Pertussis Prophylaxis in Pregnancy
Pertussis, also known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Infection causes paroxysms of coughing which can lead to dyspnea, hypoxia, and apneic spells in infants. Half of affected infants require hospital care, one in four will get pneumonia, and mortality is 1%. Although infected adults suffer less, coughing may be severe enough to fracture ribs. It is uncertain if pertussis infection in a pregnant adult is associated with increased morbidity or mortality.
Pertussis infections in infants generally are contracted from family members and caregivers. Pertussis occurring in the first three months of life accounts for the majority of pertussis-related morbidity and mortality. Infants do not begin the pertussis vaccine series until two months of age, when a diphtheria, tetanus, and acellular pertussis (DTaP) vaccine is recommended. This period of immunologic vulnerability for the infant is best addressed by maternal vaccination during pregnancy and vaccinating those close to and caring for the infant. Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) stimulates development of maternal anti-pertussis antibodies that pass through the placenta to result in passive immunization of the fetus. Repeat Tdap administration is required each pregnancy because the immune response wanes rapidly. There has been no evidence of adverse fetal effects when women are vaccinated with Tdap during pregnancy.
The CDC’s Advisory Council on Immunization Practices (ACIP) updated their recommendations in response to the infant’s lack of endogenous protective antibody in the early months. Tdap vaccination is recommended during every pregnancy, irrespective of the patient’s age and history of immunization with Tdap or other related vaccines. To maximize maternal antibody response, passive antibody transfer, and antibody levels in the neonate, the optimal timing of Tdap administration is between 27 and 36 weeks’ gestation. Increasing evidence supports vaccination earlier in this window to allow maximal maternal immune response prior to birth. Tdap vaccination at any time during the pregnancy is safe. If Tdap is not administered during the pregnancy, vaccination should occur immediately post-partum. It is safe to administer Tdap to breastfeeding women.
All adults and adolescents who have not previously received Tdap vaccine and who will have close contact with an infant younger than 12 months of age should receive the Tdap vaccine at least two weeks prior to contact.
Reproductive-age women who live or work in areas with pertussis epidemics should be immunized per recommendations for non-pregnant adults. Vaccination of pregnant women in epidemic areas is encouraged outside the 27 to 36 week window. Women should not be re-vaccinated with Tdap if it was administered during the first or second trimester. If a tetanus and diphtheria (Td) booster is required by a pregnant woman as part of a wound management protocol, it should be replaced with a Tdap vaccine, irrespective of gestational age. Pregnant woman who have never been vaccinated for tetanus should start the Td three-vaccine series (0 weeks, 4 weeks and 6-12 months). One dose of Td should be replaced with Tdap, preferably timed near or in the 27 to 36 week window.
Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83. doi: 10.15585/mmwr.mm6903a5. PMID: 31971933; PMCID: PMC7367039. Also available in full text at: http://dx.doi.org/10.15585/mmwr.mm6903a5
Committee Opinion No. 718: Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination. Obstet Gynecol. 2017 Sep;130(3):e153-e157. doi: 10.1097/AOG.0000000000002301. PMID: 28832489. Also available in full text at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/09/update-on-immunization-and-pregnancy-tetanus-diphtheria-and-pertussis-vaccination
Initial approval November 2017. Reaffirmed May 2019, Revised December 2020. Reaffirmed July 2022
Previously titled: Pertussis in Pregnancy – title changed July 2022
********** Notice Regarding Use ************
The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. (“SASGOG”) is committed to accuracy and will review and validate all Pearls on an ongoing basis to reflect current practice.
This document is designed to aid practitioners in providing appropriate obstetric and gynecologic care. Recommendations are derived from major society guidelines and high-quality evidence when available, supplemented by the opinion of the author and editorial board when necessary. It should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. SASGOG reviews the articles regularly; however, its publications may not reflect the most recent evidence. While we make every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. SASGOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither SASGOG nor its respective officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.
Copyright 2021 The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. All rights reserved. No re-print, duplication or posting allowed without prior written consent.
Back to Search Results