Tetanus and whooping cough vaccine during pregnancy

Pertussis is on the rise, and outbreaks are occurring across the United States. Infants are most at risk of contracting pertussis and having severe, potentially life-threatening complications from the infection. In fact, the incidence rate of pertussis among infants is higher than the rate in any other age group, and the majority of pertussis-related deaths occur in infants younger than 3 months of age.

Pertussis by the Numbers

• 28,660 Pertussis cases in the United States (18% increase from 2013)
  
• 6,951 Pertussis cases in California (other states reporting more than 1,000 pertussis cases were Colorado, Michigan, Ohio, Texas, and Wisconsin)
• 2,974 Pertussis cases in infants younger than 6 months of age (10.4% of all reported cases)

Tdap Vaccine Recommendation

Public health efforts are focused on protecting infants until they are old enough to receive their own vaccines to build immunity against pertussis.

For this reason, pregnant women should receive a dose of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy, ideally between 27 and 36 weeks of gestation. By getting the Tdap vaccine during pregnancy, a mother builds antibodies that are transferred to her baby to provide protection against pertussis until the infant can start getting the diphtheria, tetanus, and pertussis (DTaP) vaccine at 2 months of age.

Tdap Vaccine Safety

The Tdap vaccine is safe for both mother and baby at any time during pregnancy, but vaccination is recommended between 27 and 36 weeks of gestation because the maternal immune response to the vaccine peaks approximately two weeks after administration. This recommended timing optimizes passive antibody transfer to the baby and provides the best protection at birth.

Tdap Vaccine Effectiveness

Early evidence shows that infants whose mothers are vaccinated with Tdap during pregnancy are less likely to develop pertussis during the critical first few months of life. One study from the United Kingdom suggests that up to 90% of infants are protected against pertussis when the mother is vaccinated during pregnancy.

Studies suggest that postpartum Tdap vaccination in women is not effective in reducing pertussis in infants 6 months of age or younger.

This sheet is about exposure to the Tetanus, Diphtheria and Pertussis (Tdap) vaccine in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What are tetanus, diphtheria, and pertussis?

Tetanus is a bacterial disease. It causes tightening of the muscles and painful muscle spasms in the body. Even with good medical care, 10-20% of people with tetanus die from the disease. The tetanus bacteria come from soil and animal waste. The bacteria get into the body through an open cut or sore.

Diphtheria is a bacterial infection that often starts with a fever and sore throat. A thin layer (called a membrane) can form over the back of the throat and airways, making it hard to breathe. Without treatment, diphtheria is often deadly. People get the illness from other people with diphtheria through droplets when they cough or sneeze. The use of vaccines has made diphtheria uncommon in the United States, Canada, and many other countries.

Pertussis (also called whooping cough) is a bacterial illness that usually begins with symptoms like those of the common cold. Severe coughing can develop over several weeks. Fast, heavy coughing can cause a high-pitched whooping sound when breathing in. People get pertussis from other people with pertussis through droplets when they cough or sneeze. In people not vaccinated, the chance of getting pertussis in a household with an infected person is 80%. Pertussis is most serious in infants. In an outbreak in 2010 in California, 10 infants died. Serious disease and the need for hospital care can happen in up to 5% of teens and adults that get pertussis.

Do these diseases cause problems in pregnancy?

Tetanus and diphtheria infections can be deadly to a pregnant woman and can cause the loss of the baby. Birth before 37 weeks of pregnancy (premature birth) is also a concern. Tetanus can happen in infants whose mothers did not have enough tetanus protection to pass on to the newborn baby. Tetanus in the newborn period is more common in developing countries and is often deadly.

Pertussis infection during pregnancy has not been well studied. There were no pregnancy complications seen in one series of 32 women who had pertussis late in pregnancy. There are reports of problems for the baby. Premature infants or infants with health problems and infants less than 6 months of age can have severe pertussis. Pertussis has the potential to cause severe risks to the health of the pregnant person and baby.

What is the Tdap vaccine?

The Tdap vaccine provides protection against tetanus, diphtheria, and pertussis. Childhood vaccination for these diseases does not provide lifelong protection. Some brand names of Tdap are Adacel®, Boostrix® and Daptacel®.

The Tdap vaccine is noninfectious, meaning you cannot get the diseases from the vaccine. People get the vaccine by an injection. Like any vaccine, it does not provide 100% protection against the diseases.

I just got the Tdap vaccine. How long should I wait until I get pregnant?

There is no recommended waiting period for the Tdap shot. Pregnant people can get the vaccine at any time during pregnancy.

Does taking the Tdap vaccine increase the chance for miscarriage?

Miscarriage can occur in any pregnancy. The Tdap vaccine does not increase the chance for miscarriage.

Does the Tdap vaccine increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a birth defect.This is called the background risk. Noninfectious vaccines do not increase the chance for birth defects or problems in pregnancy. The tetanus and diphtheria vaccine have a long history of use during pregnancy without increased risk.

Does the Tdap vaccine increase the chance of other pregnancy related problems?

Based on the studies reviewed, the Tdap vaccine does not increase the chance for other pregnancy problems, such as preterm delivery (having the baby before 37 weeks), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), pre-eclampsia (a pregnancy related medical condition) or stillbirth.

Why should people who are pregnant get the Tdap vaccine during late pregnancy?

In the past, people who were pregnant did not regularly get the Tdap vaccine because pertussis was uncommon in adults. However, this is no longer the case and outbreaks have been happening across the United States. It is recommended that people who are pregnant get the vaccine during the third trimester of pregnancy (between weeks 27-36). However, it can be given anytime during pregnancy. Receiving the shot in the third trimester can help the baby get as many of the mother’s antibodies as possible. After delivery, these antibodies provide some protection against pertussis until the baby can receive his/her own vaccines. If all household members and caregivers get the vaccine, it can lower the chance for the baby to get pertussis.

I had Tdap in my last pregnancy. Do I need it again?

It has been recommended to get the Tdap vaccine in the third trimester of every pregnancy. Discuss current recommendations with your healthcare team.

Does the Tdap vaccine in pregnancy affect future behavior or learning for the child? 

Studies have not been done to see if Tdap vaccines in pregnancy can cause behavior or learning issues for the child. However, no vaccine given in pregnancy has caused behavior or learning issues for the child.

Breastfeeding and the Tdap vaccine:

Noninfectious vaccines like Tdap are compatible with breastfeeding. If you get the vaccine while breastfeeding, it can help prevent you from getting sick and passing the illness to your baby. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

If a male gets a Tdap vaccine, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?

There is no proof that vaccines will affect sperm, and vaccines given to men do not reach the developing baby. Vaccination of others in the home will help protect the newborn from illness. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

MotherToBaby is currently conducting a study to learn more about the pertussis vaccine in pregnancy. If you are pregnant and have received the pertussis vaccine (TDAP / DTAP), and you are interested in learning more about this study, please contact MotherToBaby Pregnancy Studies at 877-311-8972 or visit https://mothertobaby.org/join-study/.

Please click here to view references.          

OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.

Is tetanus vaccine necessary during pregnancy?

Is tetanus and whooping cough vaccine together?

In which month of pregnancy tetanus injection is given?

What happens if you get a tetanus shot while pregnant?