Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.
Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
J Matern Fetal Neonatal Med. 2021 Oct;34(20):3415-3444. doi: 10.1080/14767058.2019.1680633. Epub 2019 Oct 24.
Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization for women during pregnancy (the so-called "maternal immunization") has been introduced in several countries, and recently also in Italy, to protect mother and fetus during pregnancy, infant in his first months of life and mother during postpartum period. However, very low vaccination coverage rates have been reached due to several variables.
A literature search was conducted on PubMed and Embase, including any experimental or observational studies, to assesses existing evidence on the effectiveness, efficacy, safety and optimal timing of administration of Tdap and influenza immunization in pregnancy for mothers and their infants. The search was finalized in August 2019.
Reviewing the literature, we identified only a few studies that, among several maternal and infant outcomes, found sporadic significant associations with maternal influenza immunization and even less with Tdap immunization. Moreover, most of the authors of these studies explained these findings as a result of residual confounding effect. The effectiveness of maternal influenza immunization is more complicated to prove than the effectiveness of Tdap immunization because of several reasons. Not all nations recommend and offer vaccines in the same weeks of pregnancy and this one manifests the complexity in defining the best timing for Tdap or influenza immunization.
The safety of maternal Tdap or influenza immunization is supported by the evidence so far, however, regular surveillance should be maintained, especially with regard to the influenza vaccine that changes in formulation each year. There is a need to optimize the timing of vaccination in pregnancy and to have a national system of detection of maternal immunization in each country.
在一些国家，孕妇接种破伤风、白喉和无细胞百日咳（Tdap）以及流感疫苗（所谓的“孕妇免疫接种”）已被引入，最近意大利也开始采用这种方法，以在孕期保护母婴，以及婴儿在出生后的头几个月和母亲在产后期间的健康。然而，由于多种因素，疫苗接种覆盖率非常低。
我们在 PubMed 和 Embase 上进行了文献检索，包括任何实验或观察性研究，以评估 Tdap 和流感疫苗在孕妇中的有效性、功效、安全性和最佳接种时间的现有证据。搜索于 2019 年 8 月结束。
在文献回顾中，我们仅发现了少数几项研究，这些研究在几个母婴结局中发现了与孕妇流感免疫接种偶有显著关联的结果，而与 Tdap 免疫接种相关的结果则更少。此外，这些研究的大多数作者将这些发现解释为残余混杂因素的结果。由于多种原因，证明孕妇流感免疫接种的有效性比 Tdap 免疫接种的有效性更为复杂。并非所有国家都在同一孕期周推荐和提供疫苗，这就使得确定 Tdap 或流感免疫接种的最佳时间变得更加复杂。
迄今为止，孕妇接种 Tdap 或流感疫苗的安全性得到了证据的支持，但仍需进行定期监测，尤其是在流感疫苗每年都在改变配方的情况下。需要优化孕期疫苗接种的时间，并在每个国家建立一个国家性的孕妇免疫接种检测系统。
