Vaccination in Pregnancy - As per DC Dutta's Textbook of Obstetrics (10th Ed., pp. 86-94)

WHY VACCINATE IN PREGNANCY?

1. Protection of the mother against infections that carry heightened morbidity/mortality during pregnancy.
2. Passive protection of the neonate via transplacental IgG transfer, protecting infants too young to be actively vaccinated.

TYPES OF VACCINES - CLASSIFICATION

INDICATIONS FOR VACCINATION IN PREGNANCY

1. Tetanus Toxoid (TT) / Tdap - Routinely Recommended

• Primary indication: Prevention of neonatal tetanus (tetanus neonatorum) and maternal tetanus.
• The TT immunization schedule (as per Indian National Immunization Programme, referenced by Dutta):
  • TT-1: At first antenatal visit or as early as possible in pregnancy
  • TT-2: 4 weeks after TT-1
  • TT-Booster: If fully immunized in a previous pregnancy within the last 3 years
• Tdap (tetanus-diphtheria-acellular pertussis): Recommended in each pregnancy between 27-36 weeks to maximize passive antibody transfer to the infant and protect against pertussis in the newborn.
• Provides both maternal and neonatal protection via passive IgG transfer.

2. Influenza Vaccine (Inactivated) - Recommended

• Indications: All pregnant women, especially during influenza season (any trimester).
• Pregnancy increases the risk of severe influenza complications (pneumonia, preterm labor, ICU admission).
• Inactivated influenza vaccine (IIV) is safe in all trimesters.
• Live attenuated influenza vaccine (LAIV/FluMist) is contraindicated in pregnancy.
• Also protects the neonate in the first 6 months of life via maternal antibody transfer.

3. Hepatitis B Vaccine - Recommended when indicated

• Indications:
  • Non-immune pregnant women at risk (multiple partners, IV drug users, healthcare workers)
  • Pregnant women in endemic areas
  • Women with HBsAg-positive contacts
• Recombinant vaccine; safe in pregnancy.
• Prevents vertical transmission risk to the neonate when mother is at risk.

4. Hepatitis A Vaccine - When indicated

• Indicated in seronegative women travelling to endemic areas or with occupational/exposure risk.
• Inactivated vaccine; safe to use when benefit outweighs risk.

5. Meningococcal Vaccine - When indicated

• Indicated for travel to meningococcal-endemic regions (e.g., Sub-Saharan Africa "meningitis belt"), or outbreaks.
• Inactivated; safe in pregnancy.

6. Pneumococcal Vaccine - When indicated

• Indicated in pregnant women with high-risk conditions: asplenia, chronic pulmonary/cardiac/renal disease, diabetes, or immunocompromised states.

7. Rabies Vaccine (Post-exposure) - When indicated

• Post-exposure prophylaxis (PEP) with inactivated rabies vaccine is not contraindicated in pregnancy.
• Benefit of preventing fatal rabies clearly outweighs any theoretical risk.

8. Yellow Fever Vaccine - Conditionally indicated

• Live attenuated; generally contraindicated, but may be administered when travel to high-risk endemic area is unavoidable and exposure risk is high.
• Risk-benefit discussion mandatory.

VACCINES CONTRAINDICATED IN PREGNANCY

Note: Inadvertent administration of a live vaccine in early pregnancy is not an indication for termination of pregnancy, as no proven embryopathy has been documented.

VACCINES RECOMMENDED POSTPARTUM (IF MISSED)

• MMR and Varicella: Administer immediately postpartum to seronegative women before discharge (avoid pregnancy for 4 weeks after).
• Tdap: If not given during pregnancy, give in the immediate postpartum period.

SUMMARY TABLE (Dutta Framework)