1. VACCINATION IN PREGNANCY
14TH SAFOG CONFERENCE,
THE LALIT, MUMBAI,
23/09/2023.

2. Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital
President, MOGS (2022-2023)
Joint Treasurer, FOGSI (2021-2025)
Organising Secretary, AICOG Mumbai 2025
Treasurer, AFG (2023-2024)
Member Oncology Committee, SAFOG (2021-2023)
Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses
Editor-in-Chief, FEMAS, JGOG & TOA Journal
67 publications in International and National Journals with 172 Citations
National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-
2022)
Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16)
Member, Oncology Committee AOFOG (2013-2015)
Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at
L.T.M.G.H (2010-16)
Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023)
Editorial Board, European Journal of Gynaec. Oncology (Italy)
Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery
(AMAS) at LTMGH (2018-19)
DR. NIRANJAN CHAVAN
MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP,
DIPLOMA IN ENDOSCOPY (USA)

5. OVERVIEW
• HISTORY
• INTRODUCTION
• GENERAL PRINCIPLES OF IMMUNISATION
• TIME OF VACCINE ADMINISTRATION
• VACCINES IN PREGNANCY
• PRE-CONCEPTIONAL IMMUNISATION
• ROUTINE PRE-NATAL IMMUNISATION
• SPECIAL VACCINES
• COVID-19 VACCINE IN PREGNANCY

8. INTRODUCTION
• Maternal immunization protects both the mother and fetus from the morbidity of
certain infections.
• It can also provide the infant passive protection against vaccine-preventable
infections acquired independently after birth.
• Vaccination during pregnancy is warranted when the risk of exposure is high, the
infection poses risks to the mother and/or fetus, and the vaccine is unlikely to cause
harm.

10. GENERAL PRINCIPLES FOR
IMMUNISATION IN PREGNANCY
• Pregnancy should be ruled out prior to immunization in women of childbearing age.
• Immunization history: a part of 1st ANC visit.
• Live viral vaccines are contraindicated.
• The risk is largely theoretical.
• Pregnant women who have inadvertently received live vaccines should not undergo
termination for teratogenic risk.
• Non-pregnant women should delay pregnancy for at least 4 weeks.
• Postpartum patients should receive all recommended vaccines that could not be or
were not administered during pregnancy.

11. TIME OF VACCINE
ADMINISTRATION
• The ideal timing of vaccination is in the early third trimester to achieve maximum
maternal antibody levels and maximum antibody transfer before delivery.
• Maternal IgG levels reach their peak about four weeks after immunization.
• The influenza vaccine is given for maternal and infant protection and should
therefore be provided seasonally to all pregnant patients regardless of gestational
age.

12. VACCINES IN
PREGNANCY

14. COVID -19 VACCINE

16. PRE-CONCEPTIONAL
IMMUNISATION
• Individuals should be vaccinated against preventable diseases in their environment
before conception according to the recommended adult immunization schedule.
• Measles-related morbidity appears to be greater in pregnant than in nonpregnant patients,
and measles, mumps, and rubella infections are associated with adverse pregnancy
outcomes.
• Women should delay pregnancy for at least 4 weeks after receiving the live MMR
vaccine.
• MMR vaccine should be given in 2 doses 4 weeks apart.

17. • Consequences of measles, mumps, and rubella in pregnancy in an unvaccinated
woman
• Measles - increased rate of spontaneous abortion, preterm labor, LBW
• Mumps - if affected in the first trimester, increased risk of IUFD
• Rubella - Congenital rubella syndrome

18. ROUTINE PRENATAL IMMUNIZATIONS

19. TOG 6TH CONCLAVE BY FOGSI

20. ROUTINE PRENATAL
IMMUNIZATIONS
• Two doses of tetanus toxoid injection at least 28 days apart are to be given to all
pregnant mothers commencing from the second trimester.
• If the subsequent pregnancy occurs within 5 years only one booster is given.
• Tetanus diphtheria acellular pertussis (T-dap) vaccination can be considered instead
of the second dose of tetanus toxoid to offer protection against diphtheria and
pertussis in addition to tetanus.
• Tetanus and diphtheria vaccination can be an alternative if T-dap is not available.

21. • If a case of neonatal tetanus is identified, the mother should be given tetanus toxoid
as early as possible and the baby to be treated as per national guidelines.
• The mother should receive a second dose of toxoid 4 weeks after the first and a third
dose 6 months after the second.
• All patients who are pregnant during the influenza season should receive
the inactivated influenza vaccine as soon as it becomes available and before the onset
of influenza activity in the community, regardless of their stage of pregnancy.

24. VACCINES CONTRAINDICATED IN
PREGNANCY

25. TOG 6TH CONCLAVE BY FOGSI

26. SPECIAL VACCINES

27. TOG 6TH CONCLAVE BY FOGSI

28. HEPATITIS A
• Hepatitis A is an RNA virus, and the vaccines are formalin-inactivated
• The vaccine is indicated in special circumstances when the benefits outweigh
the risks-
1. Chronic liver disease
2. Hemophilia
3. Intravenous drug abuse
4. Working with primates and
5. Travel to endemic regions.

