<p><span>Though the 2009-2010 flu season has come and gone, worries about the upcoming flu season and its potential effect on pregnant women have not abated.  </span><span>With the support of educational campaigns through the Center for Disease Control, the general population was made aware of the potentially fatal H1N1 virus and identifying increased risk of serious complications. The disease had a particularly devastating effect on pregnant women. As of April 2010, 28 out of 700 reported cases in pregnant women resulted in a fatality, meaning one death out of every 25 women with H1N1. Because of this alarming mortality rate and to prevent further adverse outcomes, the medical world strove to increase the reach of patient education and awareness campaigns. <br /> <br />In October 2009, the Preeclampsia Foundation prepared a study to measure the effectiveness of these educational campaigns, as well as the proportion of pregnant patients who were receiving the H1N1 vaccine. Because of limited supplies, the CDC recommended the following limitations on those receiving the H1N1 vaccine: "These target groups included pregnant women, people who live with or care for children younger than six months of age, health care and emergency medical services personnel, anyone six months through 24 years of age, and people ages of 25 through 64 years of age at higher risk for 2009 H1N1 influenza because of certain chronic health conditions or compromised immune systems." Pregnancy, and possibly preeclampsia, alters the immune system in a way that makes women and their unborn babies much more likely to suffer dangerous complications from H1N1. </span></p>
<p style="margin: 0in 0in 4.5pt;"><span>The Preeclampsia Foundation asked women about the information they received from their doctors about both the regular flu and the H1N1, as well as whether they received either or both vaccines. Of 190 pregnant women surveyed by the Preeclampsia Foundation, an overwhelming 73% had been counseled by their doctors to receive the H1N1 vaccine. Surprisingly, of those, only 66% said they would likely receive the vaccine, with 15% saying they would "probably" receive it and another 18% saying they would not at all. The Preeclampsia Foundation Medical Board encouraged all pregnant women to strongly consider the non-live version of the H1N1 vaccine, as the risk of the vaccine is far lower than the risk to those who do not receive it. The protection of the vaccine also extends to the baby after birth.<br /> <br />As with preeclampsia, the key for improving health outcomes and decreasing mortality is to recognize the signs and symptoms and receive proper medical treatment immediately. </span></p>
<p style="margin: 0in 0in 4.5pt;"><span>Our Medical Board has requested that we post this warning to protect you. This applies to all pregnant women, regardless of whether or not you may have or get preeclampsia. You also may have heard the H1N1 virus mistakenly referred to as "swine flu."</span></p>
<p style="margin: 0in 0in 4.5pt;"><span>1) Strongly consider vaccination. </span></p>
<p style="margin: 0in 0in 4.5pt; padding-left: 30px;"><span>• The H1N1 vaccine is produced like the seasonal flu vaccine. <br />• The injected vaccine is not alive - it is considered safe for pregnant women. <br />• Vaccination is the BEST strategy to avoid H1N1. <br />• It will also help protect your unborn baby when he/she is born. </span></p>
<p style="margin: 0in 0in 4.5pt;"><span>2) Do you have a FEVER and COUGH or SORE THROAT?</span></p>
<p style="margin: 0in 0in 4.5pt; padding-left: 30px;"><span>• You may already have H1N1 - Act NOW! <br />• Call your doctor NOW. <br />• Immediate treatment with an antiviral drug such as Tamiflu® (oseltamivir) may be life saving and is recommended by the CDC. </span></p>
<p style="margin: 0in 0in 4.5pt; padding-left: 60px;"><span>o Treatment must be started early. <br />o Do not wait for H1N1 confirmation. <br />o Tamiflu® is thought to be safe in pregnancy. <br />o Tamiflu® 150 mg twice per day (dose is increased during pregnancy) </span></p>
<p style="margin: 0in 0in 4.5pt;"><span>3) Have you been exposed to H1N1? </span></p>
<p style="margin: 0in 0in 4.5pt; padding-left: 30px;"><span>• Call your doctor. <br />• Consider starting an antiviral drug such as Tamiflu®. </span></p>
<p style="margin: 0in 0in 4.5pt;"><span> </span><span>Want more information? </span></p>
<p style="margin: 0in 0in 4.5pt; padding-left: 30px;"><span>• You can read more about this issue in the article entitled "<a href="http://journals.lww.com/greenjournal/pages/default.aspx" target="_blank">H1N1 Influenza in Pregnancy: Cause for Concern</a>" in Obstetrics &amp; Gynecology. <br />• Visit the U.S. Centers for Disease Control and Prevention (CDC) <a href="http://www.cdc.gov/flu/" target="_blank">website</a> for information to take to your doctor. <br />• The <a href="http://www.marchofdimes.com/pnhec/188_57994.asp" target="_blank">March of Dimes</a> also has more information, explaining, for instance, why pregnant women are at higher risk. <br /></span></p>
<p style="margin: 0in 0in 4.5pt;"><span>The Preeclampsia Foundation encourages all of our members to take charge of their health and talk with their physicians about any medical concerns. This article is provided for informational purposes only and is not meant to substitute for the advice provided by your own medical professional or for diagnosing or treating a health issue.</span></p>

