- Hey, y'all welcome back.
I'm Mama Doctor Jones, a Board Certified ObGyn,
a mom to four,
and today we're talking about vaccinations in pregnancy.
What's recommended, what's contraindicated, when and why?
And we'll also be busting some myths,
like flu vaccines cause miscarriage
and vaccinations aren't tested on pregnant people.
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So what vaccinations are recommended
for people who are pregnant?
There are generally three
and there's different circumstances
under which we would give them.
But the three vaccinations
that are routinely recommended in pregnancy are flu vaccine,
TDAP, which is tetanus, diptheria, and acellular pertussis,
and RhoGAM.
So let's go through those one by one,
discuss why they're recommended at what point in pregnancy,
and if there are specific people who would or would not
be recommended to have them.
So let's start with the flu shot.
Influenza vaccination is recommended
as soon as it is available for that flu season
in which the person is pregnant.
This is generally going to be somewhere
between September and March in the United States.
And of course, that will vary depending
on where you are located.
Why do we recommend a flu shot in pregnancy?
The flu is known to be extremely difficult
for people who are pregnant.
There is a higher chance that you end up hospitalized
and a higher chance that you would end up in the ICU
or on a ventilator.
And for that reason, we recommend influenza vaccine,
the shot kind, not the inhaled mist kind for people
who are pregnant.
And we'll talk a little bit
about why we don't recommend them FluMist
later in this video.
This decreases the incidence of somebody who is pregnant
getting flu and ending up very sick and in the hospital.
We know flu shots do not prevent flu 100% of the time.
I know this, you know this, everybody knows this,
but we still recommend it because it does greatly
decrease your chances of having severe disease in pregnancy
if you've got the vaccine and you still get the flu.
So is that making sense?
Even if it doesn't 100% protect against the flu,
it does protect against the flu sometimes.
And if you're in the unlucky population who gets the vaccine
and then still gets the flu,
you are far less likely to end up hospitalized.
This is extremely important
because this lowers all kinds of complication rates
both for the person who is pregnant as well as the baby.
Okay, let's move on to TDAP.
TDAP is tetanus, diptheria, and acellular pertussis.
This is recommended somewhere between 28 and 32 weeks
as the optimal timing, but you can give it later than that
if for some reason you missed the vaccination
during that timeframe.
So as opposed to a flu shot, which is generally given
to protect the person who is pregnant
against severe disease,
a TDAP shot is given to protect against pertussis
in the newborn.
Let me tell you a little bit more about that.
So if you get pertussis as an adult,
are you very likely to get sick?
You may feel a little bad, like you have a cold or a cough
but generally adults do really well with pertussis.
However, pertussis can be extremely dangerous
and even deadly in newborns
and even infants up to toddler age.
So we recommend giving the TDAP vaccination
in particular for the pertussis part of that in pregnancy,
so that the person who is pregnant can create antibodies
and send those through the placenta
because that helps to protect the baby after birth.
I've linked a ton of studies about flu vaccines,
TDAP, all of these things in the description box below.
Please feel free to look through those.
But one in particular is a study from Baxter et al.
And this looked at almost 150,000 infants
and found that vaccination against TDAP
during pregnancy greatly lowered the risk of pertussis
in the infant up until the time
that they were able to be fully vaccinated themselves.
So what this tells us is that vaccination
helps protect the baby.
The other thing with this is that the most common way
an infant gets pertussis is from the parents
or someone else that is a close caregiver.
And for this reason, the American Academy of Pediatrics
as well as every other major medical institution
recommend something called "cocooning."
And this means anybody who's going to be around baby
in the first several months and maybe even up to a year
should be vaccinated against pertussis.
So how often do you need a pertussis vaccine
or TDAP vaccine?
For the person who's pregnant we give it in every pregnancy.
I don't care if you had a baby last year
and now you're pregnant again,
we're gonna give it to you again.
And the reason for that is that
increasing that antibody production
helps push those through the placenta
to what we call passively immunized baby as well.
But if you are just a parent or caregiver of infant
you're not the person who's pregnant,
then we recommend a TDAP vaccine at least every 10 years.
So if you haven't had a booster for your tetanus shot
that includes the pertussis component
because some tetanus vaccines are not including that.
So you need to look back at your vaccination records
and be sure, then we would recommend that you get it
at least a month before the baby is born.
The other vaccine that I mentioned that we recommend
is something called RhoGAM or Rhophylac.
Those are the brand names.
This is for people who have negative blood types,
O negative, A negative, AB negative,
doesn't matter, whatever it is
if your blood type ends in negative, RhoGAM is recommended.
We give this any time in pregnancy that there is bleeding,
so if you have an incidence of vaginal bleeding
at any point in the pregnancy
it is recommended that we give you a RhoGAM shot.