29. HEPATITIS B
• Hepatitis B is a DNA virus and is an inactivated subunit vaccine. Three doses
are highly effective in disease prevention.
• The vaccine is recommended for pregnant women who are at high risk during
pregnancy such as
1.Women with multiple sex partners during the previous 6 months,
2.Those who inject drugs/partner injects drugs,
3.Regular blood transfusion,
4.Liver disease and chronic kidney disease,
5.Women traveling to high-risk countries and,
6.Risk of contact with body fluids like doctors, nurses, and lab staff

31. PNEUMOCOCCAL VACCINE
• Thirteen-valent pneumococcal conjugate vaccine and 23-valent
polysaccharide vaccines are recommended for mothers who have risk factors.
The vaccine can be given during breastfeeding.
• The risk factors recommended for vaccine usage are
• Diabetes mellitus,
• Congenital or acquired immunodeficiencies,
• Anatomic or functional asplenia,
• Chronic liver disease,
• Smoking, alcoholism, cirrhosis of the liver, and chronic renal failure.

33. YELLOW FEVER
• Yellow fever is caused by an RNA flavivirus and is spread by mosquitoes, and
the vaccine is live attenuated.
• The disease is endemic in South America and sub-Saharan Africa.
• CDC recommends vaccination during pregnancy if there is a risk of exposure.
• Non-pregnant women of reproductive age group are advised to avoid
conception for 4 weeks post-vaccination.
• In countries where the Yellow fever vaccine is an entry requirement but the
disease is not endemic, pregnancy constitutes medical grounds for exemption
from the vaccination requirement.

35. RABIES
• The rabies vaccine, an inactivated vaccine, can be given as pre-exposure
prophylaxis during pregnancy if the risk of exposure is substantial.

37. HUMAN PAPILLOMA VIRUS
• HPV vaccines are not recommended for use in pregnant women.
• If a woman is found to be pregnant after initiating the vaccination series, the
remainder of the 3-dose series should be delayed until completion of
pregnancy.
• A pregnancy test is not needed before vaccination.
• If a vaccine dose has been administered during pregnancy, no intervention is
needed.

39. BCG VACCINE
• BCG vaccination should not be given during pregnancy as it is a live
vaccine and can harm the fetus.

40. COVID -19 VACCINE
• The Ministry of Health and Family Welfare, Government of India, approved the vaccination
of pregnant women against COVID-19 on 2nd July 2021.
• Vaccination is highly effective in reducing the severity of COVID-19 infection,
hospitalization, and death.
• Protective antibodies are found in umbilical cord blood and breast milk which shows
protection to the neonate.

41. • Vaccines available in India are:
1. Covishield- produced by Serum Institute of India (SII) in collaboration with
Astra-Zeneca. This is an adenovirus-based viral vector vaccine.
2. Covaxin- produced by Bharat Biotech Ltd. This is an indigenous vaccine and is
an inactivated (killed) whole virus vaccine.
3. Sputnik V- produced by Gamaleya Research Institute. This is an adenovirus-
based viral vector vaccine.
4. ZYCOV-D – produced by Zydus Cadila Healthcare. It is a DNA plasmid-based
vaccine.

43. • All vaccines at present recommend 2 doses. They are to be administered intramuscularly
preferably on deltoid muscle. The vaccinated person is to be observed for 30 minutes for any
immediate adverse effects. The interval between two doses is generally 4 to 8 weeks.

45. FIGO STATEMENT ON COVID-19
VACCINATION AND BREASTFEEDING

49. • ICMR is currently doing a project on “Severity of COVID disease and pregnancy outcome
among women with COVID infection with or without COVID vaccination – A multicentric
case-control study”
• The study will be conducted in Govt. Medical colleges from 6 zones of the country, namely
JIPMER (South Zone), Lokamanya Tilak Municipal Medical College in Mumbai (West
Zone), AIIMS Bhubaneswar (East Zone), AIIMS Bhopal (Central Zone), Maulana Azad
Medical College (North Zone), and Tripura Medical College (North-East Zone).
• I am contributing to this research project as I am the Principal Investigator of the West Zone.

54. TOG 2019
• REFERENCES
• Bhatt B, Jindal H, Malik JS, et al. Vaccination for pregnant women: Need to address. Hum Vaccin
Immunother. 2014; 10(12):3627-8.
• Swamy GK, Heine RP. Vaccinations for Pregnant Women. Obstet Gynecol. 2015 Jan; 125(1): 212–
226.
• WHO recommendation on tetanus toxoid vaccination for pregnant women. 2018.
https://extranet.who.int/rhl/topics/ preconception-pregnancy-childbirth-and-postpartum-care/antenatal-
care/who-recommendation-tetanus-toxoid vaccination-pregnant-women
• B, Jindal H, Malik JS, et al. Vaccination for pregnant women: Need to address. pregnant-women

55. THANK YOU!