The National Foundation for Infectious Diseases (NFID) is celebrating its 50th anniversary in 2023 with a look back at our remarkable accomplishments and significant moments in public health history. Special thanks to ACOG Fellow Tamika C. Auguste, MD, chair of Women’s and Infants’ Services at MedStar Washington Hospital Center, for this guest blog post sharing her reflections on the evolution of vaccines recommended during pregnancy.

Pertussis (whooping cough) is a highly contagious disease that can be deadly for newborns who are too young to get vaccinated against the disease. Over the past 15 years, vaccine recommendations have evolved based on ongoing evaluation of the safety and effectiveness of vaccinating pregnant women to help protect their newborns:

2006: The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommended postpartum Tdap (tetanus-diphtheria-acellular pertussis) administration to mothers, but noted that the vaccine could be administered during pregnancy to provide infants with indirect protection from pertussis
2011: ACIP changed preferred timing of Tdap administration to mothers, recommending that previously unvaccinated pregnant women should receive Tdap after 20 weeks’ gestation
2012: ACIP recommendation for Tdap vaccination expanded to include all pregnant women during the third trimester of every pregnancy

What was the significance of the CDC recommendation?

Pregnancy is a tough time. Everyone is worried about what they do, and what they should be doing, during pregnancy. While many healthcare professionals know that vaccines are safe during pregnancy, it is helpful to have CDC and specialty organizations agree, endorse, and strongly recommend certain immunizations during pregnancy.

Since the Tdap recommendation has been in place for all pregnant women for the past 10+ years, it is becoming more routine and accepted that this vaccine should be given in the third trimester of each pregnancy. During my career, I have seen how the recommendations and support of all these organizations do make a difference. Patients and communities hear and listen to these organizations, and it coincides with what healthcare professionals are saying as well—a win-win for all.

How has the healthcare environment changed in the past decade?

The overall environment around trust and knowledge among patients and healthcare delivery teams has changed a lot. The pendulum has swung from, “You are the doctor—whatever you say goes” to “I am uncertain—I need and want to hear more about the recommendations and the risks.” As the pendulum swings, we are settling in a good place, “Let’s have a conversation about this. Let’s discuss this together so I can share the recommendations, you can ask your questions, we can review and meet together to discuss what is best for you.”

Why is Tdap vaccine recommended during each pregnancy?

We recommend Tdap vaccine during the third trimester of each pregnancy to protect against pertussis, which can be deadly for newborns. A lot of patients will say, “I was pregnant just 2 years ago and got it then.” The concern is that protection might wane, and the risk is just too high. In certain regions of the US, there are higher incidences of pertussis in newborns, and we think it is because the moms are getting the infection and passing it on to their newborns. Which is why we recommend Tdap vaccination during each pregnancy—to help protect the newborn.

In fact, CDC and the American Academy of Pediatrics recommend that anyone who is around newborns should be up to date on all recommended vaccines, including Tdap. Partners, grandparents, caregivers, and others can spread diseases to newborns even if they don’t feel sick. That’s how we frame the conversation: “I’m talking with you, but let’s have a broader conversation about your family as well.”

What other vaccines are recommended during pregnancy?

Flu: We recommend influenza (flu) vaccine for pregnant patients during any stage of pregnancy. We gear up for flu vaccination each year and from early fall through spring, we routinely recommend flu vaccination because we know that flu can be worse for pregnant women. We discuss this with our patients, and we let them know why we are recommending flu vaccine for them.
COVID-19: We also recommend COVID-19 vaccination during any stage of pregnancy, because, like flu, we know that this disease can be worse in pregnant women.

Pregnancy is natural, but the effects on the body are significant. As any pregnant woman knows, as the uterus grows, it potentially decreases lung capacity. Your lungs may not be able to expand as much, and with respiratory viruses such as flu and COVID-19, you may be more affected. Your immune system is also affected by pregnancy, which can make you more prone to getting an infection.

What else should women and healthcare professionals know?

Times have changed, for the better! We have shifted from a “Sure, it’s okay to get vaccinated when you are pregnant” approach to one that is now woven into how we practice and how we teach—certain vaccines are recommended during each pregnancy.

Some vaccines are not recommended during pregnancy, such as the measles-mumps-rubella (MMR) vaccine or the nasal flu vaccine, since they are live vaccines that use a weakened (or attenuated) form of the germ that causes a disease. But that is why all pregnant women should have a conversation with their healthcare professional and healthcare team about vaccines specifically recommended for them.

Vaccination during pregnancy is part of routine prenatal care.

Tamika C. Auguste, MD, ACOG Fellow and chair of Women’s and Infants’ Services at MedStar Washington Hospital Center

Learn More about Vaccines during Pregnancy

To learn more about current US immunization recommendations for pregnant women and best practices for making strong vaccine recommendations, watch the on-demand webinar from NFID and the American College of Obstetricians and Gynecologists (ACOG): The Benefits of Maternal Immunization: 2-for-1 Approach to Disease Prevention

To join the conversation and get the latest news on infectious diseases, follow NFID (@NFIDvaccines) and Tamika C. Auguste, MD (@OByourself) on Twitter using the hashtag #GetVaccinated, like NFID on Facebook, follow NFID on Instagram, visit NFID on LinkedIn, listen to the Infectious IDeas podcast, and subscribe to receive future NFID Updates.