Safety of Tetanus, Diphtheria, and Pertussis Vaccination During Pregnancy: A Systematic Review

Obstet Gynecol. 2017 Mar;129(3):560-573. doi: 10.1097/AOG.0000000000001888.


Objective: To assess antenatal, birth, and infant outcomes for pregnant women, fetuses, and infants after antenatal vaccination with any antigen present in combination pertussis vaccines.

Data sources: PubMed, EMBASE, Literature in the Health Sciences in Latin America and the Caribbean,, Cochrane Library, and World Health Organization (inception to May 5, 2016).

Methods of study selection: Studies reporting outcomes for pregnant women, their fetus, or infant after antenatal exposure to either monovalent or combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) or inactivated polio vaccines were considered for inclusion.

Results: A total of 21 studies were included in this review. Point estimates ranged from 0.47 to 1.50 for preterm birth (less than 37 weeks of gestation), 0.65-1.00 for small for gestational age (birth weight less than the 10th percentile), 0.36-0.85 for stillbirth, 0.16-1.00 for neonatal death, 0.76-1.20 for low birth weight (less than 2,500 g), and 0.20-0.91 for congenital anomalies. All lower 95% confidence intervals (CIs) were less than 1.0. Of three retrospective studies assessing chorioamnionitis after vaccination, one showed a small but statistically significant increase. Point estimates for all anomalies after antenatal tetanus toxoid vaccination ranged from 1.20 to 1.60 and had 95% CIs that crossed 1.0. There was substantial clinical and methodologic heterogeneity from mainly retrospective observational studies with an overall high risk of bias. Objective rates of fever were low, 3% or below, and more common systemic events observed included headache, malaise, and myalgia.

Conclusion: Evidence suggests that antenatal combined Tdap administered during the second or third trimester of pregnancy is not associated with clinically significant harms for the fetus or neonate. Medically attended events in pregnant women are similar between vaccinated and unvaccinated groups.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Chorioamnionitis / epidemiology
  • Congenital Abnormalities / epidemiology
  • Diphtheria Toxoid* / adverse effects
  • Female
  • Fever / chemically induced
  • Headache / chemically induced
  • Humans
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Myalgia / chemically induced
  • Perinatal Mortality
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Premature Birth / epidemiology
  • Stillbirth / epidemiology
  • Vaccination* / adverse effects


  • Diphtheria Toxoid