Is the Tetanus and Diphtheria (Td) vaccine safe to administer during pregnancy?

From the Guidelines

Yes, the Td (Tetanus and diphtheria) vaccine is safe to give during pregnancy, as recommended by the CDC, with the preferred vaccine being Tdap, which should be administered between 27 and 36 weeks gestation 1.

Key Points

• The Td vaccine helps protect both the mother and newborn from tetanus and diphtheria.
• These are inactivated vaccines, meaning they don't contain live bacteria, so they pose no risk of causing infection in pregnant women or their developing babies.
• The maternal antibodies produced in response to vaccination cross the placenta and provide passive immunity to the newborn until they can begin their own vaccination series.
• If a pregnant woman has a wound that requires tetanus prophylaxis and hasn't had a tetanus-containing vaccine in the past 5 years, Td or Tdap should be administered regardless of the stage of pregnancy.
• Side effects are generally mild and may include soreness at the injection site, mild fever, or body aches.

Administration Guidelines

• The CDC recommends that pregnant women receive the Tdap vaccine during each pregnancy, preferably between 27 and 36 weeks gestation 1.
• If Tdap is not available, Td vaccine can be substituted.
• Adults who have never received Tdap are also recommended to receive a booster dose of Tdap, and then a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria 1.

Special Considerations

• Pregnant women with unknown or incomplete tetanus vaccination should receive three vaccinations containing tetanus and reduced diphtheria toxoids, with Tdap replacing one dose of Td, preferably between 27 and 36 weeks gestation 1.
• For wound management, a tetanus toxoid–containing vaccine might be recommended for wound management in a pregnant woman if ≥5 years have elapsed since the previous Td booster, with Tdap being the preferred vaccine 1.

From the Research

Safety of Tetanus and Diphtheria (Td) Vaccine in Pregnancy

• The Td vaccine is considered safe to administer during pregnancy, as it is an inactivated vaccine 2.
• Inactivated vaccines, such as the Td vaccine, are generally safe for use in pregnant women, as they do not cause fetal viremia or bacteremia 2, 3.
• The Advisory Committee on Immunization Practices (ACIP) recommends administering a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) during each pregnancy, between 27 and 36 weeks of gestation 3, 4.
• Studies have shown that Tdap vaccination during pregnancy is effective in preventing pertussis in infants, with a vaccine effectiveness of 91.4% during the first 2 months of life and 69.0% during the entire first year of life 5.
• There is no evidence of adverse fetal effects from vaccinating pregnant women with the Td vaccine or other inactivated vaccines 3, 6.

Recommendations for Td Vaccine Administration in Pregnancy

• The ACIP recommends that all pregnant women receive Tdap vaccination during the third trimester, regardless of prior Tdap vaccination history 3, 4.
• The Td vaccine can be administered at any time during pregnancy if needed for wound management or other extenuating circumstances 3.
• Pregnant women who have not received Tdap previously should receive a dose during pregnancy, and those who have received Tdap previously should receive a booster dose during each subsequent pregnancy 3, 4.

Studies on Td Vaccine Safety in Pregnancy

• A study published in 2020 found no evidence of appreciable risks for specific major malformations associated with Tdap vaccine exposure during early or late pregnancy 6.
• Another study published in 2017 found that maternal Tdap vaccination was highly protective against infant pertussis, especially in the first 2 months of life 5.
• A review of vaccination safety in pregnancy published in 2021 concluded that inactivated vaccines, such as the Td vaccine, are generally safe for use in pregnant women 2.