Pregnant women are barraged with warnings to avoid many potential dangers to their developing babies: Alcohol. Sushi. Unpasteurized soft cheese.
But a brand-new, rapidly developed vaccine for the swine flu virus that has become a global pandemic?
Public health experts believe expectant mothers should be the first in line to receive it.
Although swine flu is unpredictable, scientific evidence indicates potential benefits of vaccination far outweigh the risks, they say. Early evidence suggests that expectant mothers who get swine flu face greater chances of being hospitalized, and even dying, from complications.
"If I was pregnant, I would do everything possible to get swine influenza vaccine to protect myself and my baby," said Dr. Carol J. Baker, a member of the Advisory Committee on Immunization Practices to the U.S. Centers for Disease Control and Prevention. The CDC recently placed pregnant women at the top of the priority list for the vaccination when it becomes available in the fall.
"But," she acknowledged, "it's going to be a hard sell."
Jill Spohn, who is expecting a boy in early November, learned about the recommendation from her older son's pediatrician.
"At first I was a little objecting, because I always heard you aren't supposed to have vaccines and things," she said. "He explained how your immune system is compromised when you're pregnant, so it's a benefit."
The 29-year-old Tampa mother wants to double-check with her doctor. But as Spohn cooed at the close-up view of her baby's developing face Friday at Meet the Baby Ultrasound, she said she felt fine about receiving the vaccine when it becomes available.
Since the first reports of a swine flu outbreak this spring, pregnant patients have placed numerous calls to Women's Care Florida, a Tampa-based network of more than 100 obstetricians.
Chief medical officer Dr. Robert Yelverton tells them the swine flu vaccine, currently under development, will be safe for both mother and unborn child.
"There's no known harmful effects of immunization to mom or baby," he said. "But there could be significant harm to mom and baby if one should get severe respiratory problems from flu."
As pregnancy advances to the second and third trimesters, he said, the diaphragm rises, which decreases lung capacity, leaving women feeling short of breath. So pregnant women have a harder time tolerating a respiratory infection such as influenza.
Women also experience changes to their immune systems during pregnancy, when they are essentially carrying a foreign body. These changes can make it more difficult for them to shake off the flu, experts say.
The CDC has long recommended the seasonal flu vaccine for pregnant women. But few heed the message.
During the 2007-08 flu season, about 75 percent of pregnant women didn't get vaccinated for seasonal flu, according to the National Health Interview Survey. Pregnant women were less likely to get vaccinated than people in other high-risk categories.
Higher death rate
In an article in the Lancet, researchers reported that 11 of the 34 reported pregnant women who contracted swine flu during the first month of the outbreak were hospitalized.
That rate — four times higher than the general population — could be because doctors are more likely to hospitalize pregnant women who are ill. But there's a more disturbing statistic: About 6 percent of 266 U.S. swine flu deaths the CDC had details about last month involved pregnant women, according to the Associated Press.
That's 15 women, a small number, but alarming because pregnant women make up just 1 percent of the population.
"These people were healthy, and that's just a tremendously high death rate," said Baker, the CDC Advisory Committee member and a professor of pediatrics at Baylor College of Medicine in Texas. "Yes, death is uncommon. But this 6 percent, based on small numbers to date, is pretty shocking."
Protection for child
Another factor for pregnant women to consider is that seasonal flu vaccine has been found to provide some protection to the unborn child. So, experts say, could the swine flu vaccine.
The CDC Advisory Committee on Immunization Practices points to a randomized controlled trial in Bangladesh, where infants born to vaccinated women had a 63 percent reduction in flu cases during the first six months of life. In the trial, the women breast-fed their infants.
Dr. John Sinnott, director of Infectious Disease and International Medicine at the University of South Florida, says this of those who think they don't need a flu shot: "People sometimes put their head in the sand and say, 'Well, I won't get influenza.' But they have little choice," he said.
In the U.S., about 36,000 deaths and 200,000 hospitalizations each year are attributed to seasonal flu, according to the CDC. And pregnant women and their unborn children were disproportionately affected in past pandemic outbreaks.
The government has begun clinical trials for the new H1N1 vaccine, which will include participants from all recommended age groups. Pregnant women will be involved in a trial once some preliminary data has been collected from healthy adults, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is overseeing the research.
He said experts have confidence in the safety of the vaccine, which is being produced using the same methods and companies as the seasonal flu immunization. The researchers want to make sure that they are administering the proper dosage for immunity in pregnant women.
The swine flu vaccine uses inactivated virus, for which there is no evidence of risks in pregnant women. Fauci anticipates the side effects will be the same as with a seasonal flu shot, a little swelling of the arm and soreness.
"This is not a novel thing, giving vaccines to pregnant women," he said. "Influenza vaccines have been given to pregnant women for decades."
Letitia Stein can be reached at firstname.lastname@example.org or (813) 226-3322. For more health news, visit www.tampabay.com/health.