Baby & Toddler - December 2008

Flu Shots Recommended During Pregnancy

By Elizabeth Heubeck
Have you gotten your flu shot yet? You may think you can sit this season out because you’re pregnant. But you shouldn’t.
During pregnancy, your risk of complications from the flu increases. What’s more, a flu shot will not only protect you, but it will also protect your newborn from the flu during the first few months of life. If this news comes as a surprise to you, you’re not alone.
Misconceptions abound about the effects of the flu shot during pregnancy. Many pregnant women don’t recognize the importance of getting a flu shot; countless moms-to-be even think it may be harmful. That’s according to a recent survey of 528 U.S. women either pregnant or with a child under 2 years of age.
Specifically, an overwhelming 75 percent of respondents were unaware or unsure of long-standing national health recommendations that women receive a flu shot during pregnancy. Only 20 percent of respondents who were pregnant planned to get a flu shot during influenza season. These findings, released in October 2008, were culled from a Harris Interactive survey conducted for the non-profit National Women’s Health Resource Center (NWHRC).
The survey findings come in the midst of the public information campaign Flu-Free and a Mom-to-BE: Protect Yourself, Protect Your Baby—Get a Flu Shot, sponsored by NWHRC and the Association of Women’s Health, Obstetrics, and Neonatal Nurses (AWHONN). The campaign aims to drive home a decade-old message of the importance of the flu shot for moms-to-be, combined with an exciting new message of how it boosts babies’ immunity during the first few months of life.
“The Centers for Disease Control has been recommending the flu vaccine during pregnancy since 1998. Many gynecologists and nurse midwives have been regularly recommending and providing it,” says Catherine Ruhl, a certified nurse midwife and associate director of Women’s Health Programs at AWHONN.
And yet, a disconnect remains between pregnant women’s perceptions regarding the flu shot and health providers’ recommendations. To bridge this information gap, Ruhl urges pregnant moms to get a flu shot based on the following findings.

Why Extra Protection While Pregnant
Ruhl and other health care providers routinely encounter pregnant women who think: “I’m healthy, I feel great, and I rarely get sick—why should I get a flu shot just because I’m pregnant?”
The reality is that physiological changes during pregnancy lower your immunity, placing you at higher risk for developing the flu and serious flu-related complications such as pneumonia.
During the third trimester, the risks increase. A high fever and dehydration, oftentimes associated with the flu, can increase your risk for premature contractions. It may also slightly elevate your baby’s risk of birth defects. A study out of Vanderbuilt University School of Medicine reported that women in their third trimester are three to four times more likely than postpartum women to be hospitalized for a cardiopulmonary illness during flu season.

Double Bonus: Newborn Immunity Booster
Getting the flu shot during pregnancy not only protects you from developing the flu, it offers protection to your newborn during the first few months of life.
Here’s how it works. The antibodies (or the proteins made by the body to fight infection) that you develop when you get a flu shot cross through the placenta to your fetus, where they remain until up to six months after your baby is born.
This information was discovered only recently—a study published in the September 2008 issue of the New England Journal of Medicine yielded the first tangible evidence to date of this. In the study, infants up to 6 months of age whose mothers received a flu shot during pregnancy lowered their rate of influenza virus by 63 percent; they were also 29 percent less likely to develop a respiratory illness with fever, compared to infants whose mothers hadn’t received a flu shot during pregnancy.
This is good news for two reasons. First, the flu shot isn’t recommended for infants younger than 6 months of age. Therefore, receiving Mom’s antibodies in utero offers protection young babies wouldn’t otherwise get. Secondly, newborn infants haven’t yet built up their own immune systems to fight infections, making moms’ antibodies their sole source of immunity.

About the Mercury Question
Fears associated with flu shots—specifically, that they may contain thimerosal (a preservative with mercury)—may be one more factor preventing women from getting the flu vaccine.
Ruhl responds to these concerns: “Despite 80 years of data, researchers have never proven that there’s a concern with thimerosal.”
However, six states have passed laws that ban thimerosal for children and pregnant women. Maryland is not one of these six, but it is among several states currently proposing the ban of thimerosal for children and pregnant women.
If you would prefer, ask your healthcare provider specifically for a thimerosal-free flu shot. BC

Fast Facts about the Flu and Flu Shot during Pregnancy
Inactive flu vaccines (delivered via needle) are safe during any stage of pregnancy.
Live flu vaccine (delivered via nasal spray) should NOT be administered during pregnancy.
Getting a flu shot during pregnancy reduces a woman’s chance of developing the flu and related complications.
Infants whose mothers receive a flu shot during pregnancy are less likely to develop influenza and respiratory illnesses during the first six months of life.
Sources: National Women’s Health Resource Center (NWHRC); the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN); and “Effectiveness of Maternal Influenza Immunization in Mothers and Infants,” by K. Zaman et al., New England Journal of Medicine, Oct. 9, 2008.

© Baltimore’s Child Inc. December 2008