Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes
- PMID: 25387187
- PMCID: PMC6599584
- DOI: 10.1001/jama.2014.14825
Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes
Abstract
Importance: In 2010, due to a pertussis outbreak and neonatal deaths, the California Department of Health recommended that the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) be administered during pregnancy. Tdap is now recommended by the Advisory Committee on Immunization Practices for all pregnant women, preferably between 27 and 36 weeks' gestation. Limited data exist on Tdap safety during pregnancy.
Objective: To evaluate whether maternal Tdap vaccination during pregnancy is associated with increased risks of adverse obstetric events or adverse birth outcomes.
Design and setting: Retrospective, observational cohort study using administrative health care databases from 2 California Vaccine Safety Datalink sites.
Participants and exposures: Of 123,494 women with singleton pregnancies ending in a live birth between January 1, 2010, and November 15, 2012, 26,229 (21%) received Tdap during pregnancy and 97,265 did not.
Main outcomes and measures: Risks of small-for-gestational-age (SGA) births (<10th percentile), chorioamnionitis, preterm birth (<37 weeks' gestation), and hypertensive disorders of pregnancy were evaluated. Relative risk (RR) estimates were adjusted for site, receipt of another vaccine during pregnancy, and propensity to receive Tdap during pregnancy. Cox regression was used for preterm delivery, and Poisson regression for other outcomes.
Results: Vaccination was not associated with increased risks of adverse birth outcomes: crude estimates for preterm delivery were 6.3% of vaccinated and 7.8% of unvaccinated women (adjusted RR, 1.03; 95% CI, 0.97-1.09); 8.4% of vaccinated and 8.3% of unvaccinated had an SGA birth (adjusted RR, 1.00; 95% CI, 0.96-1.06). Receipt of Tdap before 20 weeks was not associated with hypertensive disorder of pregnancy (adjusted RR, 1.09; 95% CI, 0.99-1.20); chorioamnionitis was diagnosed in 6.1% of vaccinated and 5.5% of unvaccinated women (adjusted RR, 1.19; 95% CI, 1.13-1.26).
Conclusions and relevance: In this cohort of women with singleton pregnancies that ended in live birth, receipt of Tdap during pregnancy was not associated with increased risk of hypertensive disorders of pregnancy or preterm or SGA birth, although a small but statistically significant increased risk of chorioamnionitis diagnosis was observed.
Conflict of interest statement
Figures
Comment in
-
The administration of pertussis vaccine to pregnant women was associated with a small increased risk of chorioamnionitis, but not an increased risk of hypertensive disorders or preterm birth.Evid Based Med. 2015 Apr;20(2):73. doi: 10.1136/ebmed-2014-110149. Epub 2015 Feb 16. Evid Based Med. 2015. PMID: 25686618 No abstract available.
Similar articles
-
Obstetric and perinatal health outcomes after pertussis vaccination during pregnancy in Ontario, Canada: a retrospective cohort study.CMAJ Open. 2021 Apr 13;9(2):E349. doi: 10.9778/cmajo.20200239. Print 2021 Apr-Jun. CMAJ Open. 2021. PMID: 33849984 Free PMC article.
-
Factors associated with Tdap vaccination receipt during pregnancy: a cross-sectional study.Public Health. 2020 Feb;179:38-44. doi: 10.1016/j.puhe.2019.10.001. Epub 2019 Nov 11. Public Health. 2020. PMID: 31726399 Review.
-
Pertussis Immunisation in Pregnancy Safety (PIPS) Study: A retrospective cohort study of safety outcomes in pregnant women vaccinated with Tdap vaccine.Vaccine. 2018 Aug 16;36(34):5173-5179. doi: 10.1016/j.vaccine.2018.07.011. Epub 2018 Jul 18. Vaccine. 2018. PMID: 30031662
-
Association of Tdap Vaccination With Acute Events and Adverse Birth Outcomes Among Pregnant Women With Prior Tetanus-Containing Immunizations.JAMA. 2015 Oct 20;314(15):1581-7. doi: 10.1001/jama.2015.12790. JAMA. 2015. PMID: 26501534 Free PMC article.
-
Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Recomm Rep. 2008 May 30;57(RR-4):1-51. MMWR Recomm Rep. 2008. PMID: 18509304 Review.
Cited by
-
Prenatal Maternal Immunization for Infant Protection: A Review of the Vaccines Recommended, Infant Immunity and Future Research Directions.Pathogens. 2024 Feb 23;13(3):200. doi: 10.3390/pathogens13030200. Pathogens. 2024. PMID: 38535543 Free PMC article. Review.
-
Defining and reporting adverse events of special interest in comparative maternal vaccine studies: a systematic review.Vaccine X. 2024 Feb 23;18:100464. doi: 10.1016/j.jvacx.2024.100464. eCollection 2024 Jun. Vaccine X. 2024. PMID: 38495929 Free PMC article. Review.
-
Safety and Clinical Benefits of Adacel® and Adacel®-Polio Vaccination in Pregnancy: A Structured Literature Review.Infect Dis Ther. 2023 Aug;12(8):1955-2003. doi: 10.1007/s40121-023-00847-5. Epub 2023 Sep 1. Infect Dis Ther. 2023. PMID: 37653123 Free PMC article. Review.
-
Pregnancy, fetal, and neonatal outcomes after a first booster dose of covid-19 vaccine during pregnancy in Ontario, Canada: population based, retrospective cohort study.BMJ Med. 2023 Jul 11;2(1):e000632. doi: 10.1136/bmjmed-2023-000632. eCollection 2023. BMJ Med. 2023. PMID: 37456362 Free PMC article.
-
Tdap vaccination during pregnancy and risk of chorioamnionitis and related infant outcomes.Vaccine. 2023 May 22;41(22):3429-3435. doi: 10.1016/j.vaccine.2023.04.043. Epub 2023 Apr 26. Vaccine. 2023. PMID: 37117057 Free PMC article.
References
-
- Broder KR, Cortese MM, Iskander JK, et al.; Advisory Committee on Immunization Practices (ACIP). Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-3):1–34. - PubMed
-
- Murphy TV, Slade BA, Broder KR, et al.; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57(RR-4):1–51. - PubMed
-
- Centers for Disease Control and Prevention (CDC). Pertussis epidemic—Washington, 2012. MMWR Morb Mortal Wkly Rep. 2012;61(28):517–522. - PubMed
-
- Winter K, Harriman K, Zipprich J, et al. California pertussis epidemic, 2010. J Pediatr. 2012;161(6): 1091–1096. - PubMed
-
- Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep. 2013;62(7):131–135. - PMC - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical