Uptake of Tetanus, Diphtheria, and Acellular Pertussis Immunization During Pregnancy in a Metropolitan Tertiary Referral Hospital [17]. (May 2015)

• Record Type: Journal Article
• Authors: Swaim, Laurie S.; Taylor, Rustin S.; Ng, Nancy; Rench, Marcia; Healy, Mary
• Is Part Of: Obstetrics and gynecology. Volume 125(2015)Supplement 1
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000463535.73772.17
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Tetanus, diphtheria, and acellular pertussis (Tdap) is recommended during each pregnancy, but national uptake is suboptimal. We audited Tdap uptake in a metropolitan tertiary referral hospital served by university-affiliated and private obstetric offices. METHODS: Audit of women delivering at Texas Children's Hospital Pavilion for Women, Houston, Texas, during April 2013 to June 2014. RESULTS: A total of 6, 583 deliveries occurred during the study period. Mean maternal age was 29.9 years (range 13–49 years); race and ethnicity was 66% white, 21% black, 7% Asian, 5% Hispanic, and 1% other. A total of 253 were multiple gestations: 230 twins, 21 triplets, and two quadruplets. Antenatal Tdap was administered to 3, 677 (56%) women. After education including the American College of Obstetricians and Gynecologists "toolkit, " Tdap uptake increased from 37% in April 2013 to a sustained uptake of 65% since November 2013. Where antenatal Tdap was administered, mean gestation at Tdap was 31.4 weeks. Ninety-five percent received Tdap at the recommended 27–36-week gestation and 73% during the 28–32-week gestation window judged optimal for placental transport. Ninety-six percent of vaccinated women received Tdap more than 14 days before delivery, the minimum period required for maternal antibody response to occur. Of 19 women with two pregnancies, four (21%) had Tdap during both. Black women were less likely to receive antenatal Tdap (41% compared with 60%; P <.001) than women of other races and ethnicities. CONCLUSION: Sustained antenatal Tdap uptake rates exceeding 65% were achieved with most women immunized at a gestation optimal for maternal antibody response and efficient placental transport. Further increases may require system changes such as best practice alerts in electronic medical records.