6 things you should know about pregnancy and H1N1

Source: Web exclusive: October 2009

Maureen Turner is six-and-a-half-months pregnant and worried about the H1N1 virus. The 36-year-old mother-to-be from Georgetown, Ont., just discovered that, as a pregnant woman, she is at a significantly higher risk of becoming seriously ill from swine flu. ‘My most pressing concern [is that] the virus [will] cause complications in my pregnancy,’ she says.

As Canadians face a flu season with H1N1, public health agencies are focusing their attentions on the effects the virus will have on pregnant women. Though the H1N1 death rate remains low in Canada (79 deaths as of October 13, 2009), women like Turner are concerned about their own health and the health of their babies. Here’s what you need to know about the new flu.

Are pregnant women more likely to contract the H1N1 virus?

No. ‘[Pregnant women] are not at increased risk of contracting the infection,’ says Dr. Andrée Gruslin, an associate professor of maternal fetal medicine at the University of Ottawa. ‘I’m not concerned that my patients are going to get [H1N1] more than anybody else. I’m concerned they’re going to be sicker.’

The worry for pregnant women is that if they do catch the H1N1 virus in their second or third trimester, or within four weeks of giving birth, they will be at higher risk for complications such as pneumonia and severe respiratory distress.

Why are pregnant women at higher risk for complications?

The answer is not known for sure, but Gruslin points to two possible reasons. First, the immune system is not as strong during pregnancy as it usually is. This makes it tougher for pregnant women to fight off the virus that has mostly been causing mild symptoms in healthy people. Second, the weight of the uterus and space that it uses during pregnancy means there’s a lot less room for your lungs to expand normally. ‘We believe that may be a reason why they’re at increased risk of having lung complications,’ she says.

What is the H1N1 vaccine and is it safe for pregnant women?

The H1N1 vaccine was approved for use in Canada on October 21, and OBGYNs have a lot of unanswered questions about it, says Gruslin.’ Here’s what we do know:

‘ The company GlaxoSmithKilne will be supplying 50.4 million doses of the H1N1 vaccine to Canadians.

‘ Most provinces will start rolling out the vaccine the week of October 26. You can find links to specific details for your province from Health Canada’s FightFlu.ca website.

‘ Though the vaccine has been formulated quickly, the PHAC maintains that Health Canada has the capacity to review a vaccine quickly as part of their pandemic planning. And Gruslin says that the H1N1 vaccine isn’t much different from those formulated to protect against the seasonal flu. ‘This vaccine has been manufactured in the same way and by the same company as the regular flu vaccine,’ says Gruslin. ‘There is no reason to believe that this would be any different than giving the regular flu vaccine to pregnant women. And we know that there is no data to link the seasonal flu vaccine to any problems with pregnancy or the fetus or the child after [it’s born].’

‘ Most of the doses available to the general public will contain an adjuvant or booster, an agent that will improve the body’s response to the vaccine and allow more doses to be produced. While the PHAC says that all evidence suggests that adjuvanted vaccines don’t pose a threat to pregnant women, there is no direct clinical data that proves it’s safe for pregnant women. Some unadjuvanted vaccinations will also be available for pregnant women; however, it’s been reported that those formulations will not be included in the first round of vaccinations available to the public. ‘I am very surprised at this news because young kids and pregnant women are some of the high risk priority groups,’ says Gruslin. ‘It would be theoretically best for pregnant women to receive the non-adjuvant. However, I would not wait very long to get this formulation’the risks then may potentially outweigh the benefits of waiting.”

‘ The vaccine will also include thermarisol, a preservative that contains some mercury. This has posed some concern for pregnant women, but Gruslin says there’s no need to worry. ‘There’s never been any studies that have shown that thimerosal could be a problem in pregnancy,’ she says.

‘ There are some potential risks with [the vaccine],’ says Caleb Ng, a naturopathic doctor based in Surrey, B.C. He points to a small increased risk of neurological problems with vaccination such as Guillain-Barré Syndrome (GBS), a disorder where the body’s immune system attacks its own nervous system. Following an influenza vaccination program in New Jersey in 1976, 535 people were diagnosed with GBS after receiving the flu shot. However, PHAC maintains that the risk of suffering from GBS as a result of complications with the flu is higher than as a reaction to the vaccine.

Should you get the vaccine if you’re pregnant?

This is the question that many pregnant women are struggling with. Though her doctor highly recommends she get the vaccine, Turner is still undecided.  ‘I still hesitate because of the ‘what if’ factor: what if there are side effects, what if the vaccine can reach the baby and affect it, what if I have a reaction that causes complications. Often, you hear of medical research done years later where they hadn’t realized what the side effects could be at the time,’ she says.

This is a tough decision that requires a lengthy conversation with your own healthcare provider. For her part, Gruslin says she absolutely recommends the vaccine to her pregnant patients and plans to get vaccinated herself so that she doesn’t unwittingly infect anyone. ‘Think of the possible problems if you do get H1N1’you could actually die,’ she says. ‘You’ve got to look at the pros and cons.’

Ng echoes that sentiment and stresses that each individual should learn as much as she can about the vaccine in order to make an educated decision. ‘The naturopathic community’s stance is informed consent,’ he says. ‘You have to consider the risks and the benefits. For certain individuals who are at higher risk, it might be a more serious consideration.’

Where can women get the vaccine?

OBGYNs don’t typically vaccinate their patients, so yours may not be equipped to give you the H1N1 vaccine. However, he or she will recommend a clinic or hospital where you can get vaccinated before the rest of the general public (pregnant women are one of several high-risk groups who will be vaccinated first).

How to protect yourself

PHAC recommends that pregnant women continue with their daily lives throughout the flu season. In other words, try not to freak out. Take reasonable precautions such as frequent hand washing and using a hand sanitizer. Try to avoid crowded public situations when you can and keep in touch with your doctor. And if you start to experience symptoms such as cough, shortness of breath, nausea, full-body aches or fever, consult your healthcare provider pronto because you might need a prescription for the antuviral Tamiflu. ‘People who get Tamiflu in pregnancy do well, provided that the medication can be started within 48 hours of onset of symptoms,’ says Gruslin.

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