Infectious Disease and Immunization in Pregnancy
Core concepts
Know vaccine recommendations in pregnancy: inactivated influenza vaccine and Tdap (each pregnancy, 27–36 weeks) and RSV vaccine timing per current guidance; live vaccines (MMR, varicella) are contraindicated. Understand group B streptococcus screening and intrapartum prophylaxis (penicillin; alternatives for allergy). Know the management of HIV in pregnancy (antiretroviral therapy, viral load suppression, mode of delivery based on viral load), syphilis (penicillin; desensitize if allergic), hepatitis B (newborn immunoprophylaxis), and varicella/zoster and toxoplasmosis counseling. Also understand cytomegalovirus and parvovirus risks.
Traps
A frequent trap is administering a live vaccine during pregnancy. Another is using an alternative to penicillin for syphilis in pregnancy - penicillin is required, with desensitization if needed. Questions may test that GBS prophylaxis is intrapartum, not antepartum treatment of colonization.
Rule of thumb
For any infection question, ask: Is this treated with a pregnancy-safe antimicrobial, and does the newborn need prophylaxis? Penicillin remains first-line for syphilis and GBS.