And then we also routinely give it at 28 weeks
to protect against any transfer of blood
that happens at delivery.
Why do we care about that?
People who have a negative blood type
if there is fetal transfer of blood cells
to the maternal system
and the fetus has a positive blood type,
which we don't know prior to delivery in 99.9% of cases,
this can cause development of antibodies
which fight against blood cells.
Now in general, this won't harm that current pregnancy,
this is to protect any future pregnancies.
But if you have that, what we call ISO immunization occurred
during this pregnancy, then it can cause fetal anemia
and something called hydrops in future pregnancies
and is oftentimes very dangerous or deadly.
So we give RhoGAM anytime there's bleeding
and then prophylactically at 28 weeks
knowing there will be some of that transfer
at the time of delivery to protect
against maternal antibodies being made
which could combat healthiness in a future pregnancy.
We also give another dose of the RhoGAM
or Rhophylac shot after delivery
if the baby's blood type is found to be positive.
We test the cord blood, get the baby's blood type,
if it's also negative,
then we don't have to give that shot after delivery.
But if baby's blood type is found to be positive
then we go ahead and give that shot
so that we are just a 100% sure
you won't be making antibodies
which could cause problems in future pregnancies.
So what vaccinations are contraindicated
or never recommended in pregnancy?
This would be anything that is a live vaccine,
MMR, varicella or chicken pox,
things like this are not recommended.
And that takes us back to the FluMist
which is the like nasal spray flu shot.
It is a live virus vaccine and so for that reason
we recommend against it during pregnancy.
Let's go to the myth-busting portion of this video
which I am so excited to talk about.
And that first myth that I know all of you have heard
is "vaccines aren't tested on pregnant people."
This is so far from the truth.
We have so many studies on vaccines and pregnancy
and the safety of those for both the baby and the mom,
so let me read a couple of those titles to you.
I have linked all of these in the description box below.
This first one is from American journal of ObGyn.
It is called safety of influenza immunization
during pregnancy for fetus and neonate.
There are a VAERs data review from American journal
of ObGyn for the flu shot and pregnancy.
That basically is going through any reported side effects
or complications from the flu shot,
and it's a really good article to read as well.
There is an article safety of TDAP in pregnancy.
Pregnancy outcomes after TDAP vaccination
or the PIPS study,
infant outcomes after TDAP vaccination in pregnancy.
And then just some general information
from the American College of Nurse Midwives,
the American College of ObGyn
for immunization in general, flu vaccine in pregnancy,
and then the Baxter et al study
that I talked about a little bit earlier.
I've also linked a lot of resources from the CDC
regarding flu vaccine in pregnancy
as well as ACOG information on TDAP
and influenza in pregnancy.
So there you go.
That is all you need to know if somebody says flu vaccine
or TDAP or any of these things
have never been tested in pregnancy, it's absolutely false.
I just gave you a whole list of studies on this exact topic.
Mythbusting number two.
The flu vaccine causes miscarriage.
This misconception is based on a single underpowered study
which unfortunately has sparked a large amount
of rhetoric that is really inaccurate.
At some point, I can do an entire video on this study
and how it has been inappropriately used
to make a conclusion that it was not powered to make,
but the short of this is,
this is a study which was designed to look at something else
and in post-hoc analysis,
meaning after they had looked at that,
they also looked at this.
They found 21 incidences of miscarriage
that they were able to say,
maybe could be related to the flu vaccine.
The problem is we have a lot of other studies
which can't back up this claim,
and this is a very small number
with a lot of confounding factors
that weren't controlled for.
Again, I can do a whole video on this sometime
if you all are interested,
but the TLDR of that
is that this is an unsubstantiated claim
that is being made from a study
which really didn't have the ability to make that assumption
of a causal link between a flu shot and miscarriage.
So this is an unsubstantiated claim.
We recommend the flu shot at any point in pregnancy.
I have personally gotten a flu shot
in every single one of my pregnancies,
as soon as it was available,
because I see the harmful effects of influenza
for people who are pregnant.
I have watched people intubated in the ICU,
have a stillbirth because of influenza.
And that is terrifying.
And this is something we know is linked,
really severe illness causes really sick moms
and really sick babies,
and if we can prevent that, we have to do that.
So I always recommend flu shot in pregnancy
as soon as it is available.
As always this is not specific medical advice for you.
This is simply meant to empower you and educate you
and give you some talking points
to bring up with your doctor
or advanced practice provider.
I recommend flu shot and TDAP
in almost every single patient who walks through my clinic,
who is pregnant and RhoGAM in anybody
who has a negative blood type.
There are some other vaccines which we would recommend
under specific instances.
But for the most part,
these are the three that you should be expecting your doctor
or advanced practice provider to bring up in pregnancy.
Thank you for being here today.
I hope you learned something.
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