Tetanus, Diphtheria, Acellular Pertussis Vaccine during Pregnancy: Pregnancy and Infant Health Outcomes


      To assess pregnancy and birth outcomes in infants born to women who did or did not receive tetanus, diphtheria, acellular pertussis (Tdap) vaccine during pregnancy.

      Study design

      Retrospective cohort. Pregnant women 12-45 years of age who received Tdap at Intermountain Healthcare facilities and their infants were identified and compared with mother-infant pairs without documented Tdap from May 2005 through August 2009. Primary measures included pregnancy outcomes and infant health outcomes at birth through 12 months.


      From 162 448 pregnancies we identified 138 women (0.08%) with documented Tdap administration during pregnancy (cases); 552 pregnant women without documented Tdap were randomly selected as controls. Of 138 immunized women, 63% received Tdap in the first trimester and 37% after. Tdap was given most commonly as wound prophylaxis. The incidence of spontaneous or elective abortion was no greater in Tdap cases than in controls. There were no significant differences in preterm delivery, gestational age, or birth weight between groups. One or more congenital anomaly was identified in 3.7% (95% CI 1.2%-8.5%) of case infants and 4.4% (95% CI 2.7%-6.5%) of control infants ( P = .749). In infants born to women receiving Tdap during pregnancy, 3.6% (0.8%-10.2%) had International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses consistent with complex chronic conditions within 12 months compared with 10.4% (95% CI 7.2%-14.4%) of infants of controls ( P = .054).


      Documented Tdap administration during pregnancy was uncommon and occurred most often in the first trimester as prophylaxis following trauma. No increase in adverse outcomes was identified in infants born to women receiving Tdap compared with infants of controls.
      ACIP ( Advisory Committee on Immunization Practices), EDW ( Enterprise Data Warehouse), ICD-9-CM ( International Classification of Diseases, Ninth Revision, Clinical Modification), Tdap ( Tetanus, diphtheria, acellular pertussis)
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      1. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months. Advisory Committee on Immunization Practices (ACIP), 2011.
        MMWR. 2011; 60: 1424-1426
        • Murphy T.V.
        • Slade B.A.
        • Broder K.R.
        • Kretsinger K.
        • Tiwari T.
        • Joyce P.M.
        • et al.
        Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR recommendations and reports.
        MMWR. 2008; 57: 1-51
        • Tanaka M.
        • Vitek C.R.
        • Pascual F.B.
        • Bisgard K.M.
        • Tate J.E.
        • Murphy T.V.
        Trends in pertussis among infants in the United States, 1980-1999.
        JAMA. 2003; 290: 2968-2975
        • Haberling D.L.
        • Holman R.C.
        • Paddock C.D.
        • Murphy T.V.
        Infant and maternal risk factors for pertussis-related infant mortality in the United States, 1999-2004.
        Pediatr Infect Dis J. 2009; 28: 194-198
        • Halperin S.A.
        Pertussis–a disease and vaccine for all ages.
        N Engl J Med. 2005; 353: 1615-1617
        • McIntyre P.
        • Wood N.
        Pertussis in early infancy: disease burden and preventive strategies.
        Curr Opin Infect Dis. 2009; 22: 215-223
      2. Pertussis (Whooping Cough): Outbreaks. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/pertussis/outbreaks.html/. Accessed February 3, 2013.

        • Gall S.A.
        • Myers J.
        • Pichichero M.
        Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels.
        Am J Obstet Gynecol. 2011; 204: e1-e5
        • Leuridan E.
        • Hens N.
        • Peeters N.
        • de Witte L.
        • Van der Meeren O.
        • Van Damme P.
        Effect of a prepregnancy pertussis booster dose on maternal antibody titers in young infants.
        Pediatr Infect Dis J. 2011; 30: 608-610
        • Gonik B.
        • Puder K.S.
        • Gonik N.
        • Kruger M.
        Seroprevalence of Bordetella pertussis antibodies in mothers and their newborn infants.
        Infect Dis Obstet Gynecol. 2005; 13: 59-61
        • Healy C.M.
        • Munoz F.M.
        • Rench M.A.
        • Halasa N.B.
        • Edwards K.M.
        • Baker C.J.
        Prevalence of pertussis antibodies in maternal delivery, cord, and infant serum.
        J Infect Dis. 2004; 190: 335-340
        • Van Savage J.
        • Decker M.D.
        • Edwards K.M.
        • Sell S.H.
        • Karzon D.T.
        Natural history of pertussis antibody in the infant and effect on vaccine response.
        J Infect Dis. 1990; 161: 487-492
        • Shakib J.H.
        • Ralston S.
        • Raissy H.H.
        • Stoddard G.J.
        • Edwards K.M.
        • Byington C.L.
        Pertussis antibodies in postpartum women and their newborns.
        J Perinatol. 2010; 30: 93-97
      3. ACOG Committee Opinion No. 521: Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination.
        Obstet Gynecol. 2012; 119: 690-691
      4. Updated Recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—Advisory Committee on Immunization Practices (ACIP), 2012.
        MMWR. 2013; 62: 131-135
        • Zheteyeva Y.A.
        • Moro P.L.
        • Tepper N.K.
        • Rasmussen S.A.
        • Barash F.E.
        • Revzina N.V.
        • et al.
        Adverse event reports after tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines in pregnant women.
        Am J Obstet Gynecol. 2012; 207: e1-e7
      5. Methodology for Safety Surveillance of Adverse Events Following Vaccination During Pregnancy. Sanofi Pasteur, 2012 (Avialable at:) (Accessed February 12, 2013)
        • Feudtner C.
        • Christakis D.A.
        • Connell F.A.
        Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997.
        Pediatrics. 2000; 106: 205-209
        • Black S.
        • Eskola J.
        • Siegrist C.A.
        • Halsey N.
        • Macdonald N.
        • Law B.
        • et al.
        Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines.
        Lancet. 2009; 374: 2115-2122
        • Group SCRNW
        Causes of death among stillbirths.
        JAMA. 2011; 306: 2459-2468
      6. Pertussis Maternal Immunization Study. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00553228. Accessed February 12, 2013.

      7. Pertussis Vaccine in Healthy Pregnant Women. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00707148). Accessed February 12, 2013.