What type of tetanus (Tetanus toxoid) vaccine is given during pregnancy?

Tetanus Vaccination During Pregnancy

The tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine should be administered during each pregnancy between 27-36 weeks gestation, preferably during the earlier part of this window (27-30 weeks), regardless of prior vaccination history. 1

Recommended Timing and Rationale

• Optimal timing: 27-36 weeks gestation

  • Preferably at 27-30 weeks for highest antibody concentrations in newborns 1
  • A minimum of 2 weeks is required after vaccination to mount a maximal immune response 2
  • Active transport of maternal immunoglobulin G does not substantially occur before 30 weeks gestation 2
  • Maternal antibodies wane quickly; women immunized during first or second trimester have low antibody levels at term 2

• Clinical effectiveness:

  • 80-91% effective in preventing pertussis in newborns 1
  • Reduces hospitalizations due to pertussis in infected infants by 58% 1
  • 85% more effective than postpartum vaccination at preventing pertussis in infants <8 weeks of age 3

Special Situations

1. Women due for tetanus booster during pregnancy:

   • Tdap should be administered instead of Td
   • Optimal timing remains 27-36 weeks gestation 2, 1

2. Wound management during pregnancy:

   • If tetanus prophylaxis is indicated (≥5 years since previous booster), Tdap should be administered
   • Can be given at any gestational age if clinically indicated 2, 1

3. Women with unknown or incomplete tetanus vaccination:

   • A 3-dose series should be initiated (0,4 weeks, and 6-12 months)
   • Tdap should replace one dose of Td in this series, preferably at 27-36 weeks 2

4. If Tdap not administered during pregnancy:

   • Should be administered immediately postpartum if the woman has never received Tdap 2, 1

Implementation Considerations

• Vaccination rates are significantly higher when there is a direct recommendation from the healthcare provider 1
• The vast majority of Tdap vaccinations (96%) are received in traditional healthcare settings (obstetrician's office, primary care physician's office, or prenatal clinic) 4
• Vaccination coverage has increased significantly over time, from <1% before 2009 to 54% by 2015 4

Safety and Efficacy

• Tdap vaccine is considered safe during pregnancy 1, 5
• There is no evidence of adverse fetal effects from vaccinating pregnant women with inactivated virus, bacterial vaccines, or toxoids 5, 6
• The overwhelming majority of pertussis morbidity and mortality occurs in infants younger than 3 months 5
• Infants don't begin their own pertussis vaccine series until approximately 2 months of age, leaving a window of vulnerability 5

Cocooning Strategy

In addition to maternal vaccination, all close contacts of infants <12 months (parents, siblings, grandparents, caregivers) should receive Tdap if they haven't previously received it 1, 5

Common Pitfalls to Avoid

• Delaying vaccination until after delivery - postpartum vaccination is 85% less effective at preventing infant pertussis than vaccination during pregnancy 3
• Vaccinating too early in pregnancy - antibody levels wane if vaccination occurs in first or second trimester 2
• Missing the opportunity to vaccinate during the optimal window - every prenatal care visit between 27-36 weeks should be viewed as an opportunity for Tdap administration 3