Pharmacists and vaccination in pregnancy

Introduction Across Canada, pharmacists are increasingly involved in providing vaccinations. The accessibility of pharmacists provides opportunity to improve adult vaccination rates for influenza and other routinely recommended vaccines. Since pregnant women are an important segment of the population that may require vaccines, pharmacists should be aware of vaccine recommendations as well as contraindications in pregnancy. Physiologic changes that occur during pregnancy, such as alterations in the balance of type 1 and 2 T-helper cells, increase the susceptibility of pregnant women to illness. Vaccination in pregnancy provides protection not only for the woman but also for the fetus and infant in the first few vulnerable months of life (i.e., before infant vaccines can be given) and thus addresses a previous gap in vaccination coverage. However, misperceptions around the safety of vaccines have been shown to influence patient decisions to refuse vaccinations during pregnancy. Other commonly reported patient barriers include not receiving a provider recommendation for the vaccine and pregnant women perceiving they are not at risk for contracting the disease. This article highlights vaccines that are recommended in all pregnant women, as well as vaccines that should be avoided. The significant role and responsibility of pharmacists in proactively promoting maternal vaccination are also underscored (summarized in Box 1).