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
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