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Bacteria Fight Back
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Childhood Obesity
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Foodborne Illness
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The Flu and You
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H1N1 Virus - Plan Ahead
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15 Great Reasons to Breastfeed
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Third Generation Birth Control Pills
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Family Health Magazine - CHILDBIRTH

Vaccinations During Pregnancy
Are they wise?

With flu season just around the corner, you may be wondering about vaccinations in pregnancy. Vaccinations, also called immunizations, are the shots you can get to help protect you from catching some illnesses.

There are a number of infections that can be very serious for pregnant women and their unborn babies. There are vaccines for some of these diseases. Some of the vaccines are safe to take during pregnancy, but others are not. If you are planning a pregnancy, you should ask your doctor about getting these vaccines before you get pregnant. If you are already pregnant, talk to your doctor or midwife about the best way to be protected from each disease.

German measles

The medical name for German measles is rubella. Rubella was a common disease many years ago, but now it is rare in Canada because most children get the vaccine. For most healthy people, this is not a dangerous disease. However, if a woman catches rubella early in her pregnancy, there can be very serious effects on the baby. These effects depend on which parts of the baby are forming at the time of the infection. They can include deafness, eye problems, heart disease, or damage to the brain or other organs.

There is a vaccine against rubella. It also protects against measles and mumps, and it is called MMR (for measles-mumps-rubella). Most people who grew up in Canada have had the rubella vaccine at least once, but some people need two or three shots to be well protected against this disease (to be immune). Women who grew up in other countries may never have had the vaccine at all.

The best way to find out if you should have the rubella vaccine is to have a blood test to check your immunity. If you are immune, you are unlikely to catch rubella, and so you do not need the vaccine. If you are not immune, you should get the vaccine. If possible, it is best to have the immunity test, and get the vaccine if you need it, before you get pregnant. It is not safe to get the shot during pregnancy. If you are already pregnant and have not had the immunity test, your doctor or midwife will arrange the test for you. If you are immune, you do not need to worry about rubella. If you are not immune, you will need to get the shot after your baby is born. It is important to remember to get this shot, because if you get pregnant again, it will help protect your next baby.

Chicken pox

People call this disease chicken pox, but the medical name is varicella. Most adults can remember having this disease of itchy blisters when they were growing up. Today it is much less common in Canada, because we have a vaccine that is given to most children. Chicken pox is not a serious disease for most healthy people, but it can be dangerous to young babies, elderly people, and pregnant women.

If a woman catches chicken pox when she is pregnant, there is a small chance that her baby will have serious problems. The effects depend on when in the pregnancy the mother gets sick. If she gets chicken pox early in the pregnancy, the baby may have deformed arms or legs. Some babies even die before birth. If the mother gets chicken pox at the end of her pregnancy, her baby can be born with chicken pox or can catch it soon after birth. Chicken pox can be a very serious disease for newborns.

As with rubella, the chicken pox vaccine is not safe in pregnancy. If you are sure you have had chicken pox before, you do not need to worry about it – you will be immune. If you do not know whether you have had chicken pox, your family doctor can test your immunity, and arrange for you to get the shot if you need it, before you get pregnant. If you are already pregnant and have not been tested yet, your care provider will arrange for testing. If the test shows you are not immune, you will need to get the shot after your baby is born.

Whooping cough

Whooping cough, or pertussis, has been in the news a lot in the past few years because there is a worldwide outbreak of this disease. Whooping cough is a respiratory disease, a bit like a cold, except that it lasts a very long time (up to a few months in some cases). It causes very severe coughing fits. In children, the coughing fits can be followed by a loud whooping noise when inhaling. In adults this does not usually happen. In rare cases, people can get very seriously ill with this disease, and some people die from it. In the past few years, there have been many more people getting whooping cough than usual, and also many more who have died of this disease. The number of deaths is still small, however it is a very worrisome disease. Many of the people who die of it are babies under one year of age.

