title: Use of the combined tetanus-diphtheria and pertussis vaccine during pregnancy.
abstract: OBJECTIVE
  A recent increase in pertussis cases prompted the Advisory Committee on Immunization Practices to recommend administering the perinatal tetanus, diphtheria, and pertussis (Tdap) vaccine during each pregnancy. We sought to describe uptake of Tdap and identify predictors of vaccination in pregnancy.
  
  
  METHODS
  We conducted a retrospective study of all women delivering at a university hospital between February and June 2013. Demographic, pregnancy, and vaccination data were abstracted from the medical record. The relationship between maternal age, parity, gestational age, race/ethnicity, marital status, prenatal provider/site, insurance, influenza vaccination status, and Tdap vaccine was described by univariate analysis. Independent predictors were identified by multivariable logistic regression.
  
  
  RESULTS
  In our cohort of 1467 women, 1194 (81.6%) received a Tdap vaccine. After adjusting for potential confounders, 3 factors were found to be independent predictors of receiving the vaccine. Patients were more likely to receive Tdap if they had been vaccinated against influenza during this pregnancy (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.4-2.3). Black women were less likely to receive Tdap when compared with other women (aOR, 0.42; 95% CI, 0.27-0.67). Also, women who delivered preterm were less likely to receive the Tdap vaccine (aOR, 0.33; 95% CI, 0.22-0.48).
  
  
  CONCLUSIONS
  A high overall Tdap vaccination rate was observed following implementation of the Advisory Committee on Immunization Practices guidelines. Black women, however, had significantly lower vaccine uptake than other women. Further research is needed to understand and minimize this disparity. Women who delivered prematurely also had a decreased rate of Tdap vaccination; vaccinating earlier should be considered to better capture this population.
authors.affiliation: Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: igoldfarb@partners.org.
authors.forename: Ilona T
authors.initials: IT
authors.lastname: Goldfarb
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Little
authors.affiliation: Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Joelle
authors.initials: J
authors.lastname: Brown
authors.affiliation: Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Riley
mesh_terms: D000328:Adult; D044383:Black People; D015331:Cohort Studies; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000276:immunology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy / Q000276:immunology*; D012189:Retrospective Studies; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
keywords: Tdap; pertussis; pregnancy; vaccination