Beyond healthy babies: Why we discuss vaccines, maternal health during pregnancy
August 7, 2018
It’s natural for pregnant women to defer much of their attention to their developing babies. But increasingly, providers are recognizing that prenatal visits are opportunities for women to establish health care for themselves that continues after the baby is born.
Sometimes women are surprised when we ask questions that seem unrelated to pregnancy, such as how they’re managing chronic health conditions or whether their vaccinations are up to date. However, we know that such areas affect a woman’s health, not only during pregnancy but also for years after she gives birth.
In June 2018, the American College of Obstetricians and Gynecologists (ACOG) published an opinion that providers should routinely check patients’ vaccination statuses throughout pregnancy and offer vaccines when women are eligible. We’re implementing their recommendation with our patients and adding another step – empowering them during prenatal visits to prioritize their own lifelong health along with that of their babies.
Vaccines we recommend for women
Immunizations are an essential part of health maintenance and shouldn’t be overlooked because a woman is pregnant. Historically, we’ve emphasized the health benefits for women and babies of certain vaccinations, such as the flu and whooping cough (pertussis) in pregnancy. In fact, an exhibitor at the 2018 ACOG national meeting told me our blog about Tdap (tetanus and whooping cough) helped her decide to get the vaccination during her third pregnancy (it’s currently recommended during every pregnancy). She’d thought – incorrectly – that since she’d had one with her past pregnancy she didn’t need another one.
But along with discussing Tdap during prenatal visits, Ob/Gyns also should use the time to review each patient’s history of vaccinations against the following diseases:
● Chickenpox (varicella vaccine)
● Hepatitis A
● Human papillomavirus (HPV)
● MMR (measles, mumps, and rubella)
● Meningitis (meningococcal vaccine)
● Pneumonia (pneumococcal vaccine)
Not all patients require these vaccinations, and a review of a patient’s health history can guide the doctor’s decision on which to recommend. Some vaccines, including MMR and chickenpox, should be postponed until after pregnancy because the formulations contain live viruses. The HPV vaccine isn’t typically recommended during pregnancy, but if a woman receives it before knowing she’s pregnant there isn’t any risk to her or the baby.
Women who are planning a “babymoon” – a vacation before the baby arrives – should consider additional immunizations. Doctors can recommend specific vaccinations based on a patient’s personal history, risk factors, and travel destinations. Take a look at the Centers for Disease Control and Prevention’s Travelers Health guidelines for destination-specific information.
“Sometimes women are surprised when we ask questions that seem unrelated to pregnancy, such as how they’re managing chronic health conditions or whether their vaccinations are up to date. However, we know that such areas affect a woman’s health, not only during pregnancy but also for years after she gives birth.”
Health conditions we’ll address during pregnancy
Along with vaccinations, Ob/Gyns should take a step back and assess a woman’s current health and opportunities for improved care. For example, we routinely discuss Pap smears with our pregnant patients. While this test for cervical cancer isn’t part of a traditional prenatal visit, if a woman is due for one, it just makes sense to get it done while she’s there for prenatal care.
Additionally, the prenatal period is an opportunity to review a patient’s history of or risk factors for chronic health issues, including:
● Diabetes
● Mental health concerns, such as anxiety, depression, and stress
● Routine health care considerations, including dental care
We’ll also ask about partner status and family support at home. We want to help women transition smoothly from pregnancy to motherhood, and if our patients need a hand at home, we can suggest resources to close the gap.
Prenatal care is evolving to encompass more than healthy fetal development and surveillance for the development of obstetric problems. We’re moving toward a new era of care in which women are encouraged to think about their own health and seek the care they need during pregnancy that will optimize their health long after their babies are born.
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