Is Tdap (Tetanus, diphtheria, and pertussis) vaccine given during every pregnancy?

Tdap Vaccination During Pregnancy

Yes, Tdap vaccine should be administered during EACH pregnancy, regardless of prior Tdap vaccination history, with optimal timing between 27-36 weeks gestation to maximize protection for newborn infants. 1, 2

Rationale and Recommendations

The Advisory Committee on Immunization Practices (ACIP) recommends that healthcare providers implement a Tdap immunization program for all pregnant women, administering a dose during each pregnancy regardless of the patient's prior history of receiving the vaccine 1. This recommendation is supported by:

• FDA approval for Tdap use "during the third trimester of pregnancy to prevent pertussis in infants younger than 2 months of age" 3
• Evidence that maternal antibodies wane quickly, making vaccination during each pregnancy necessary 1
• Data showing 80-91% effectiveness in preventing pertussis in newborns when mothers are vaccinated during pregnancy 2

Optimal Timing

• Recommended window: 27-36 weeks gestation 1, 2
• Most effective timing: Early within this window (27-30 weeks) to maximize antibody transfer 1, 2
• Minimum time needed: At least 2 weeks after vaccination to mount maximal immune response 1
• Rationale: Active transport of maternal immunoglobulin G doesn't substantially occur before 30 weeks gestation 1

Clinical Evidence Supporting Vaccination in Each Pregnancy

• Tdap vaccination during pregnancy is 85% more effective at preventing infant pertussis than postpartum vaccination 4
• Highest antibody concentrations are achieved when vaccination occurs at 27-30 weeks gestation, with peak levels at week 30 5
• Higher antibody avidity (strength of antibody binding) is found in infants whose mothers were vaccinated at 27-30 weeks compared to later in pregnancy 6

Special Situations

1. Women due for tetanus booster during pregnancy: Administer Tdap instead of Td 1
2. Wound management during pregnancy: If tetanus prophylaxis is indicated, use Tdap 1
3. Women with unknown/incomplete tetanus vaccination: Initiate 3-dose series with Tdap replacing one dose, preferably at 27-36 weeks 1
4. If Tdap not given during pregnancy: Administer immediately postpartum only if the woman has never received Tdap 1

Common Pitfalls to Avoid

• Delaying vaccination until after delivery: This approach is 85% less effective at preventing infant pertussis 4
• Skipping vaccination because of prior Tdap: Antibody levels wane quickly, even from recent vaccination 1
• Vaccinating too early in pregnancy: May result in insufficient antibody levels at birth 1, 2
• Waiting for the 10-year tetanus booster interval: Tdap should be given during each pregnancy regardless of interval since last tetanus-containing vaccine 1

Implementation

Vaccination coverage during pregnancy has increased substantially, from <1% before 2009 to 54% by 2015 7. Most vaccinations (96%) are administered in traditional healthcare settings such as obstetrician offices, primary care practices, or prenatal clinics 7.

By ensuring Tdap administration during each pregnancy between 27-36 weeks gestation (preferably earlier in this window), healthcare providers can significantly reduce pertussis-related morbidity and mortality in vulnerable infants too young to be vaccinated themselves.