Recognizing the importance of vaccinations and immunity

People are immune to all kinds of infections, for one of two reasons:

✓ They've suffered through the disease. Most people are immune to chickenpox, for example, because they had it when they were kids, causing their immune systems to make antibodies to the chickenpox virus.

✓ They've been vaccinated. That is, they've been given a shot of something that causes the body to develop antibodies.

Rubella is a common example. Your practitioner checks to see whether you're immune to rubella (also known as German measles) by drawing a sample of blood and checking to see whether it contains antibodies to the rubella virus. (Antibodies are immune system agents that protect you against infections.) If you are not immune to rubella, your practitioner is likely to recommend that you be vaccinated against rubella at least three months before becoming pregnant. Getting pregnant before the three months are over is highly unlikely to be a problem. No cases have been reported of babies born with problems due to the mother having received the rubella vaccine in early pregnancy. Many vaccines, including the flu vaccine, are safe, and in fact recommended, while you're pregnant. See Table 1-1 for information on several vaccines.

Most people are immune to measles, mumps, poliomyelitis, and diphtheria, and your practitioner is unlikely to check your immunity to all these illnesses. Besides, these illnesses aren't usually associated with significant adverse effects for the baby. Chickenpox, on the other hand, does carry a small risk that the baby can contract the infection from her mother. If you've never had chickenpox, tell your practitioner, so you can discuss possible vaccination before you get pregnant.

Finally, if you're at risk of HIV infection, get tested before contemplating pregnancy. Some states now require that doctors discuss and offer HIV testing to all pregnant women. If you have contracted HIV, taking certain medications throughout pregnancy will decrease the chances that your baby also will contract HIV.

A vaccine has recently been made available for the human papilloma virus (HPV), the virus associated with some kinds of abnormal pap smears, genital warts, and cervical cancer. Studies suggest that it's similar to other vaccinations that are safe in pregnancy; just to be extra careful, wait at least 30 days after the shot before attempting pregnancy.

Table 1-1 Safe and Unsafe Vaccines before or during Pregnancy

Disease

Risk of Vaccine to Baby during Pregnancy?

Immunization Recommendations

Comments

Cholera

None confirmed

Same as in nonpregnant women

Hepatitis A (inactivated)

None confirmed

Okay if high risk for infection or for prevention due to recent exposure

Hepatitis B

None confirmed

Okay if high risk for infection

Used with immunoglobulins for acute exposure; newborns need vaccine

Human

Papilloma Virus

None confirmed, but little data

If found to be pregnant after initiating series, give remainder postpartum

Influenza (inactivated)

None confirmed

Recommended

Measles

None confirmed

No

Vaccinate postpartum

Mumps

None confirmed

No

Vaccinate postpartum

Plague

None confirmed

Selected vaccination if exposed

Pneumococcus

None confirmed

Okay, if high risk

Poliomyelitis

None confirmed

Only if exposed

Get if traveling to endemic area

Rubella

None confirmed

No

Vaccinate postpartum

Rabies

Unknown

Indication same as for nonpregnant woman

Consider each case separately

Smallpox

Possible miscarriage

No, unless emergency situation arises or fetal infection

(continued)

Table 1-1 (continued)

Disease

Risk of Vaccine to Baby during Pregnancy?

Immunization Recommendations

Comments

Tetanus and diptheria

None confirmed

Recommended if no primary tetanus/diphtheria series given or no booster in past 10 years, or if high-risk exposure like a cut from a sharp non-sterile object

Typhoid

None confirmed

Only for close, continued exposure or travel to endemic area

Varicella (chickenpox)

None confirmed

Immunoglobulins recommended in exposed nonimmune women; should be given to newborn if around time of delivery

Vaccine recently available but little information concerning pregnancy; vaccinate postpartum (second dose 4 to 8 weeks later)

Yellow fever

Unknown

No, unless exposure is unavoidable

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