Can I receive tetanus toxoid (Td) vaccine if I'm pregnant?

Tetanus Toxoid Vaccination During Pregnancy

Yes, you can and should receive tetanus toxoid (Td) vaccine during pregnancy if you are due for vaccination. In fact, for pregnant women who need tetanus protection, the Advisory Committee on Immunization Practices (ACIP) now recommends Tdap (tetanus, diphtheria, and acellular pertussis) vaccine instead of Td, preferably between 27-36 weeks gestation 1.

Recommendations for Tetanus Vaccination During Pregnancy

For Routine Immunization:

• Pregnant women should receive 1 dose of Tdap during each pregnancy, regardless of prior vaccination history 1
• Optimal timing is between 27-36 weeks gestation (preferably earlier in this window) to maximize maternal antibody response and passive antibody transfer to the infant 1, 2
• Tdap may be administered at any time during pregnancy if needed for wound management or during pertussis outbreaks 2

For Women with Incomplete or Unknown Vaccination History:

• If you've never been vaccinated against tetanus, you should receive a 3-dose series starting during pregnancy 1
• The recommended schedule is:
  • First dose as soon as possible (preferably Tdap)
  • Second dose at least 4 weeks later (Td or Tdap)
  • Third dose 6-12 months after the second dose (Td or Tdap) 1

For Wound Management During Pregnancy:

• If you have a wound and need tetanus protection (>5 years since last tetanus vaccine), Tdap is recommended 1
• For clean, minor wounds: Tdap if ≥10 years since last tetanus-containing vaccine
• For all other wounds (contaminated, puncture, etc.): Tdap if ≥5 years since last tetanus-containing vaccine 1

Safety of Tetanus Vaccination During Pregnancy

The safety profile of tetanus vaccination during pregnancy is well-established:

• There is no evidence of adverse fetal effects from vaccinating pregnant women with inactivated vaccines or toxoids 2
• While the second or third trimester is preferred for vaccination to minimize perception of association with first-trimester adverse outcomes 1, the vaccine can be given at any time during pregnancy when indicated 2
• A developmental toxicity study in animals showed no evidence of harm to the fetus due to tetanus vaccine 3

Benefits of Tetanus Vaccination During Pregnancy

1. Maternal protection against tetanus and diphtheria 4
2. Neonatal protection through transplacental antibody transfer 5, 6
3. Prevention of maternal and neonatal tetanus, which remains a significant cause of mortality in developing countries 4
4. When Tdap is used, additional protection against pertussis for both mother and infant 5

Important Considerations

• Studies have shown that Tdap vaccination during pregnancy is 77.7% effective in preventing pertussis in infants <2 months of age, and 90.5% effective against hospitalized cases 5
• Vaccination during the third trimester results in efficient maternal antibody transfer to the newborn 6
• Replacing TT with Td or Tdap improves immunogenicity for both tetanus and diphtheria 7

If you have concerns about vaccination during pregnancy, discuss them with your healthcare provider, who can provide personalized advice based on your specific medical history and circumstances.