By Annie Gowen
Washington Post Staff Writer
Thursday, August 20, 2009
They are usually urged not to drink coffee, sip wine or pop aspirin. But now pregnant women find themselves high atop the federal government's priority list for those who ought to receive the new swine flu vaccine -- a prospect that some mothers-to-be are greeting with caution.
Although the vaccine is in clinical trials and won't be available until fall, expectant moms in the region are starting to ask their doctors, and each other, whether the H1N1 vaccine is safe for them and their babies. Swine flu questions now mingle with sale notices for strollers and nanny postings on local community e-mail lists.
The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists are recommending that all pregnant women be vaccinated against swine flu after a study in the Lancet medical journal last month showed that pregnant women are four times more likely to be hospitalized from the disease than people in general. Fifteen swine flu patients in the United States were expectant mothers -- about 6 percent of all swine flu deaths reported to the CDC. Pregnant women make up 1 percent of the U.S. population.
The CDC and the obstetricians' group have long urged pregnant women to get the seasonal flu vaccine and said it is safe for all trimesters. But a surprisingly low number -- less than 15 percent -- do so, according to the CDC. That's in part because some expectant mothers are loath to get vaccines or take over-the-counter medicines, experts said.
Maggie Little, director of the Kennedy Institute of Ethics at Georgetown University, who has written extensively about pregnancy and risk, said there is often a strong reticence by pregnant women and providers to take medications -- even ones that are relatively low-risk.
The culture "tends toward perfectionism and control around pregnancy," Little said. "Pregnant women drive themselves crazy sometimes, doing more harm than good, like not taking the medication they need."
She is worried about the consequences of that mindset, warning that "if we get a bad resurgence of the flu and these women don't get vaccinated, we're going to have a lot of dead mommies and babies."
Acadia Roessner, 31, a D.C. resident and government contractor pregnant with her second child, said she was "still a little bit on the fence" about whether to get the vaccine but is leaning toward getting it if it is deemed safe. Her due date is in January, so she wonders whether she could avoid the vaccine and remain flu-free for the last eight weeks of her pregnancy just by being careful, washing her hands and taking Vitamin C.
"Certainly it's not something to take lightly. I'm weighing all the options," Roessner said.
But many moms -- as well as some special interest groups concerned about vaccine safety -- worry about whether the new vaccine will have been tested enough before millions of doses are administered this year.
The National Institute of Allergy and Infectious Diseases is testing the vaccine on 2,800 children and adults and will be testing it on 360 to 720 pregnant women beginning in mid-September, said Anthony S. Fauci, the institute's director.
"This influenza vaccine . . . is being made in the same way and by the same companies we have worked with every year for seasonal flu vaccine, literally for decades," Fauci said. "Although you never take the safety issue lightly or presume anything, historically the use of it [with pregnant women] has not been a red flag-issue."
A new Washington Post-ABC News poll shows that Americans are not as concerned about a possible swine flu pandemic as public safety and health officials seem to be -- more than six in 10 are not worried, although more than half said they would probably get the vaccine, according to the poll.
"My chances of actually getting swine flu are slim to none," said Keenia Adams, 23, a student at Marymount University who is pregnant. "Why take this vaccine? What if it makes me sick in other ways? What if I find out after I take it it could be harmful to my baby? I'm a little worried about that."
Wendy Lubell, 36, a personal trainer who is pregnant with her second child, said she will not get the vaccine, in part because she said she had a bad reaction to a seasonal flu vaccine in college. She's careful about what she eats while pregnant, she said, but will occasionally treat herself to a cup of coffee or ice cream.
"I'm a not an expert. I am not a scientist. I am not a doctor," Lubell said. "I have to make my decision based on the information I hear and my intuition."
Her intuition is saying no.
"I personally don't understand if you're perfectly healthy person why you'd inject yourself with something that could potentially cause risk to you and your fetus," Lubell said.
A pregnant woman's body is more susceptible to flu for several reasons, experts say. Pregnant women typically have altered immune systems and, in the advanced stages, their growing bellies compress lung capacity, which can make them vulnerable to pneumonia -- a potentially fatal complication of swine flu.
Local obstetricians and midwives say they have been fielding more questions about the vaccine in recent days.
"I get a couple of phone calls and patients every day asking about it," said obstetrician Laura Pickford, who delivers babies at Inova Fair Oaks Hospital. "Most of them are wanting to know how to get it. I tell them it's not out yet." But she will probably recommend that they get it.
Laurel Todd, 30, a health policy analyst who lives in Glover Park, said she has been monitoring media reports about the spread of the flu -- as well as fielding concerned calls from her mother-in-law on the topic. She plans to get the vaccine when it's available if her doctor says it's safe.
"I'm totally comfortable with it," Todd said.