A primigravida at 12-weeks gestation who just moved to the United States indicates she has not received any immunizations. Which immunization(s) should the nurse administer at this time?

• A. Tetanus.
• B. Rubella.
• C. Diphtheria.
• D. Chickenpox.

Answer: (A)

Vaccines during pregnancy are chosen based on safety for the fetus and the mother's protection needs. Live vaccines, like rubella (MMR) and varicella, are avoided during pregnancy because of potential risk to the fetus, so those are given after delivery if the mother is nonimmune. Inactivated vaccines are preferred when vaccination is needed during pregnancy.

A tetanus-containing vaccine is appropriate to administer now. It is inactivated and safe for use during pregnancy, and it helps protect both the mother and the newborn from tetanus, including neonatal tetanus. The tetanus component is typically given as a tetanus-diphtheria combination (Td) or as Tdap, depending on the patient’s prior vaccination history. Diphtheria alone isn’t given as a stand-alone vaccine in this context, since it’s combined with tetanus. For nonimmune rubella or varicella, vaccination would be deferred until postpartum. If influenza season applies, an inactivated flu vaccine can be given in any trimester.