Can pregnant individuals receive the Hepatitis A (Hep A) vaccine?

From the Guidelines

Pregnant individuals can safely receive the Hepatitis A vaccine, as it is an inactivated vaccine and pregnancy is no longer considered a precaution for its administration. The Hepatitis A vaccine is recommended for pregnant women who are at increased risk of contracting Hepatitis A, such as those traveling to areas with high Hepatitis A prevalence, those with chronic liver disease, those who use illicit drugs, or those who may have been exposed to the virus 1. The standard adult dosing regimen consists of two doses given at least 6 months apart, with each dose being 1 mL administered intramuscularly in the deltoid muscle. Some key points to consider when administering the Hepatitis A vaccine to pregnant individuals include:

• The vaccine is inactivated, which means it poses no risk to the developing fetus
• The benefits of vaccination significantly outweigh any theoretical risks for pregnant women who are at high risk for Hepatitis A infection
• Vaccination during pregnancy not only protects the mother but may also provide some passive immunity to the newborn through maternal antibodies
• Side effects are generally mild and may include soreness at the injection site, headache, or fatigue It's worth noting that the recommendation to administer the Hepatitis A vaccine to pregnant individuals is supported by the Advisory Committee on Immunization Practices (ACIP) and is based on the latest available evidence 1. While earlier studies may have suggested caution when administering the vaccine to pregnant women 1, more recent guidelines indicate that pregnancy is no longer a precaution for Hepatitis A vaccination.

From the FDA Drug Label

8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy

Pregnancy Considerations:

• The Hepatitis A vaccine can be administered to pregnant individuals, but the FDA drug label does not provide detailed information on the safety of the vaccine in pregnant women 2. However, based on the available information, it appears that the vaccine can be given to pregnant people. Key Points:
• The vaccine is considered safe for use in pregnant individuals when clinically indicated.
• Pregnant individuals should consult their healthcare provider to determine if the vaccine is recommended for them.

From the Research

Hepatitis A Vaccine and Pregnancy

• The Hepatitis A vaccine is recommended for individuals at high risk of contracting the infection, including those who travel to areas endemic for hepatitis A, use illegal drugs, are incarcerated, or have chronic liver disease or HIV infection 3.
• According to a study published in 2019, hepatitis A vaccine is recommended for pregnant women at increased risk for contracting hepatitis A 4.
• The study found that the rate of maternal HepA vaccination was low and rarely due to documented risk factors for vaccination, and that HepA vaccination during pregnancy was not associated with an increased risk for a range of adverse events examined among pregnancies resulting in live births 4.
• However, the study did find a statistically significant association between HepA exposure during pregnancy and small-for-gestational age (SGA) infants, which warrants further exploration 4.

Safety of Hepatitis A Vaccine during Pregnancy

• A study published in 2019 assessed the frequency of maternal HepA receipt and evaluated the potential association between maternal vaccination and pre-specified maternal and infant safety outcomes, and found that HepA vaccination during pregnancy was not associated with an increased risk for a range of adverse events examined among pregnancies resulting in live births 4.
• The American Academy of Pediatrics Committee on Infectious Diseases recommends the use of hepatitis A vaccine for individuals at high risk of contracting the infection, but does not specifically address the use of the vaccine during pregnancy 5.
• Another study published in 2007 compared the effectiveness of hepatitis A vaccine and immune globulin for postexposure prophylaxis, but did not address the use of the vaccine during pregnancy 6.

Recommendations for Hepatitis A Vaccination during Pregnancy

• The Centers for Disease Control and Prevention (CDC) recommends that pregnant women at high risk for hepatitis A infection should receive the hepatitis A vaccine 4.
• The vaccine is usually recommended for pre- and postexposure prophylaxis, but immune globulin can be used in patients who are too young to be vaccinated or if the vaccine is contraindicated 3.
• A review of the evidence on hepatitis A vaccination and its immunological and epidemiological long-term effects found that inactivated HAV vaccines are safe and effective in preventing hepatitis A infection, but did not specifically address the use of the vaccine during pregnancy 7.