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A recent study in the September 2012 issue of Obstetrics & Gynecology took a look at the seasonal flu vaccine, recognizing that many women are concerned (check out our forum posts about it, here and here) about introducing any drugs or vaccinations during pregnancy.

During the 5-year study period, over 10,000 women received the seasonal influenza vaccine while they were pregnant, a few during the first trimester, but most of them during the second and third trimesters. The babies born to those mothers who got vaccinated in any trimester did not have an increase in major malformations. In addition, stillbirth or neonatal death, as well as premature delivery were significantly decreased in the vaccinated group. Although this study corroborates other similar research and further supports CDC reports, one of its newer findings is that getting vaccinated in the first trimester was not associated with an increase in major malformation rates and was associated with a decrease in the overall stillbirth rate.

Further, the flu vaccine will also provide some secondary passive immunity (antibody transfer to the baby) to the newborn during a very vulnerable time, especially important if they are babies from preeclampsia-complicated pregnancies since that often means prematurity or growth restriction. Pregnant women who get the flu shot pass their immunity to their babies in the form of flu antibodies. Influenza protection was seen in newborns up to four months old. Babies born to women who were not vaccinated during pregnancy showed no antibody protection.

When the "swine flu" and its associated vaccine first made news several years ago, we researched the issue and reported that the H1N1 vaccine, as it was more accurately labeled, was safe and in fact recommended for pregnant women as a protection against that dangerous virus. Fortunately, that version of the flu has pretty much come and gone for now.

However, another disease that is very dangerous to new babies is whooping cough. While it may result in an annoying cough to the mother, it can be lethal to newborns. Research studies have similarly supported the safety of that vaccine.

"It is much better to get vaccinated during pregnancy and have your newborn somewhat protected, before starting the usual schedule of infant immunizations," explains Dr. Tom Easterling, Director of the Foundation's Medical Advisory Board and a Maternal-Fetal Medicine physician at the University of Washington.

What does all that mean for you? It's flu season and unless you live in a plastic bubble, you should get yourself inoculated against the seasonal flu and whooping cough, even if you're pregnant. It has no bearing on whether or not you will develop preeclampsia. Most local pharmacies offer the vaccines for very a low fee; your doctor's office or local clinic often provide easy-to-schedule nurse appointments; and public health departments provide them at no cost for qualified individuals. More information including where you can get the flu shot and who's most vulnerable can be found here.

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The Preeclampsia Registry

    The Preeclampsia Registry is a "Living Database" bringing together those affected, their family members, and researchers to advance knowledge and discover preventions and treatments for preeclampsia, HELLP syndrome, and related hypertensive disorders of pregnancy.

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