This study by McMillan et al. (Obstetrics Gynecology, 2017) aimed to determine if vaccination with the combined tetanus, diphtheria, and pertussis vaccine during pregnancy affects antenatal, birth, and infant outcomes for the mother, fetuses, and infants.
Systematic Review
The authors included tetanus toxoid, reduced diphtheria toxoid, and pertussis (or combined Tdap) and inactivated polio vaccines. Most studies were a retrospective cohort design and did not include timing of the vaccination, although there were some prospective studies and an RCT. Studies were reviewed and rates of preterm birth, small gestational age (less than the 10th percentile), low birth weight (<2,500g), stillbirth, neonatal death, and congenital anomalies were examined. There was no association with vaccine administration with SGA, stillbirth or low birth weight. Neonatal death, ventilation, sepsis, and Apgar score estimates were statistically imprecise and a larger sample would be required to provide greater statistical certainty for these outcomes. Congenital anomaly outcomes were analyzed and no harmful associations were found. Childhood development was studied in one RCT and there was no statistical impact, however the authors point out the small sample size. Rates of fever were 3% or lower, and more common side effects included malaise, headache, and myalgia. If the combined Tdap vaccine is administered during the second or third trimester there do not seem to be any harms for the mother or fetus. While there was no evidence of harms in the first trimester, sample sizes were small so the authors did not feel they could adequately rule out associations. Pertussis is making a resurgence and maternal antenatal vaccination can have a positive impact on newborns.
Safety of Tetanus, Diphtheria, and Pertussis Vaccination During Pregnancy: A Systematic Review
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
