Tdap (Whooping Cough) Vaccine Safety & Risks
What is the Tdap vaccine?
Tdap stands for tetanus, diphtheria, and acellular pertussis. The Tdap vaccine helps protect you and your baby from three diseases: diphtheria, tetanus and pertussis. You may have also heard of the Tdap vaccine referred to as the “whooping cough” vaccine. “Whopping cough” is another name for pertussis.
Why should I get the Tdap vaccine when I’m pregnant?
The Tdap (whooping cough) vaccine is recommended during the third trimester of pregnancy because it helps protect your newborn from whooping cough (pertussis). Babies are not able to get the whooping cough vaccine until they are two months old, so they are vulnerable to whooping cough infection in the first few months of life. When a pregnant individual is vaccinated for whooping cough during pregnancy, their body produces germ fighting cells that cross the placenta and can help protect their newborn baby until they can be vaccinated.
What is whooping cough (pertussis)?
Whooping cough, or pertussis, is an infection that cause svere coughing and sometimes difficulty breathing. It can affect anyone, but the infection is most serious in newborn babies, and can even cause death. Unfortunately, the CDC reports that about 30% of babies in the U.S. <1 year-old who get whoopingcough are hospitalized and 1 in 100 who need treatment in the hospital die.Newborns whose mothers did not receive the Tdap vaccine in pregnancy are at greater risk of severe illness.
Source:
https://www.cdc.gov/pertussis/about/complications.html
What are the recommendations for the Tdap vaccine in pregnancy?
The most reputable society of doctors caring for pregnant women, the American College of Obstetrics and Gynecology, recommends that pregnant individuals get the Tdap/whooping cough vaccine between 27 and 36-weeks of pregnancy. Vaccinating during this time allows the pregnant person’s body to make cells that detect and fight off germs and transfer those cells to the baby. Pregnant individuals should receive the Tdap vaccine during every pregnancy.
Source:
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/09/update-on-immunization-and-pregnancy-tetanus-diphtheria-and-pertussis-vaccination
Is the Tdap vaccine safe for me and my baby?
Yes! Studies have shown that there is no increased risk to you or your baby after receiving the Tdap vaccine during pregnancy.
Should people in my family also get the Tdap vaccine?
Most adults will have received the Tdap vaccine at some point during adolescence. If an adult in close contact with your baby has never received a Tdap vaccine, the American College of Obstetricians and Gynecologists recommends the adult receive a Tdap vaccine 2 weeks before visiting your baby.
Source:
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/09/update-on-immunization-and-pregnancy-tetanus-diphtheria-and-pertussis-vaccination
Where can I get the Tdap vaccine?
Most clinics carry the Tdap vaccine and you can receive the vaccine at one of your routine visits. If your provider does not carry the Tdap vaccine, most local pharmacies can provide the vaccine.
COVID-19 Vaccine Safety & Risks
Numerous studies including thousands of pregnant and breastfeeding individuals have shown that COVID-19 vaccinations are safe and effective. More than 100,000 pregnant individuals in the US have already received one of the COVID-19 vaccines.
We have included a Google Doc table that summarizes the findings on the safety of COVID-19 vaccination in pregnancy from more than 25 studies in different countries that include more than 315,000 pregnant women. Overall, there was no harmful effect of COVID-19 vaccination on pregnancy outcomes found in any of these studies. Some studies found that women vaccinated for COVID-19 had a lower risk of preterm birth, stillbirth, a small baby, or having a newborn that required admission to a neonatal intensive care unit. This means that these studies found that COVID-19 vaccination supported healthier pregnancy outcomes. If you read this document, it uses abbreviations to describe the many pregnancy outcomes that were studied. Here is what some of these abbreviations mean. "PTB" means a preterm birth that occurs at least 3 weeks earlier than the expected due date. "NICU" stands for a neonatal intensive care unit. "SGA" means having a smaller baby than would be expected based on the time (gestational age) in pregnancy when the baby was delivered.
Thank you to Viki Male, a Lecturer in Reproductive Immunology at the Imperial College London for updating this document.
Source:
https://docs.google.com/document/d/19FNXcmdI0MU6RPmvKYo_g9zEWPKl2-l760OX_8zww3E/edit
How can I be sure the COVID-19 vaccine is safe for me and my baby?
