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Stay healthy throughout your pregnancy--and throughout flu season

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You also need to practice preventive protection like washing your hands several times a day, avoiding people who are sick, eating healthy, exercising and getting enough rest. © istockphoto.com/Olivier Lanzendorffer You also need to practice preventive protection like washing your hands several times a day, avoiding people who are sick, eating healthy, exercising and getting enough rest. © istockphoto.com/Olivier Lanzendorffer

From the Flue-Free and Mom-to-Be Health Center

Never thought of yourself as high-risk, health wise? If you're pregnant during flu season, consider yourself on the list. And, if it's been years since you've had the flu--that classic seasonal illness that brings on the "I-feel-like-I've-been-hit-by-a-truck-how-can-anything-hurt-this-much" symptoms of fever, aching muscles and extraordinary fatigue--the time is now to take action to keep you and your baby healthy.

Here's why: About one in five people--adults and children--get the flu each year. You might tough it out at home or you might find yourself one of the more than 200,000 people hospitalized each year with flu-related complications, such as dehydration, bacterial or viral pneumonia, infections of the brain and spinal cord, Reye syndrome and heart conditions, as well as seizures in children. If you have a chronic health condition like congestive heart failure, asthma or other lung diseases, or diabetes, you're particularly susceptible to complications.

Then there's the simple, but scary, fact that every year about 36,000 people in the United States die from the flu.

A Little Prevention Goes a Long Way

Like most viral diseases, the flu is highly contagious. Unlike the common cold, however, there's a relatively simple, easy, safe way to prevent the flu: an annual vaccine.

Maybe you think you don't need a vaccine because you're young and healthy and don't work in day-care centers or nursing homes. Or maybe you think you shouldn't get a vaccine because you're pregnant.

Unless you're severely allergic to eggs, had a severe reaction to the flu vaccine in the past or currently have a fever, you should get vaccinated. Even if you're young and healthy, a flu vaccine is important. One study found that healthy working adults receiving the vaccine had 43 percent fewer sick days from work. Since many companies are cutting back on sick days, that's a good benefit!

When you're pregnant (or soon plan to be) during flu season, you should get vaccinated. Here's a fact you might not have learned from your pregnancy planning books: if you get the flu during pregnancy, you are more likely to be sicker and to develop flu-related complications like pneumonia than if you weren't pregnant. Your risk of dying is higher if you have the flu while you're pregnant. Blame pregnancy-related changes in your respiratory and immune systems.

But here's the kicker--if you get the flu, it could affect your baby. After major worldwide flu outbreaks like the one in 1918, infected women had higher rates of miscarriage and premature births, especially those who developed pneumonia. During the Asian influenza pandemic of 1957, it appeared that babies of women who developed the flu were more likely to have birth defects. Even normal flu years may increase the risk of cleft lip or palate, neural tube defects such as spina bifida (in which the spinal column doesn't completely close) and heart defects. Some studies also suggest higher rates of leukemia, schizophrenia and Parkinson disease in people whose mothers had the flu during pregnancy.

That's why the U.S. Centers for Disease Control and Prevention recommend flu vaccines for all pregnant women, no matter where they are in their pregnancy. In fact, the American College of Obstetricians and Gynecologists say that getting the flu shot is an essential part of prenatal care. And, it's safe to get the vaccine while breastfeeding.

Yet a 2004 survey that included responses from roughly 500 obstetricians and gynecologists found that just 52 percent would recommend a flu vaccine for a healthy woman in the first trimester of pregnancy, although 95 percent would recommend the vaccine for a healthy pregnant woman beyond the first trimester, and 63 percent would recommend vaccination for a woman with a medical condition in the first trimester. Importantly, a third of the doctors who said they would recommend the vaccine did not offer it in their offices.

