Immunisations in pregnancy and breast feeding

Pregnancy & breastfeeding

• no evidence of risk from vaccinating pregnant women or those who are breastfeeding with inactivated virus, bacterial vaccines or toxoids
  • inactivated vaccines do not replicate and so cannot damage an unborn foetus
  • some inactivated vaccines (influenza, TdaP-IPV) are actively recommended for pregnant women as they can prevent severe complications during pregnancy or to the new-born infant
  • if exposure to infection can be avoided until after the mother delivers, deferring vaccination will reduce the chance of any pregnancy complication being incorrectly attributed to vaccine exposure
    
    
• live vaccines are contraindicated during pregnancy as a precaution because of the theoretical risk of foetal infection
  • has been no evidence to date of direct foetal injury after the administration of live viral vaccines to pregnant women - however, since the theoretical possibility of foetal infection exists, live vaccines should generally be delayed until after delivery
  • follow-up of women who have received certain vaccines inadvertently in pregnancy is still underway (https://www.gov.uk/guidance/ vaccination-in-pregnancy-vip), data are extremely reassuring
  • termination of pregnancy following inadvertent immunisation is therefore not recommended

Immunisation with live vaccines should be delayed for 6 months in children born of mothers who were on immunosuppressive biological therapy during pregnancy

• implies that children born of mothers who were on immunosuppressive biological therapy during pregnancy will not be eligible to receive rotavirus vaccine (and will need to defer BCG, if indicated, for 6 months)
• if there is any doubt as to whether an infant due to receive a live attenuated vaccine may be immunosuppressed due to the mother's therapy, including exposure through breast-feeding, specialist advice should be sought

Reference:

• The Green Book. Chapter 11 - The UK Immunisation Schedule (April 2019).