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    Should I give the flu shot to my pregnant patients?

     

    Putting the new study in context of other research

    Millions of women have received the influenza vaccination in pregnancy and a vast amount of epidemiologic and clinical studies support the safety of inactivated influenza vaccines in pregnant women and their infants.11,12 A number of earlier well-designed studies have not found a link between flu vaccination and any adverse pregnancy outcomes, including miscarriage or stillbirth.  A meta-analysis performed to look specifically at the association between influenza immunization and the birth outcomes of stillbirth and spontaneous abortion found that women in the influenza vaccine group had a statistically lower likelihood of stillbirth (relative risk, 0.73; 95% confidence interval [CI], 0.55-0.96) and the pooled estimate for spontaneous abortion based on limited evidence suggested no increase in risk.13

    Current stance by ACOG/SMFM/CDC

    Given the information noted above, the CDC and the ACIP continue to recommend flu vaccination in pregnancy.12 Both ACOG and the Society for Maternal-Fetal Medicine (SMFM) also support the administration of influenza vaccine in pregnant women stating “SMFM agrees with the study’s authors that there are insufficient data to change the current recommendation and therefore continues to recommend that pregnant women get a flu vaccine any time during pregnancy”14 and “ACOG continues to recommend that all women receive the influenza vaccine. This is particularly important during pregnancy. In evaluating all of the available scientific information, there is insufficient information to support changing the current recommendation which is to offer and encourage routine flu vaccinations during pregnancy regardless of the trimester of pregnancy.”15

    NEXT: Take-home message and references

    Take-home message

    We continue to encourage you to advocate for influenza vaccination in your practice based on the compelling evidence that benefits outweigh risks, and that these discussions form the basis for informed decisions by your patients.  Further information from ACOG at this http://immunizationforwomen.org/2017-2018-influenza-season may be helpful.

    REFERENCES

    1. Rasmussen SA, Jamieson DJ, Uyeki TM.  Effects of influenza on pregnant women and infants. Am J Obstet Gynecol. 2012 Sep;207(3 Suppl):S3-8.

    2. Burney LE. Influenza immunization: statement. Public Health Rep. 1960;75:944

    3. Fiore AE, Uyeki TM, Broder K, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010; 59: 1–62

    4. Louie JK, Acosta M, Jamieson DJ, Honein MA, for the California Pandemic (H1N1) Working Group* Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California. N Engl J Med. 2010; 362:27-35

    5. Madhi SA, Cutland CL, Kuwanda L, et al; Maternal Flu Trial (Matflu) Team. Influenza vaccination of pregnant women and protection of their infants. N Engl J Med. 2014 Sep 4;371(10):918-31.

    6. Thompson MG, Li DK, Shifflett P, et al.  Effectiveness of seasonal trivalent influenza vaccine for preventing influenza virus illness among pregnant women: a population-based case-control study during the 2010-2011 and 2011-2012 influenza seasons. Pregnancy and Influenza Project Workgroup. Clin Infect Dis. 2014 Feb;58(4):449-57.

    7. Tapia MD, Sow SO, Tamboura B, et al. Maternal immunisation with trivalent inactivated influenza vaccine for prevention of influenza in infants in Mali: a prospective, active-controlled, observer-blind, randomised phase 4 trial. Lancet Infect Dis. 2016 Sep;16(9):1026-1035

    8. Steinhoff MC, Katz J, Englund JA, et al. Year-round influenza immunisation during pregnancy in Nepal: a phase 4, randomised, placebo-controlled trial. Lancet Infect Dis. 2017 Sep;17(9):981-989.

    9. Ding H, Black CL, Ball S, et al; Centers for Disease Control a nd Prevention (CDC). Influenza vaccination coverage among pregnant women‐‐United States, 2014‐15 influenza season. MMWR Morb Mortal Wkly Rep. 64(36);1000‐1005

    10. Donahue JG, Kieke BA, King JP, et al. Association of spontaneous abortion with receipt of inactivated influenza vaccine containing H1N1pdm09 in 2010-11 and 2011-12. Vaccine. 2017 Sep 25;35(40):5314-5322.

    11. Kharbanda EO, Vazquez-Benitez G, Shi WX, et al. Assessing the safety of influenza immunization during pregnancy: the Vaccine Safety Datalink. Am J Obstet Gynecol. 2012 Sep;207(3 Suppl):S47-51.

    12. Centers for Disease Control and Prevention. Pregnant women & influenza (flu). Available at https://www.cdc.gov/flu/protect/vaccine/pregnant.htm Accessed October 18, 2017.

    13. Bratton KN, Wardle MT, Orenstein WA and Saad BO. Maternal Influenza Immunization and Birth Outcomes of Stillbirth and Spontaneous Abortion: A Systematic Review and Meta-analysis Clinical Infectious Diseases® 2015;60(5):e11–9

    14. Society for Maternal-Fetal Medicine. Prepare for flu season. Available at https://www.smfm.org/flu Accessed October 18, 2017.

    15. American College of Obstetricians and Gynecologists. It is safe to receive flu shot during pregnancy. Available at https://www.acog.org/About-ACOG/News-Room/Statements/2017/It-is-Safe-to-Receive-Flu-Shot-During-Pregnancy  Accessed October 18, 2017.

    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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