Numerous studies including thousands of pregnant and breastfeeding individuals have shown that COVID-19 vaccinations are safe and effective. More than 100,000 pregnant individuals in the US have already received one of the COVID-19 vaccines.
We have included a Google Doc table that summarizes the findings on the safety of COVID-19 vaccination in pregnancy from more than 25 studies in different countries that include more than 315,000 pregnant women. Overall, there was no harmful effect of COVID-19 vaccination on pregnancy outcomes found in any of these studies. Some studies found that women vaccinated for COVID-19 had a lower risk of preterm birth, stillbirth, a small baby, or having a newborn that required admission to a neonatal intensive care unit. This means that these studies found that COVID-19 vaccination supported healthier pregnancy outcomes. If you read this document, it uses abbreviations to describe the many pregnancy outcomes that were studied. Here is what some of these abbreviations mean. "PTB" means a preterm birth that occurs at least 3 weeks earlier than the expected due date. "NICU" stands for a neonatal intensive care unit. "SGA" means having a smaller baby than would be expected based on the time (gestational age) in pregnancy when the baby was delivered.
Thank you to Viki Male, a Lecturer in Reproductive Immunology at the Imperial College London for updating this document.
Source:
https://docs.google.com/document/d/19FNXcmdI0MU6RPmvKYo_g9zEWPKl2-l760OX_8zww3E/edit
I have kept my family safe so far by masking, hand washing, and social distancing. Why is it still important to get vaccinated against COVID-19?
Great question! Thousands of Americans have been unfortunately surprised when they acquired COVID-19 despite being very careful. It’s tough to control for every possible exposure especially when masking isn’t universal in all communities. The Delta variant of COVID-19 is highly infectious and two times as contagious as the original COVID-19 strain. It is as infectious as chicken pox. Given the risks in pregnancy of COVID-19 and the safety of the COVID-19 vaccines, it is highly recommended to become vaccinated in pregnancy or while breastfeeding. This is the best way to protect you and your family.
Can I get the COVID-19 vaccine and another vaccine at the same time?
Yes. The immune system is very skilled at making protective antibodies to different vaccines or infections at the same time. Common prenatal vaccines like the influenza and the TdAP (tetanus/pertussis) are recommended in all pregnancies and can safely be paired with the COVID-19 vaccines.
I’m worried that pharmaceutical companies rushed the production of the vaccine for financial gain. Why should I trust them that the vaccine is safe?
The COVID-19 vaccine was developed quickly, but the clinical trials to examine the safety and efficacy were not rushed. Vaccine development and testing often takes years because there is a lot of bureaucratic and administrative hurdles that often take a long time. Due to the pressing public need, these administrative blocks were minimized without compromising the many months needed to conduct thorough testing. And while companies do make money off of vaccines, they are often the least profitable product in comparison to other drugs like Viagra.
We understand that it can be difficult to trust pharmaceutical companies, especially considering their role in the current opioid crisis. However, the vaccine still has no individual cost to you and is an important measure in protecting the health of you and your child, just like taking prenatal supplements and wellness checks.
There is so much conflicting information out there about vaccine safety. How can I tell what’s accurate?
There has been so much conflicting information online, especially in the media. We recommend following traditional misinformation debunking techniques:
1. First, identify the source of the information you are seeing. Is it a reputable source? Is the source from a well-established, scientifically credible organization such as the CDC, American College of Obstetrics & Gynecology or the, Society for Maternal and Fetal Medicine etc. If the source is an individual, what are their credentials? If it's difficult to assess, always feel free to ask your OB provider. They are on your care team and happy to help you find accurate and trusted information about the COVID-19 vaccine.
2. Find coverage on the topic from multiple sources. What do multiple experts, outlets, and organizations say about the topic?
On this page, we have referenced all of our answers with scientific studies and recommendations from highly credible medical societies. Thousands of pregnant and breastfeeding individuals have contributed to these studies.
Sources:
• The American College of Obstetricians and Gynecologists Podcast: Episode 1: “COVID-19 Vaccine Development and Safety”
• The American College of Obstetricians and Gynecologists Podcast: Episode 2: “Maternal Health Disparities and COVID-19”
• The American College of Obstetricians and Gynecologists Podcast: Episode 4: “Dismantling Myths about COVID-19 Maternal Health”
• The American College of Obstetricians and Gynecologists Podcast: Episode 5: “The Mental Health Toll of COVID-19 and Looking to the Future”
Risks of COVID-19 Disease While Pregnant
What are my risks of COVID-19 in pregnancy or soon after delivery?
