Vaccine decisions to make during pregnancy

 

During pregnancy, parents need to make these decisions regarding vaccination:

1. Decide whether your newborn child will receive a Hepatitis B (HepB) vaccine on the day of birth:

A case could be made that the HepB vaccine may be beneficial to the child only if the mother is HepB-positive, and that there are significant vaccine-injury risks associated with this vaccine that should otherwise be avoided by the child whose mother is not HepB-positive.  For background information, read SmartVax Approach to HepB vaccine and Why Vaccinate a Baby for HepB?.

Within minutes after the mother gives birth to the newborn child, hospital personnel will arrive to administer a HepB vaccine to the newborn.  If the parent chooses to not have this vaccine administered at birth, then this decision needs to be communicated in writing to the hospital and the pediatric practice that will be at the hospital administering the vaccine (for completeness, the decision should also be communicated in writing to the OB/GYN).  Hospitals routinely administer this vaccine, and hospitals occasionally don’t fully communicate patient decisions to all staff.  Thus, it is recommended that the pregnant mother also appoint some other adult to be in the delivery room (husband, grandmother, etc) with the role of ensuring that the nurses don’t come in and quickly administer the vaccine in the midst of the flurry of action.

Parents should make a decision whether there is potential for the pregnant mother to be HepB-positive, and if so could take action to be tested for HepB early in the pregnancy.  This will allow the test results to be returned in sufficient time to make a decision about the HepB vaccine prior to childbirth.

As an additional note, nurses will still visit the room to administer other preventative treatments, such as eye drops that help prevent a cause of blindness and a Vitamin K shot (see Newborn Tests and Procedures During Your Baby’s Hospital Stay).  For more information on the why Vitamin K is needed and on an oral Vitamin K alternative, see Routine Newborn Vitamin K shot.  These preventative treatments are not vaccines, and are outside the scope of this website analysis on risks and benefits.  The HepB vaccine is typically administered at the same time as these treatments. Additionally, the nurses will also prick the heel of the newborn to take blood samples for PKU testing, which is important because it is necessary to determine quickly whether a newborn has phenylketonuria (PKU) so that necessary treatments can begin.

 

2. Decide whether to get a flu vaccine during pregnancy, and if so then decide whether the flu vaccine can contain mercury:

The influenza vaccine has been shown to be ineffective in a large study of pregnant women [1] (see Black, Shinefield, France et al study in references).  In Influenza Vaccination During Pregnancy, Drs. Ayoub and Yazbak question the recommendation of influenza vaccines for pregnant women because they are ineffective and because of the risk from thimerosal [2]. In an ongoing study published in 2009 and updated this year entitled “Vaccines for preventing influenza in healthy adults,” scientists said they found no plausible substantiation that the flu vaccine prevented death or hospitalization from flu-related complications and only marginally reduced the number of days of lost work attributed to the illness. (see Recent studies bolster earlier evidence: Flu shots not beneficial).

Many flu vaccines still contain thimerosal, a mercury-based preservative (see SafeMinds Mercury-free Vaccine Project).  A long and growing list of scientific research, including animal research, indicates that thimerosal in vaccines is harmful (see Thimerosal Science Summary).  The Eli Lilly Manufacturer’s Safety Data Sheet (MSDS) for thimerosal states: “exposure in-utero can cause mild to severe mental retardation and motor coordination impairment”.  Per the product inserts for each flu vaccine, approved flu vaccines were not tested by manufacturers prior to approval to determine whether they were safe for the fetus.

 

3. Decide whether to get the Tdap vaccine during pregnancy, if encouraged to do so by your doctor:

An advisory committee to the CDC recommended in June 2011 that pregnant women receive the Tdap vaccine to protect against pertussis (whooping cough) (HERE).  Current recommendations are for women to receive pertussis vaccine just after childbirth, but the group said vaccination during pregnancy may provide protection to the fetus. Infants get their first pertussis shot at age 2 months. The recommendations of this advisory committee are often adopted by the CDC.

However, the Tdap vaccine has not been tested for safety or effectiveness during pregnancy:

  • The product insert for the Tdap vaccine Boostrix states “Safety and effectiveness of BOOSTRIX have not been established in pregnant women.”
  • The product insert for Adacel states “Animal reproduction studies have not been conducted with the Adacel vaccine.  It is also not known whether Adacel vaccine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.  Adacel vaccine should be given to a pregnant woman only if clearly needed.”

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References:

[1] Black SB, Shinefield HR, France EK, et al. Effectiveness of the influenza vaccine during pregnancy in preventing hospitalizations and outpatient visits for respiratory illness in pregnant women and their infants. 2004;21:333-339.

[2] Ayoub DM, Yazbak FE.  Influenza Vaccination During Pregnancy: A Critical Assessment of the Recommendations of the Advisory Committee on Immunization Practices (ACIP)http://www.jpands.org/vol11no2/ayoub.pdf