The vaccine for whooping cough is called Tdap (or dTap in some countries), as it also protects against two other diseases called tetanus and diphtheria. Another vaccine, called Td, protects against tetanus and diptheria but ot whooping cough. In Canada, all adults are recommended to get the Td vaccine against tetanus and diphtheria every ten years, and at least once they should get the Tdap shot for whooping cough protection. However, many people do not know that they need these shots, or forget to get them.
These vaccines are safe in pregnancy. Since whooping cough is most serious for babies, it is very important that people who will be around babies get the shots. Without the shots, people who are not protected could get whooping cough, and then a baby could catch it from them.

If you have not had the Tdap vaccine at least once as an adult, or if it has been more than ten years since your last tetanus shot, talk to your family doctor about these vaccines. If you are pregnant or planning to get pregnant, these shots are especially important for you. Your family, and everyone else who will be around your baby, also needs them. If any of these people catch whooping cough, they could give it to your baby. Your baby could get very sick from this disease.

Planning a Pregnancy? A guide on getting vaccinated

Vaccine type

Recommended
before
pregnancy, if possible

Recommended during pregnancy (if not already done)

Recommended after pregnancy

Rubella (German measles) yes, if not immune no yes, if not immune
Varicella (chicken pox) yes, if not immune no yes, if not immune
Pertussis (whooping cough) yes yes yes
Influenza
(the flu)
yes, every year yes yes, every year

Travel vaccines

If you are planning to travel during your pregnancy, you should find out whether vaccines are needed to protect you against diseases in the countries you plan to visit. Some vaccines that travellers need, such as the flu shot, are safe in pregnancy. Others are not, so it is best to get them before you get pregnant. If it is too late for that, you may need to think carefully about whether you can do the trip at another time, or perhaps visit a different place where these diseases are not a problem. The best way to get this information is to visit a travel clinic or your family doctor for advice. Please note that appointments for travel advice usually are not covered by your government health insurance. You might need to pay for the visit and for any shots or medications you need for your trip.

Flu

The flu shot is probably the most common of all the vaccines that doctors and midwives recommend in pregnancy. In fact, the influenza vaccine is recommended for all Canadians, but especially for people at higher risk, such as pregnant women. This vaccine helps protect against influenza, which is a respiratory infection that most often causes cough, fever and muscle aches. Although it causes a week or two of very unpleasant symptoms, for most people it is not a dangerous disease. However, for children, the elderly, people with lung diseases like asthma, and pregnant women, influenza can be serious. Some people need to be in the hospital or even the intensive care unit. Every year in Canada, several thousand people die from the flu.

Some women worry that if they get the flu shot when they are pregnant, it could harm the baby. However, the flu shot is safe in pregnancy. Studies show that the babies of women who get the flu shot in pregnancy are actually healthier than the babies of women who do not get it. If you are pregnant, get the flu shot as it will protect you while you are pregnant. After giving birth you will also be less likely to catch the flu and give it to your baby. Your family members and everyone else who will be around your new baby should consider getting the flu shot too, to prevent them from catching the virus and giving it to your baby.

Many different viruses can cause the flu. The viruses are always changing. Each year the flu shot protects against three different viruses. The shot is changed every year to include the viruses expected to cause the most flu that winter. For this reason, it is important to get the flu shot every year.

Everyone, especially women who are planning to get pregnant, should discuss vaccinations with their family doctor. If you have records from your previous immunizations, bring them with you to this visit. Your doctor can tell you what vaccines you should have, and can arrange immunity testing if needed. Your doctor can also tell you how to get the vaccines you need.

If you are already pregnant, your midwife or doctor will probably test your immunity to rubella and chicken pox, and sometimes to other diseases as well. They may recommend certain immunizations during your pregnancy, such as the flu shot. Depending on your immunity, your care provider may also recommend vaccines to get after your pregnancy, such as for rubella and chicken pox.

It is good for all of us to stay up to date on our immunizations, because it helps protect our health. If people get the shots they need, they will be less likely to get sick and there will be fewer viruses around for all of us to catch. This helps protect everyone, especially newborn babies, pregnant women and other people who can be seriously harmed by these diseases.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [CB_FHc13]
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