I recently followed a listserve discussion, the topic of which revolved around the influenza vaccine and its safety/efficacy/recommendation during pregnancy.

Vaccination has, of course, been a dicey topic approached within this blog community in the past - a divisive topic to be sure. But when we are considering vaccination of a pregnant woman - the stakes feel even higher, with two (or more) individuals being involved.

There are certainly many resources out there which question the safety of childhood vaccination such as this one. Likewise, numerous resources abound, describing the justification for and safety of vaccination.

If nothing else, the decision about whether or not to vaccinate - for a pregnant woman hoping to avoid influenza, or a parent hoping to protect their child from various illnesses - becomes a cost-benefit analysis: Is the potential (physical/health) cost of vaccination worth the benefit of avoiding a given disease?

Now entering flu season, this debate over whether or not to vaccinate includes the influenza vaccine and pregnant women. From the listserve, here are the comments of Dr. Mark Sloan, pediatrician and author of the *fabulous* book, Birth Day:

"Here's a pediatrician's perspective: This is my 32nd flu season working with children, and I strongly recommend influenza vaccine to the pregnant women I encounter, both for their own health and that of their babies. Infants (0-6 months) with influenza have a 30-fold increased risk of hospitalization compared with children ages 5-17 years. They're much more prone to bacterial complications too, like pneumonia, and they have the highest mortality rate of any age group except the > 65 year old demographic. If a mother catches influenza, it's almost a given that her baby will, too.

Personal experience: We hospitalized 15 children with influenza from our pediatric clinic last year - 8 were less than 6 months old. 6 of the 8 had no risk factors for severe disease, and 4 of that 6 were solely breast fed.

It's good to emphasize less obvious complications as well. For example, even in milder cases, influenza can disrupt breast feeding from the baby's perspective, whether from fussiness, lack of appetite, frequent cough, nasal congestion, or general exhaustion. And a mother with influenza can easily become dehydrated, compromising her milk supply. All in all, influenza is an excellent disease to avoid, and the best way to do that is vaccination.'

Those who may have experienced influenza in the past year or so will likely vividly recall the misery of high fevers, body aches, exhaustion, cough, lost time at work, etc., etc. But, beyond the woeful symptoms caused by influenza, contracting the virus while pregnant can have additional negative effects on the mother and fetus. The Organization of Teratology Information Specialists (OTIS) has this to say about influenza during pregnancy:

"The influenza virus itself has not been shown to cause birth defects. However, having a high fever during pregnancy may increase the risk for birth defects. Therefore, fever during pregnancy should be treated. Acetaminophen is the drug of choice for reducing fever during pregnancy. Tylenol® is one brand of acetaminophen. Being very sick from the flu may increase the risk of pregnancy complications such as miscarriage or premature delivery. It is important to talk with your doctor if you are pregnant and have symptoms of the flu.'

(You can read the rest of the information form OTIS regarding influenza/flu vaccine during pregnancy here.)

There are, of course, many, MANY more resources out there - both supporting and advising against - influenza vaccination in pregnant women, such as this paper published in the 2006 Journal of American Physicians and Surgeons. Many of the dissenting opinions are based on a concern for inclusion of neurotoxic Thimerosal - a mercury-based ingredient used to preserve the vaccine and disallow bacterial growth within the vaccine vial. Per the CDC, this year's flu vaccinedoes contain Thimerosal in the multi-dose vials but does not contain the preservative in the single dose vials. So, for pregnant women seeking influenza vaccination that is free of Thimerosal - asking for a vaccination from a single dose vial would be advisable.

As always, regardless of whether you (or someone you know) chooses to vaccinate or not, the other important prevention methods still hold: wash your hands often, avoid touching your eyes/nose/mouth whenever possible, avoid being around people you know to be sick with the flu, stay well-hydrated, focus on eating healthy foods, and get plenty of rest.

I know many readers will have their own two cents to add to this discussion. I encourage you to do so, including references to your pro/con points, as well as respectful and professional dialogue.

Wishing you all (and the expectant families with which you interact) good health!

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