Risks and benefits of immunizing pregnant women: The risk of doing nothing

Abstract

The medical, social and legal risks of immunizing pregnant women are obstacles preventing the initiation of programs to immunize women for their protection and for their infant's protection. Recent projects devoted to vaccine development have focused on protecting newborns and infants. But there are many other reasons for developing or utilizing vaccines before or during pregnancy, beyond the protection of the newborn. Besides the usual reasons for utilizing immunizations to protect the mother and the neonate, the threat of bio-terrorism adds a new dimension to the necessity for addressing this issue. The potential advantages for thinking about vaccinating pregnant women include an array of possible programs associated with risks and benefits. The immunization of pregnant women or women of reproductive age has multiple purposes: to protect the mother, to protect the newborn and infant and to prevent diseases and complications of pregnancy. (1) Preparation of vaccines against infectious agents that are known to result in reproductive pathology and congenital malformation if the infection of the mother occurs during pregnancy. (2) To utilize vaccines used routinely to protect the non-pregnant population, for administration during pregnancy, i.e., influenza, tetanus and other vaccines. Should these vaccines and other routinely used vaccines for children and non-pregnant adults be administered to women during pregnancy if they are medically indicated? (3) Utilization of vaccines to protect women from diseases to which they are susceptible because of pregnancy (poliomyelitis, hepatitis). (4) Utilization of vaccines for use before or during pregnancy, primarily to protect the newborn and infant via maternal transplacental antibodies, i.e., GBD (group B streptococcus). (5) The prevention of intrauterine infection that has been alleged to initiate premature labor. (6) The preparation of a vaccine for use before or during pregnancy to protect both the mother and the neonate, i.e., botulism toxin vaccine. The regulatory agencies and the vaccine producers will need a great deal of objective scientific advice and support and it is the scientific community's responsibility to provide that support. If the scientific and medical community ignores the opportunity to develop vaccines that could reduce the occurrence of reproductive and developmental problems, then we can be accused of acquiescing to the "risk of doing nothing.". © 2005 Elsevier Inc. All rights reserved.