Vaccinations in Pregnancy
Vaccination recommendations and guidelines are constantly changing. Pregnant people are at greater risk than non-pregnant people for more severe illness from exposure to some vaccine-preventable diseases. Accordingly, midwives need to be aware of current guidelines for vaccinations that can be offered to pregnant people. Click here for documentation considerations.
Other resources regarding vaccines, for midwives and clients, are available from the Canadian Association of Midwives and the Vaccines in Pregnancy Canada website, maintained by a partnership of universities and children's hospitals.
This table provides information on the most current Canadian vaccination guideline recommendations based on guidelines from the SOGC, PHAC, and NACI. Download the AOM’s RM Rx App for more information on the proper dosing, warnings and precautions, for each of these vaccines.
| Illness | Recommended Course of Action |
|---|---|
| Influenza | The influenza vaccine should be offered to all pregnant people at any stage of pregnancy to protect against influenza-related morbidity and mortality. (1, 2) |
| Tdap (Tetanus, Diphtheria, Pertussis) |
Tdap vaccination should be offered to all pregnant people in every pregnancy, regardless of previous Tdap vaccination history, as a means of protecting the infant from pertussis. (2, 3) The National Advisory Council on Immunizations (NACI) recommends vaccination between 27 and 32 weeks (3); the SOGC recommends Tdap between 21 and 32 weeks. (2) |
| COVID-19 |
The SOGC recommends all pregnant people get vaccinated, regardless of trimester or chest/breastfeeding status in their Statement on COVID-19 vaccination in pregnancy. This aligns with NACI guidelines which recommend pregnant individuals receive a primary series and/or boosters. (4) Pregnant people can receive booster doses of COVID-19 vaccine three months after their last dose from the primary series. The Provincial Council for Maternal and Child Health (PCMCH) created this resource to provide information and help decision-making for pregnant people about the COVID-19 vaccine. |
| Respiratory syncytial virus (RSV) |
The RSV vaccine, RSVpreF (Abrysvo®), will be available to pregnant residents of Ontario from 32 to 36 weeks gestational age who will deliver near the start of or during the 2024–25 season. When administered during pregnancy, RSV protection is provided to the infant from birth to six months of age. Nirsevimab (Beyfortus®) is a monoclonal antibody for RSV prophylaxis in infants. It can be offered to infants born in the 2024-25 RSV season. More information on eligibility can be found here. For most dyads, one of these options is sufficient. NACI recommends nirsevimab as the preferred product to protect infants due to current evidence of superior efficacy, duration of protection, and available safety data. |
| Rubella |
Immunity to rubella can be assumed if there is documentation of an individual having received one dose of a rubella vaccine (e.g. MMR) after 12 months of age, laboratory-confirmed disease, or laboratory evidence of immunity. (2) No additional rubella vaccine is required postpartum for clients who meet the above criteria, even when there is no rubella IgG detectable by conventional assays. If vaccination after 12 months cannot be confirmed by documentation and there is no serologic evidence of immunity or laboratory-confirmed disease, a booster of the rubella vaccine in the postpartum period is considered best practice. The SOGC advises delaying rubella vaccination if the client received Rh-immune globulin or other blood products. (2) |
| Hepatitis B |
The SOGC (2018) recommends that pregnant people at high risk for acquiring hepatitis B infection during pregnancy be offered recombinant hepatitis B vaccine series, which is not contraindicated in pregnancy. Pregnant people at high risk are:
|
| Hepatitis A | Vaccinating pregnant people for hepatitis A to protect against liver failure is indicated when the person is travelling to an endemic area for post-exposure or when there has been close contact to a person with a known hepatitis A diagnosis. |
| Travel | Recommendations around vaccinating pregnant travelers are dependent on a number of factors, including the destination, duration of travel, risk of contracting the disease, and the severity of the effect of the disease and/or the vaccine on the pregnant person and/or fetus. For information on travel vaccinations, refer to Public Health Agency of Canada's Statement on Pregnancy and Travel. |
Documentation
Documentation for vaccine administration is of key importance, both for pregnant individuals and newborns. Ensure the chart includes the date and site of administration, the medication name, DIN, dosage, lot number and expiry. If a client brings a yellow immunization record card, a midwife can update it with any vaccines they administer. Midwifery practice settings where publicly funded vaccines are administered should be able to order new yellow cards from their public health unit; these can be issued to newborns. Any adverse events following immunization (AEFI) should be reported to Public Health Ontario.
References
1. Government of Canada (2023). Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022–2023. Retrieved August 2023.
2. The Society of Obstetricians and Gynaecologists of Canada (2018). Immunization Clinical Practice Guideline: No. 357 - Immunization in Pregnancy. Retrieved July 2018.
3. Government of Canada (2018). Update on immunization in pregnancy with Tdap vaccine. Retrieved March 2018.
4. Government of Canada (2023) COVID-19 vaccine: Canadian Immunization Guide. Retrieved August 2023.