he frequency of pertussis infection has substantially risen in the United States. Young infants are at increased risk for death from pertussis and are entirely dependent on passive immunization from maternal antibodies until the infant vaccine series is initiated at age 2 months. For this reason, a three-agent tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (T dap) vaccine is recommended and is safe for pregnant women (Centers for Disease Control and Prevention, 2013b, 2016; Morgan, 2015). However, as demonstrated by Healy and coworkers (2013), maternal antipertussis antibodies are relatively shortlived, and T dap administration before pregnancy-or even in the first half of the current pregnancy-is not likely to provide a high level of newborn antibody protection. Thus, to maximize passive antibody transfer to the fetus, a dose of T dap is ideally given to gravidas between 27 and 36 weeks' gestation (American College of Obstetricians and Gynecologists, 2017j; Centers for Disease Control and Prevention, 2013b, 2016).
All women who will be pregnant during inluenza season should be ofered vaccination, regardless of gestational age. hose with underlying medical conditions that increase the risk for influenza complications are provided the vaccine before lu season starts. In addition to maternal protection against infection, prenatal maternal vaccination in one study reduced the infant influenza incidence in the irst 6 months of life by 63 percent (Zaman, 2008). Moreover, it reduced all febrile respiratory illnesses in these infants by a third.
Women who are susceptible to rubella during pregnancy should receive measles, mumps, rubella (MMR) vaccination postpartum. Although this vaccine is not recommended during
TABLE 9-7. Continued
Rabies Postexposure prophylaxis Half dose at injury site, half dose in Used in conjunction with rabies deltoid killed-virus vaccine
Tetanus Postexposure prophylaxis One dose 1M Used in conjunction with tetanus
Varicella Should be considered for One dose 1M within 96 hours of Indicated also for newborns or exposed pregnant women exposure women who developed varicella to protect against maternal, within 4 days before delivery or not congenital, infection 2 days following delivery
Hepatitis A: Postexposure prophylaxis and 0.02 mUkg 1M in one dose Immune globulin should be given Hepatitis A those at high risk as soon as possible and within virus vaccine 2 weeks of exposure; infants should be used born to women who are with hepatitis A incubating the virus or are immune globulin acutely ill at delivery should receive one dose of0.5 mL as soon as possible after birth 'Two doses necessary for students entering institutions of higher education, newly hired medical personnel, and travel abroad. blnactlvated polio vaccine recommended for nonimmunized adults at increased risk.
10 = intradermally; 1M = intramuscularly; MMR = measles, mumps, rubella; PO = orally; SC = subcutaneously. From the Centers for Disease Control and Prevention, 201 1; Kim, 201 6.
pregnancy, congenital rubella syndrome has never resulted from its inadvertent use. Breastfeeding is compatible with MMR vaccination (Centers for Disease Control and Prevention, 201l).
Whether adverse pregnancy outcomes are related to cafeine consumption is somewhat controversial. As summarized from Chapter 18 (p. 348), heavy intake of cofee each day-about five cups or 500 mg of cafeine-slightly raises the miscarriage risk. Studies of "moderate" intake-less than 200 mg dailydid not find a higher risk.