Considerations for Vaccination in Pregnancy

VACCINATIONS

Defined: CDC recommended maternal vaccinations in pregnancy

Tdap- tetanus, diphtheria, and pertussis

Influenza-flu

Why it is recommended: Influenza vaccination reduces pregnant women’s risk for influenza-associated hospitalization by an average of 40%. Maternal vaccination also reduces influenza-associated hospitalization risk in infants aged <6 months by an average of 72%. Third-trimester maternal Tdap vaccination is 77.7% effective in preventing pertussis cases and 90.5% effective in preventing pertussis hospitalizations in infants aged <2 months.

Vaccinating with the influenza vaccine and Tdap can provide infants with trans-placentally transferred passive immunity against influenza and pertussis during the first few months of life and can also reduce maternal risk for infection.

Standard of Care: Follow the CDC guidelines for immunizations in pregnancy. Approximately 50-55% of moms in the US were received the influenza and Tdap vaccination.

GrowBaby Care:

Our main focus is to help you make consistent (not perfect) daily decisions to improve the resiliency of your health story. In other words, we are all about prevention. Consider the following recommendations as a preventative guide to decreasing the risk of common colds and viruses like the flu. You can also use this guide to support your body in and around the time you are receiving vaccinations. 

→    Nourish 

●      Cruciferous veggies which are high in a powerful nutrient called sulforaphane (broccoli, cauliflower, kale, cabbage, Brussels sprouts, horseradish, kohlrabi)

●      Adequate B vitamin-rich foods (legumes, dark leafy greens, lean-animal protein) 

• ●      Balanced protein-at least 30% of your daily food from protein-focus on a mixed array of plant and lean animal-based proteins if it aligns dietarily. 

●      Antioxidant rich foods – in particular beta carotene (think orange, red and yellow foods), zinc (nuts/seeds, oysters), selenium (Brazil nuts and mushrooms) and vitamin E (sunflower seeds), as well as glutamine, glycine and cysteine-the three peptides that help you make make glutathione.  

●      Energy co-factors – in particular carnitine, CoQ10, specific B vitamins, B1, B2 & B6,  magnesium and omega-3 fatty acids 

●      Microbiome supportive foods that emphasize both probiotics and prebiotics  (sauerkraut, kimchi, kefir, yogurt, miso, natto, garlic, green bananas, honey, dandelion greens, leeks, onions, flaxseeds, oats, jicama root, apples and algae) 

→    How we Support:

→    Use a Humidifier: studies show that keeping the humidity of your main living space and bedroom at 40-60% can decrease the risk of infection. In fact, in one profound study, preschool classrooms who ran humidifiers for 3 months during the winter months had a 2/3 reduced absentee rate from influenza-related illness compared to the classrooms that did not run a humidifier. You can purchase a hygrometer (tests humidity in the room) to measure the humidity in your home or workplace; and then purchase a humidifier to run daily throughout the winter months. 

→    A Note about Adjuvants: Concerns over the adjuvants (particularly the metal Aluminum) in vaccines have arisen over the past years with regards to infant vaccinations. It is estimated that up to 40% of parents in the US are now delaying or refusing some vaccines altogether. In pregnancy, science still supports the safety of the two (Tdap & influenza) most recommended vaccines to decrease adverse outcomes for mom and baby. 

→    Timing: We consider the following precautions

o   Immunization spacing is important to keep immune stimulation isolated-space out vaccinations when possible, and support in and around the vaccinations with our GrowBaby Care suggestions

o   If your immune system is compromised (you are sick/immune system reactivity, such as allergic response) wait until healing occurs before vaccinating. 

→    Nutrients 

• Glutathione: works as a powerful intracellular antioxidant so you can take this as a supplement or you can choose foods that contain the necessary co-factors (glutamine, glycine and cysteine) for you to make this powerhouse antioxidant. There are some people who have a genetically altered ability to make glutathione from its 3 co-factors, in which case a supplement would be best.  

• Sulforophane (excellent source - broccoli sprouts): consumption can reduce markers of influenza viral load in the nose.

• Vitamin D: supplement based on your individual lab values, but in pregnancy we suggest 2,000-5,000 IUs for most women. 

• Zinc: 10-15 mg daily reduces the risk of getting an upper respiratory illness, even those not covered by a vaccine

• Probiotics: at least 2 different species, most commonly Bifidobacterum lactis, Lactobaccillus rhamnosus, and Lactobaccillus paracasei signifcantly reduce the risk all upper respiratory infections, not just those for which you are receiving vaccines. Probiotics may improve your immune response to the specific vaccine given.

Science Corner

2019 systematic review and meta-analysis

The safety of influenza vaccine is supported by high-quality evidence. For Tdap vaccine no evidence of any harm was found in the meta-analysis of RCTs. A slight increase in chorioamnionitis rate was reported in three out of twelve observational studies. However, this small possible risk is far outweighed by a much larger benefit in terms of infant morbidity and mortality. Meningococcal vaccines are probably safe during pregnancy, as supported by RCTs comparing meningococcal vaccines to other vaccines. Data from observational studies support the safety of hepatitis A, hepatitis B, and rabies vaccines, as well as that of the live attenuated yellow fever vaccine. The MMR vaccine is delayed until after delivery to reduce the risk of prenatal infection that can result in developmental delay in the newborn. We found little or no data about the safety of polio, typhoid, Japanese encephalitis, tick-borne encephalitis

Timing is important: The ideal timing of vaccination is in the early third trimester to achieve maximum maternal antibody levels and maximum antibody transfer before delivery. However, influenza vaccination is recommended during any trimester of pregnancy, including the first trimester.  

Sources

Brillo et al, J Matern Fetal Neonatal Med. 2019 Oct 24:1-30.

Lindley MC, Kahn KE, Bardenheier BH, et al. Vital Signs: Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants - United States. MMWR Morb Mortal Wkly Rep. 2019;68(40):885–892. Published 2019 Oct 11. doi:10.15585/mmwr.mm6840e1

Nasser et al, J Travel Med. 2019 Oct 16. pii: taz074. doi: 10.1093/jtm/taz074.

Smith TJ, Rigassio-Radler D, Denmark R, et al, Br. J Nutr. 2013 Jun; 109(11): 1999-2007.

Rizzardini G, Eskeson D, Calder PC, et al, Br. J Nutr. 2012 Mar: 10I 7(6): 876-84.

Allan G M, Arroll B, CMAJ. 2014 Feb 18; 186(3): 190-199.

https://www.isiaq.org/docs/Papers/Paper340.pdf, Accessed October 28, 2019