The use of vaccines in pregnancy

Breastfeeding after maternal immunisation during pregnancy: providing immunological protection to the newborn: a review

Vaccination during pregnancy results in an augmentation of disease specific maternal antibodies. Immunoglobulin G (IgG) is mainly transferred through the placenta during the third trimester of pregnancy, while secretory Immunoglobulin A (sIgA) is passed through breast milk. At birth, newborns are partially protected against infectious diseases by these antibodies. This review aims to provide an overview of the effect of vaccination during pregnancy on the immunological protection of the newborn by the presence of disease specific sIgA antibodies in breast milk and their possible protective function against disease. Our search produced 11 relevant papers; 1 on pertussis, 7 on pneumococcus, 2 on influenza and 1 on meningococcus. All of the studies in this review that measured disease specific antibodies in breast milk (n=8 papers), stressed the beneficial effect of maternal vaccination during pregnancy on the amount of disease specific sIgA in breast milk. Only a few studies demonstrated a potential protective effect, particularly with influenza vaccines. In an era where maternal vaccination is increasingly considered as a valuable strategy to protect both the mother and infant, further research is needed to assess the effect on breast milk sIgA and to understand the potentially beneficial effects to the infant.

Determination of vaccination status of pregnant women during pregnancy and the affecting factors

AIMS AND OBJECTIVES

To determine the vaccination status of pregnant women during pregnancy and factors affecting their vaccination.

BACKGROUND

Immunisation provided through vaccination is one of the most effective ways to reduce or prevent the risks of disease, disability and death. Maternal and newborn health may be protected and morbidity may be decreased through vaccinating pregnant women when necessary.

DESIGN

This was a descriptive and cross-sectional survey.

METHODS

This study was conducted in a university hospital in Ankara, Turkey, between 01 March and 31 May 2010. The study was carried out with 198 healthy pregnant women who had completed the 26th week of gestation. Data were collected using the data collection form composed of questions enquiring about the demographic and obstetric features of pregnant women and whether or not they knew that vaccinations could be given during pregnancy, and which vaccines could be used during pregnancy, which vaccine/vaccines they had previously received and the reasons for having been vaccinated or not.

RESULTS

Approximately half of the participants had received at least one of the vaccines that may be used in pregnancy (52·0%). The pregnant women received vaccinations for tetanus (47·0%), H1N1 (9·1%), seasonal influenza (3·0%) and hepatitis B (0·5%), respectively. The pregnant women who had been educated about vaccinations had been vaccinated at a statistically significantly higher rate compared with those who had not.

CONCLUSION

This study revealed that pregnant women's knowledge about the required vaccines during pregnancy affected their behaviour towards vaccination. Acquiring knowledge about vaccines that may be used during pregnancy from health personnel is effective to increase vaccination. This result may be interpreted as 'acquired information affects behaviour towards vaccination'.

RELEVANCE TO CLINICAL PRACTICE

Providing information about immunisation to pregnant women at the antenatal clinic is important in terms of maternal and newborn health. Nurses and midwives working in the antenatal field should be sufficiently educated about immunisation.

Thimerosal exposure (from tetanus-diphtheria vaccine) during pregnancy and neurodevelopment of breastfed infants at 6 months

AIM

We studied the effect on neurodevelopment of infants who are exposed to thimerosal in tetanus-diphtheria (Td) vaccines during pregnancy.

METHODS

We compared Gesell Developmental Schedules (GDS) of exclusive breastfed infants at 6 months born to mothers who received Td (1 to 3 doses) against those who were born to mothers who did not take such vaccines.

RESULTS

Compared with the group of infants not exposed to ethylmercury in utero, the infants of exposed mothers showed no significant difference in neurodevelopment delays. Although there was a significant correlation between hair-Hg of mothers and hair-Hg of neonates (Spearman r = 0.353; p = 0.0011), there was no significant correlation between the level of in utero exposure to ethylmercury in Td vaccines and neonate's hair-Hg concentrations (Spearman r = 0.060; p = 0.5922). However, regression analysis showed that GDS at 6 months was significantly associated with total mercury concentration of neonate's hair but was not sensitive to the number of vaccines taken by the mother.

CONCLUSION

Early neurodevelopment of exclusively breastfed infants is sensitive to in utero exposure to mercury, but maternal thimerosal exposure in tetanus-diphtheria vaccines per se cannot portend clinical neurodevelopment delays measured by GDS at 6 months.

Terrorism and the pregnant woman

Pregnant women and their infants are vulnerable, during and following a terrorist event. The threat poses a dual challenge: assessment and treatment of the trauma patient, and assessment and treatment of the pregnant woman. Some injuries in the pregnant woman are obvious; some injuries may not be easily observable. Obtaining an obstetric history coupled with careful nursing assessments ensure prompt and appropriate emergency treatment. Obstetricians, certified nurse midwives, nurse practitioners, and perinatal nurses are uniquely qualified to perform these assessments because of their understanding of the changes in maternal physiology and anatomy during pregnancy. The pregnant woman can sustain injuries owing to trauma or exposure to biological, chemical, or radiological agents. Following trauma, assessment of the gravid uterus is needed, as well as the use of traditional diagnostic, pharmacologic, or resuscitative procedures. The perinatal care provider must be familiar with the hematological changes that normally suppress any immune response to the fetus and how these protective changes increase the risk from biological agents, such as anthrax and smallpox.