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    Should I give the flu shot to my pregnant patients?

     

    Obstetric care provider involvement

    Multiple studies have shown that a provider’s recommendation and offer of a vaccine plays a critical role in a patient’s decision to be immunized. In a recent report from the CDC, 68% of pregnant women who received both a recommendation and offer from their physician or other healthcare provider were vaccinated against influenza compared to only 8.5% who received no recommendation.9 Despite some incredible improvements in influenza vaccination coverage in pregnant women during the 2009-10 H1N1 pandemic, influenza vaccination coverage for all pregnant women in the United States remains low, at about 50%.9

    Recent report about influenza vaccination and spontaneous abortion

    A study published in September in Vaccine reported an association of spontaneous abortion within 28 days of the receipt of influenza vaccination, with a more pronounced association in women who were vaccinated consecutively during the years 2010-2011 and 2011-2012. The median gestational age at the time of miscarriage was 7 weeks, a range in which many miscarriages are either not recognized or do not result in medical attention.10 The miscarriages that came to attention and could be included in the study reflect a limited subset of all the miscarriages that would have occurred in the population.  A critical question is whether women who were vaccinated might be especially inclined to have their miscarriage be medically recognized and thus included in the study.  To the extent that both receipt of vaccine and obtaining medical care for a miscarriage are correlated, the measure of their association would be biased.  The higher risk for women vaccinated in both seasons may indicate an even stronger tendency to obtain medical care and a stronger version of this same problem. 

    This article received a large amount of press and women may ask questions about receiving the influenza vaccination in pregnancy as we head into flu season.  Scientifically it would be very unlikely for the vaccine to be harmful to pregnancy, and there is an abundance of evidence indicating that it is not, in fact, harmful.  While this new study should encourage new research to replicate or refute the findings, in balance the totality of the evidence is clearly supportive of the benefits of vaccination outweighing the risks. 

    NEXT: Putting the new study in context

    Heather S Lipkind MD, MS
    Dr Lipkind is an Associate Professor of Maternal-Fetal Medicine in the Department of Obstetrics, Gynecology and Reproductive Sciences, ...
    David A Savitz, PhD
    Dr Savitz is a Professor of Epidemiology and Obstetrics and Gynecology, Brown University, Providence, RI.

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