Checking in on Tdap Vaccination during Pregnancy: How to Close the Coverage Gaps

As obstetrician–gynecologists, we know that the Tdap vaccine during pregnancy offers critical protection. It is our best means of preventing serious, sometimes fatal, symptoms of pertussis (whooping cough) in babies too young to be vaccinated. But the COVID-19 pandemic has stoked misinformation and hesitancy about vaccination generally. Preventive care has been widely deferred, so while concerning, it is not surprising that rates of Tdap vaccination during pregnancy fell slightly from 2020 to 2021, and coverage disparities endure, according to data from the CDC.

More encouragingly, while the CDC data highlights missed vaccination opportunities, it also points toward solutions. The CDC study reaffirmed that vaccine acceptance was highest among women who reported that clinicians both recommended and offered Tdap or referred them for the vaccination. Moreover, seven in 10 pregnant women who got the Tdap vaccine received it at an obstetrician–gynecologist or midwife’s office. Patient-centered, tailored conversations about the benefits of Tdap for babies, combined with easy access to the vaccine, can help broaden coverage. These findings highlight the critical role that ACOG members play in increasing Tdap vaccination rates among pregnant individuals.

Racial, Geographical, and Socioeconomic Coverage Gaps

Among the 2021 survey respondents who had recently given birth, 53.5% received Tdap during that pregnancy. This was slightly down from the previous year (56.6%). Disparities in Tdap coverage remain. Black and Hispanic women were far less likely than white women to have received Tdap during pregnancy. Coverage also lagged among Southern women, those living below the poverty line, and women whose health care was covered by Medicaid during pregnancy.

The coverage gaps reflect several key causes. These include discrepancies among clinicians recommending and offering the vaccine. In the CDC survey, 20% of new mothers reported that Tdap had not been recommended to them during pregnancy. Black women were less likely than white or Hispanic women to report that Tdap had been offered during their pregnancy. In addition, many patients remain unaware that Tdap is recommended in each pregnancy regardless of their vaccine history. Some patients express concern about the safety of Tdap, especially for their pregnancies.

Encouraging Tdap Vaccination in Pregnancy

The Advisory Committee on Immunization Practices and ACOG recommend Tdap vaccination during each pregnancy, preferably between weeks 27 and 36 of pregnancy. For more information on Tdap recommendations, see ACOG’s Committee Opinion Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination; Tetanus, Diphtheria, and Pertussis FAQs for Providers; and Tdap Immunization Tool kit.

Here are some ways in which obstetrician–gynecologists can help broaden coverage:

• Strongly recommend the Tdap vaccine to pregnant patients. Some evidence suggests that while clinicians may believe we’re already doing this, our recommendation may not register with or be remembered by patients. See strategies below.
• Incorporate Tdap vaccination into routine care. If a patient does not accept your recommendation initially, continue to offer the Tdap vaccine at subsequent visits.
• Administer Tdap in your practice, if possible. ACOG’s immunization resources includes extensive information on vaccine financing and coding; this could address perceived financial barriers to stocking vaccines. If necessary, refer patients to another vaccine provider.

Talking with Patients about Tdap Vaccination

• Say why Tdap is right for the patient. Consider sharing ACOG’s 90-second video, downloadable infographic in English and Spanish, and Ask ACOG feature.
• Emphasize the need to be vaccinated during every pregnancy, to protect each newborn.
• Reassure patients that extensive evidence shows Tdap is safe for them and for their pregnancies.
• Highlight stories of your patients’ positive experiences with Tdap.

Expanding vaccination acceptance has been a key element of my presidential term. While understandably a large emphasis is currently placed on COVID-19 vaccination, we cannot forget about other routinely recommended vaccines that also have the potential to save lives. Further, vaccine misinformation during the pandemic is frustrating for clinicians, and confusing and frightening for patients. Above all, it serves as a reminder to accelerate our efforts to improve vaccination access and hone our strategies for talking to patients about preventive care.