Flu Vaccine Is Safe and Effective for Pregnant and Breastfeeding Women

The good news is that the injectable flu vaccine, made with an inactive form of the virus, is perfectly safe for pregnant women and usually is widely available from multiple sources in our communities, if it's not offered by your obstetrics practice. You also can consider new flu vaccines that are thimerosal free. Plus, no matter what you've heard, you cannot get the flu from the flu vaccine. However, you should not get the nasal version of the vaccine, called FluMist, which contains attenuated, or partially live, viruses.

Here's some more good news: getting vaccinated while pregnant or breastfeeding is not only perfectly safe for your baby, but may help protect your newborn against the flu. Recall that babies less than 6 months old shouldn't get the flu vaccine. But a recently published study found that the risk of flu in infants dropped 63 percent when the mothers were vaccinated during pregnancy; plus, the risk of other respiratory illnesses also dropped nearly a third.

OK, so what if you forgot to get vaccinated and now here it is flu season? What can you do? Get a flu vaccine! It only takes two weeks for the vaccine to rev up your immune system to better resist the virus.

Guarding Against Flu during Pregnancy in Other Ways

That's not the only thing you should, do, however. You also need to practice preventive protection. That means washing your hands several times a day with alcohol-based sanitizers and/or lots of soap and hot water. Also, stay away from people who might be sick, and avoid crowded, close rooms if possible.

Plus, continue all the things you're already doing to ensure a healthy pregnancy--eating right, getting moderate exercise, getting enough sleep and managing stress. All will help strengthen your immune system so it is better prepared to fight off any viruses that do come calling.

And if you get the flu, see your health care professional as soon as possible. While antiviral medications--those medications that can help minimize the effects of the flu when they are taken within 48 hours of your first symptoms--are not recommended for pregnant women, it's important that your health care professional keep a close watch on you to make sure you don't get dehydrated, that your fever doesn't get too high and that you don't develop complications.

References

Harper SA, Fukuda K, Uyeki TM, et al. Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC). Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005;54(RR-8):1-40.

Key Facts about Influenza and Influenza Vaccine. Centers for Disease Control. September 28, 2005. Available at www.cdc.gov. Accessed October 26, 2005.

Key Facts: Information about Avian Influenza and Avian Influenza A. Centers for Disease Control. Available at www.cdc.gov. Accessed October 28, 2005.

Centers for Disease Control. Key facts about seasonal influenza. July 2008. Available at: http://www.cdc.gov/flu/keyfacts.htm

Nichol KL, Lind A, Margolis KL, et al. The effectiveness of vaccination against influenza in health, working adults. New England Journal of Medicine. 1995 Oct. 5;333(14):889-893.

Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis [serial on the Internet]. January 2008. Available from http://www.cdc.gov/EID/content/14/1/95.htm. Accessed September 18, 2008.

Centers for Disease Control. Guidelines for Vaccinating Pregnant Women. Available at: http://www.cdc.gov/vaccines/pubs/downloads/b_preg_guide.pdf. Accessed September 19, 2008.

ACOG Committee on Obstetric Practice. Influenza vaccination and treatment during pregnancy. ACOG Committee Opinion No. 305. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2004;104:1125-1126.

Centers for Disease Control and Prevention (CDC). Influenza vaccination in pregnancy: practices among obstetrician-gynecologists-United States, 2003-04 influenza season. Morb Mortal Wkly Rep. 2005 Oct 21;54(41):1050-2.

Centers for Disease Control and Prevention. Breastfeeding vaccination recommendations. Available at: http://www.cdc.gov/breastfeeding/recommendations/vaccinations.htm. Accessed September 18, 2008.

Zaman K, Roy E, Arifeen SE, et al. Effectiveness of Maternal Influenza Immunization in Mothers and Infants. N Engl J Med. 2008 [Epub].

© 2008 National Women's Health Resource Center, Inc. (NWHRC) All rights reserved. Reprinted with permission from the NWHRC. 1-877-986-9472 (toll-free). On the Web at: www.healthywomen.org.

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