Pregnant or recently pregnant individuals acquiring COVID-19 have a much higher risks of dying, being hospitalized, needing a breathing tube, and having a preterm birth or stillbirth. In a short time, 15 pregnant women died of COVID-19 in Mississippi alone and 8 of those deaths occurred in a few months during a Delta variant peak in 2021. Being overweight at the start of a pregnancy or having diabetes further increases these risks. Overall, pregnant individuals with COVID-19 are 22 times more likely to die in pregnancy compared to uninfected pregnant people.
When pregnant individuals become ill with COVID-19 and need a ventilator, one way to improve their breathing is by delivering the baby. This means that delivering a baby prematurely (weeks or months too early) could help the pregnant person survive, but at the expense of the baby’s health. One study found that unvaccinated pregnant individuals with COVID-19 had a 59% higher rate of preterm birth compared to those without COVID-19. Preterm birth is harmful for your baby and can lead to serious complications including developmental and physical disabilities, long NICU stays, and even fetal death.
Sources:
• CDC: COVID-19 Vaccination for Pregnant People to Prevent Serious Illness, Deaths, and Adverse Pregnancy Outcomes from COVID-19
• WJTV: 72 unborn babies, 15 pregnant women have died due to COVID-19 in Mississippi
• CDC: People with Certain Medical Conditions
• JAMA Pediatrics: Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection
Does the COVID-19 disease cause stillbirth?
Yes. When pregnant people become ill with COVID-19,damage can occur to the placenta. Pregnant people with COVID-19 disease had double the risk of stillbirth with the early SARS-CoV-2 variants. The Delta variant has been linked with a 4x higher risk of stillbirth. High levels of virus have been found in a stillborn fetus in several cases after the mother had COVID-19.
Vaccine Recommendations
What are the current recommendations regarding the Johnson & Johnson vaccine?
The Washington State Department of Health (DOH) is recommending people 18 and older choose to receive an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) instead of the single-shot Johnson & Johnson (J&J) vaccine. This update follows guidance and recommendations from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and the Western States Scientific Safety Review Workgroup. Individuals who wish to receive the J&J vaccine are encouraged to reach out to their health care provider to discuss their options as J&J will still be available.
The preferential recommendation follows new data presented to the ACIP about thrombosis and thrombocytopenia syndrome, or TTS. TTS is a rare but serious condition involving blood clots and a low blood platelet count seen in some people who received the J&J vaccine. However, the risk is rare. Nationwide, 54 cases of TTS, including nine confirmed deaths, have been reported, which is a fraction of a percent of the 14 million doses of J&J given overall. While TTS has been seen in both men and women, the most at-risk group is women 30through 49. People who received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider.
With this recommendation, COVID-19 vaccines based on mRNA are preferred over J&J vaccine, but J&J continues to be an option for those who aren’t able to receive mRNA vaccine.
How Do the COVID-19 Vaccines Work?
How do COVID-19 mRNA vaccines (Pfizer and Moderna) work?
All of the COVID-19 vaccines “train” the immune system to identify, attack and destroy a tiny piece of the virus. This is how your immune system “learns the enemy” and can then quickly respond and bring in waves of immune cells to defeat the real virus in the future.
The Pfizer and Moderna vaccines work by introducing messenger RNA (mRNA) into muscle cells. The cells make lots of copies of the COVID-19 spike protein, which triggers the body to make a protective immune response. The mRNA is quickly degraded, because the cell breaks it up into small harmless pieces after a few days. mRNA is very fragile, which is one reason the Pfizer vaccine needs to be kept in very cold freezers. There is no “live virus” in the COVID-19 vaccine or any other harmful ingredients, thus making the COVID-19 vaccine safe for pregnant and breastfeeding individuals.
Source: CDC: Understanding mRNA COVID-19 Vaccines
Variants, Boosters, and Prior COVID-19 Infection
I had COVID-19. Do I still need the vaccine?
Yes. Compared to natural infection, the vaccine triggers the body to make powerful protective antibodies, which are successfully transferred to fetuses during pregnancy. Many people have become sick with COVID-19 more than once, which is likely the case due to the weaker immune response that comes from natural infections.
