you have an egg allergy – please speak to your healthcare provider, as this is no longer considered a barrier to vaccination but you should review this in detail as if you had a more severe reaction but are still interested in receiving it, the vaccine can be administered in a safe setting.

Questions or concerns about any recommended vaccines during pregnancy (and there may be some you are missing that I did not include here) should go to your healthcare provider. They will be able to provide you with not only evidence-based and up to date information, but also health information tailored to you.

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