Wednesday, July 29, 2009

H1N1 and Pregnancy

Pregnancy can be scary enough as it is, but here's one more thing to worry about: Pregnancy is emerging as a critical risk factor for H1N1 complication and death. In a recent study, investigators found that of the 45 H1N1 deaths reported between 4/15/09 and 6/16/09, 13 percent were previously healthy pregnant women. Pregnant woman were four times more likely to be hospitalized due to H1N1 infection.

Seasonal flu disproportionately affects pregnant women also. While it is not completely clear why, there are a few theories. First, during the later stages of pregnancy, the growing fetus compresses the diaphragm, giving the mother overall lowered lung capacity. Second, the mother’s immune system changes, compensating for the growing body inside her. This change may lower her ability to fight the influenza virus.

Pregnant women will likely be a target group for H1N1 vaccination, although safety of the vaccine in pregnancy has yet to be determined. In terms of the season flu vaccine, safety has been demonstrated and pregnant women are encouraged to be vaccinated. Likewise, household members are encouraged to get the seasonal shot so that they will not give the flu to the new baby.

A health educator colleague of mine is pregnant. She has done a lot of educational work on flu prevention, while worried about her own safety. She has expressed concerns about the risks and benefits of taking the H1N1 vaccine. Fortunately for her, her baby will be here before the vaccine is released, so the point is moot. But clearly if we are promoting this vaccine to this population, evidence of vaccine safety must be a priority. Is there time to establish that if the vaccine is due out in a few months?

I know I am sounding like a broken record here but more and more I find myself on the fence over the whole issue.

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