Immunizations and pregnancy: an update for pharmacists.

OBJECTIVE: To review the safety of immunizations in pregnancy.

DATA SOURCES: PubMed search using the terms vaccine, immunizations, and pregnancy, as well as current national guidelines.

DATA SYNTHESIS: Immunizations for women of childbearing age are an integral component of pregnancy planning. Some vaccines are compatible with pregnancy, whereas others, in particular live-attenuated vaccines, are contraindicated because of the theoretical risk to the fetus. The immunizing pharmacist must be aware of updated guidelines regarding the safe and appropriate use of vaccines during pregnancy. Certain routine adult vaccines are contraindicated during pregnancy, including the live-attenuated intranasal influenza, measles-mumps-rubella, varicella, zoster, and human papillomavirus vaccines. The trivalent inactivated influenza vaccine is specifically recommended for all women who are pregnant during influenza season. The hepatitis B, tetanus-diphtheria-acellular pertussis, and several other routine adult and travel vaccines may be administered safely in pregnancy if the patient meets certain risk criteria. Breast-feeding is compatible with all routine adult vaccines. Vaccinia (smallpox) and yellow fever vaccines are cautioned against use except in certain circumstances.

CONCLUSION: Pharmacists can play an important role in recommending safe and appropriate vaccines before and during pregnancy.