Shari Roan

US Medical Groups Urge Pregnant Women to Get ‘Swine Flu’ Vaccine

As the H1N1 influenza vaccine trickles into clinics and pharmacies over the next few weeks, public health officials and doctors desperately hope that pregnant women will be at the front of the line for the shot.

Past influenza pandemics have proved that they’re at increased risk for severe complications — and they appear to be even more vulnerable to this new flu strain.

On Oct. 22, a consortium of major medical groups, including the American Medical Association, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists, released a statement pleading with pregnant women to get both the H1N1 and seasonal flu vaccines.

But pregnant women have a well-established antipathy toward vaccinations, with only 15 percent getting the vaccine in any given year, compared to 30 percent of the general population, according to the CDC reports.

The current shortage of vaccine may further stymie efforts at immunization. Also, pregnant women distrust medications in general, at least one of which could prevent or mitigate the infection should they be exposed.

All of these factors indicate doctors’ hopes will go unrealized even as rates of deaths, hospitalizations and preterm births rise. “We may have to hospitalize more pregnant women than we ever have before,” said Dr. Allison Bryant, an assistant professor of obstetrics, gynecology and reproductive health at the University of California, San Francisco, who has studied the current pandemic’s effects on pregnant patients.

By Aug. 21, the latest date for which numbers are available, pregnant women accounted for 6 percent of the 484 confirmed deaths linked to the so-called swine flu, although they make up only 1 percent of the population.

As for pregnant women diagnosed with flu, of the 700 cases reported to the CDC, 14 percent required admission to an intensive care unit — four times the hospitalization rate of non-pregnant women of similar age. That number is likely an underestimate, CDC officials said, because many cases aren’t confirmed by testing.

Further, many pregnant women are teenagers or young adults — among the groups most likely to develop severe cases of influenza.

“These otherwise healthy, pregnant women can deteriorate rapidly,” said Dr. Denise Jamieson, a medical officer in the CDC’s division of reproductive health. “We have seen some cases where pregnant women present in the emergency room and they are already so sick they are intubated and delivered very quickly.”

Unlike in previous pandemics, pregnant women have two options for protection this year: the H1N1 vaccine — for which they and young children have been given priority — and the antiviral medication Tamiflu.

“We usually say pregnant women should only take medications for which the benefits outweigh the risks,” Bryant said. “But we certainly believe that is the case with H1N1.”

Flu, in general, causes more complications in pregnancy because a woman’s immune system is naturally weakened to prevent her body from rejecting the fetus. That boosts the chances of secondary infections, such as pneumonia.

In previous pandemics, pregnant women had a 50 percent higher chance of developing pneumonia compared with other infected people, and such women were 50 percent more likely to die.

Pneumonia poses a particular threat to pregnant women because of their limited lung capacity, and the H1N1 strain appears to settle deeper into the lungs of young people.

The risk of flu complications is highest for women infected during the third trimester, when lung capacity is most reduced because of pressure from the fetus.

Pregnant women with asthma or other chronic health conditions are at especially high risk for complications — as are those who are obese or poor, who are current or former smokers or who have underlying heart disease.

Flu is not thought to be transmitted to the fetus, but the infection’s indirect effects, such as high fever, can increase the risk of neural tube defects.

Mari Abrams, 34, is 28 weeks pregnant with her second child and works in a marketing department at a hospital. She has spent the past few weeks seeking advice from her doctor, friends and family and on the Internet about the vaccine and has gone from reluctant to convinced.

“I’m going to be one of the first in line to get the vaccine,” said the Los Angeles woman. “At some point, I have to trust that this has been tested and they’re looking out for our well-being.” LA Times

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