Copilas la 3 luni de viata intauterina

Textul in limba engleza poate fi cititi aici si informatiile sunt valabile pentru USA.

“Women of reproductive age often are unaware of their need for immunization, their own immunization status, and the potentially serious consequences of preventable disease on pregnancy outcome,” Dr. Pfeifer and colleagues note.

The authors add that “[m]any physicians are reluctant to immunize pregnant women because of concerns that a spontaneous abortion or incidental congenital anomaly might be attributed wrongly to a vaccination,” and that “[t]his fear persists despite the fact that there are few vaccines that are contraindicated during pregnancy.”

Contraindicated vaccines during pregnancy include measles, mumps, and rubella (MMR); varicella; and herpes zoster. Other vaccines are either fully recommended or recommended if some other risk factor is present.

Vaccinations during pregnancy are indicated when benefits clearly outweigh the risks. “Special circumstances that may influence the indication for vaccination include military service, travel to high prevalence areas, hazardous occupations, immunocompromise, and chronic illness,” the authors write.

According to the authors, national standards for vaccinations were last updated in February 2012 by the CDC, and the current guidelines pertain specifically to vaccinations in female patients with infertility.

The authors emphasize that physicians must assess the history of immunizations in women before beginning treatment for infertility.

Dr. Pfeifer and colleagues also note that immunization schedules are best completed before beginning treatment for infertility because some vaccinations should not be administered during pregnancy.

In the general population, routine vaccinations include those for MMR; varicella; influenza; tetanus-diphtheria-pertussis (Tdap); and tetanus-diphtheria (Td). Nonroutine vaccinations include those for pneumococcus, hepatitis A and B, and meningococcus.

With regard to specific vaccinations, the authors state that in fertility patients, MMR and varicella immunity should be documented before pregnancy. If nonimmune, the vaccine should be administered and pregnancy should be avoided for 4 weeks.

In addition, the influenza and Td immunizations should be completed before pregnancy but can be administered during pregnancy, and the trivalent inactive influenza vaccine can be given at any time during pregnancy.

According to the authors, injectable influenza vaccine contains inactivated virus and therefore may be administered at any time during pregnancy. In contrast, intranasal influenza vaccines contain live attenuated virus and should not be administered during pregnancy.

“[Tdap] was approved by the Advisory Committee on Immunization Practices…in 2011 and was recommended for adults (19 to 64 years of age) who have or who anticipate having close contact with an infant less than 12 months of age,” the authors note.

“Tdap should be given preferably during the third trimester or late second trimester,” they write.

In contrast, varicella, pneumococcus, hepatitis A and B, and meningococcus vaccinations are “indicated in specific circumstances and are always administered best before pregnancy,” the authors conclude. These vaccines are indicated for fertility patients only at high risk for infection.

The guidelines were not commercially funded. The authors have disclosed no relevant financial relationships.

Fertil Steril. Published online September 13, 2012. Abstract

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