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Receipt of the Tetanus, Diphtheria, and Acellular Pertussis Vaccine During Pregnancy and Risk for Maternal Acute Respiratory Infection Within 6 Months Postpartum


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Since October 2012, the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine has been recommended for administration during every pregnancy, with optimal timing between 27% and 36% weeks gestation. This approach increases transplacental immunity and protects infants from pertussis infection before they begin the vaccination series against the disease. However, few studies have assessed whether pregnancy Tdap vaccine exposure affects maternal pertussis antibody levels or postpartum risk for pertussis infection. In this records-based analysis of pregnant active duty U.S. military women, Department of Defense Birth and Infant Health Research program data were leveraged to determine whether exposure to the Tdap vaccine during pregnancy influenced maternal risk for acute respiratory infection (ARI) within 6 months postpartum; ARI was used as a proxy for pertussis infection because clinical diagnosis of pertussis is rare. Overall, we identified 99,884 pregnancies that resulted in a singleton live birth; 13,573 (13.6%) pregnancies were exposed to the Tdap vaccine. Maternal ARI within 6 months postpartum was identified among 18.2% and 20.7% of exposed and unexposed women, respectively (adjusted risk ratio = 0.90, 95% confidence interval = 0.870.93). Associations were generally similar across exposure definitions (i.e., timing of exposure during pregnancy and before delivery) and subgroup analyses that considered other maternal vaccination characteristics (i.e., pre-pregnancy Tdap vaccine exposure, Tdap vaccine exposure within 6 months postpartum, and influenza vaccine exposure during pregnancy or within 6 months postpartum). Although we found that Tdap vaccine exposure during pregnancy was associated with a small, reduced risk for maternal ARI within 6 months postpartum, our results must be interpreted with caution because the Tdap vaccine does not confer immunity against all ARIs.



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