INTRODUCTION

Maternal immunization protects both the mother and fetus from the morbidity of certain infections. It can also provide the infant passive protection against infections acquired independently after birth [1]. Ideally, immunizations are given prior to conception, but administration during pregnancy is indicated in some situations.

Nonimmune women are immunized during pregnancy when there is a high risk of exposure to an infection, the infection is hazardous to mother or fetus, and the immunizing agent is unlikely to cause harm. Despite maternal immunological adaptations to pregnancy, immunization of pregnant women appears to be as effective as in nonpregnant women [2].

The Infectious Diseases Society of America has published general guidelines for immunization of pregnant women [3]:

• Providers should be aware of immunizations routinely recommended for all pregnant women (tetanus, diphtheria, influenza) (see 'Routine immunizations' below).
• Providers should administer appropriate vaccines to pregnant women with medical or exposure indications that put them at risk for vaccine preventable infections (see 'Selective immunization of high risk groups' below).
• Following delivery, postpartum women should receive all recommended vaccines that could not be or were not administered during pregnancy (eg, measles/mumps/rubella, varicella, Tetanus toxoids diphtheria acellular pertussis vaccine [Tdap]) (see 'Postpartum immunization' below).
• Providers should be aware of and follow contraindications and precautions for immunization of pregnant women.

Obstetrician-gynecologists are often the primary clinician for women of child-bearing age; as such, they are in a good position to screen for immunization status and to provide appropriate vaccinations. However, financial factors (eg, inadequate reimbursement, cost of storing vaccines) and knowledge about vaccine counseling, safety, and administration appear to be barriers to vaccine administration in OB/GYN offices [4,5].