What do we know about the new COVID-19 virus variants and pregnancy outcomes?
Every few months it seems that we are confronted with a new COVID-19 virus variant. In the case of the Delta variant, pregnant people acquiring this COVID-19 variant were reported to have a 2-4 times higher risk of severe disease, preterm birth and needing to be placed on a ventilator. Whether new COVID-19 variants will cause more or less infections and severe disease in pregnancy will take time to figure out. As pregnant individuals are one of the highest risk groups for severe COVID-19 disease and death, it is extremely important to get vaccinated, receive a COVID-19 vaccine booster when eligible, stay careful with masking, social distancing and keeping your “bubble” small.
COVID-19 Vaccines and Your Menstrual Period and Fertility
Is there a link between the COVID-19 vaccine and changes in periods?
This is being studied, but appears to be rare. Period changes might occur in far less than 1% of individuals and are short-lived. In the United Kingdom, out of more than 49.1 million women who have been vaccinated there were 41,332 reports of possible menstrual cycle changes (0.0008%).
A normal period can vary widely from person to person and month to month. Exercise, diet and even stress can change a period, as well as lots of medications including birth control. Several studies in different countries indicate that the psychological stress of the pandemic has increased the irregularity of women’s periods. In a study of 127 women with the COVID-19 disease, 16% noticed changes in their menstrual cycle, which most commonly was reported as an irregular period. Interestingly, women reporting more COVID-19 symptoms were more likely to have an abnormal period. In summary, it appears that irregular periods are commonly reported after COVID-19 disease (16%), especially when women are ill, and rare after COVID-19 vaccination (<1%). More research is still being done on this topic.
Sources:
• National Institute of Child Health and Development (NICHD): NIH funds studies to assess potential effects of COVID-19 vaccination on menstruation
• American Journal of Obstetrics & Gynecology (AJOG): SARS-CoV-2 infection and subsequent changes in the menstrual cycle among participants in the Arizona CoVHORT study
• Frontiers in Endocrinology: The Impact of the COVID-19 Pandemic on Women’s Reproductive Health
• The Journal of Obstetrics and Gynaecology Research: The impact of COVID-19-related mental health issues on menstrual cycle characteristics of female healthcare providers
• The Journal of Obstetrics and Gynaecology: Triangle of COVID, anxiety and menstrual cycle
• The American College of Obstetricians and Gynecologists Labor of Love Podcast: Episode 3: “Understanding COVID-19 and Fertility”
Can COVID-19 disease harm male fertility or his sex life?
Yes. There are many studies now supporting that COVID-19 disease can temporarily harm a man’s fertility or permanently harm a man’s ability to have an erection. After reviewing research databases, the American Society for Reproductive Medicine said, "No evidence of any connection between COVID-19 vaccines and male infertility was found, but there were 50 reviews, 17 commentaries/letters to editors and nine original articles on how COVID-19 disease could possibly impact male fertility." We have listed some of the ways that COVID-19 disease can do this below:
1. Temporary decrease in sperm count and quality: A severe illness (of any kind) is known to lower sperm counts in men for 3-6 months, as having a fever during a severe illness disrupts the process of making sperm. Therefore, it is not surprising that men who have had COVID-19 disease have been reported to have lowered sperm count and quality. In general, changes in sperm count due to an infection are typically short-term and recover after 3 months of time. Longer term studies of sperm count and quality in men recovering from COVID-19 are needed.
2. Testicle swelling and pain. Several studies indicate that about 10-22% of men with COVID-19 disease will experience swelling of the testicles and pain, possibly due to a direct infection of the testes.
3. Erectile dysfunction. COVID-19 is known to injure blood vessels in many organs including the lungs, heart and brain leading to higher rates of heart attack and stroke. A penile erection depends on strong blood flow into the penis and healthy veins as well as, testosterone. There are many reports and studies of men losing their ability to have an erection after COVID-19 disease, which may be due to blood vessel damage, lower testosterone and/or psychological distress. How frequently this might occur is unknown.
Sources:
• First International Journal of Andrology: Impaired semen parameters in patients with confirmed SARS-CoV-2 infection: A prospective cohort study
• Canadian Urological Association Journal: Effect of SARS-CoV-2 infection on semen parameters
• The World Journal of Men's Health: Evaluation of SARS-CoV-2 in Human Semen and Effect on Total Sperm Number: A Prospective Observational Study
