Monday, November 9, 2009

H1N1, Tamiflu, and Pregnancy

I wrote a long, thoughtful, and, let's face it, wonderful post all about H1N1 and pregnancy. And then somehow I managed to delete it before it was posted. It happens to everyone, but that doesn't make it less annoying.

The gist of the post was concern over following up on the use of Tamiflu during pregnancy. Due to a number of factors, pregnant women should be concerned about flu. Women are much more likely to suffer complications and risk death due to flu during pregnancy, and Tamiflu may be a life-saving drug. Conversely, Tamiflu is a Category C drug in pregnancy. To be classified a Category C drug, the drug must either be untested in pregnant women or have had concerning animal studies. In the case of Tamiflu, some research has demonstrated skeletal anomalies in fetal mice. How does this translate to humans? Perhaps it doesn't. Oftentimes those studies use ridiculously high dosages. Mice physiology clearly differs from human. And the timing of the medicine is likely to make a difference, with the higher risk during the first trimester as opposed to later in the pregnancy. 

This brings up the ethical concern of a woman's right to chose her treatment. If a woman refuses treatment could she be charged with fetal endangerment? Or if she did accept treatment and had a negative outcome, could she (or her health care provider) be charged with the same thing?

There is an urgent need to follow up with women who have taken Tamiflu during their pregnancies to establish the safety of the drug. I would not want to see a woman decline what might be a life-saving intervention for fear of injuring her fetus -- I have already heard of women who have made this choice and I have heard of OBs who refuse to write the prescription for pregnant women. We must ensure that the science keeps up with the H1N1 outbreak, at least as much as possible.  

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