By Lauran Neergaard
WASHINGTON It's hard for pregnant women to escape the message: They're at extra risk from swine flu. It could trigger premature labor, lead to weeks in the hospital, it can even be fatal – and they're urged to be among the first in line for vaccine next month.
But only about one in seven pregnant women gets a flu shot each winter.
While federal health officials are working hard to raise that number this year, repeated swine flu warnings won't automatically overcome a key obstacle: Many obstetricians don't vaccinate.
And not only are many women reluctant to hunt for flu shots elsewhere, historically some pharmacists and other providers have been wary of vaccinating them.
“Maybe this year we can change that culture,” says Dr. Anne Schuchat of the Centers for Disease Control and Prevention. “It's not supposed to happen that you, when you are pregnant, are fighting for your life on a respirator.”
Any kind of flu is risky during pregnancy, and pregnant women have been on the get-a-flu-shot priority list for years. Their reluctance to take any medication during pregnancy is part of the reason for the low vaccination rates.
With swine flu, what doctors call the 2009 H1N1 strain, pregnant women seem at particular risk for complications. Pregnant women make up 6 percent of H1N1-confirmed deaths even though they account for only 1 percent of the population, according to the CDC. They're at least four times as likely to be hospitalized as other flu sufferers.
Vaccine is a two-for-one deal during pregnancy: It can protect not just mom but the baby, too, for the first few months after birth. The mother's body makes flu-fighting antibodies that easily cross the placenta to be carried by the fetus, said Dr. Neil Silverman of the University of California, Los Angeles.
That's important because flu can easily kill newborns, yet babies can't be vaccinated until they're 6 months old.
But where do women get the shot?
The American College of Obstetricians and Gynecologists has no count of how many OBs offer flu vaccine. It's still a minority although recent surveys suggest many more may start this year.
An extra complication: Each state's health department ultimately will decide who gets to offer the H1N1 vaccine, aiming for locations that vaccinate the most people. Those decisions haven't been made public yet. Even if the OB requested swine flu shots, he or she may not get initial shipments.
So the CDC and ACOG are urging obstetricians to partner with a nearby site to guarantee their patients a flu-shot source, a message the government will reiterate today in a swine flu training seminar for obstetricians nationwide.
Yet providers who don't routinely treat pregnant women may not understand flu's risk and the shot's safety record, said Silverman, who helps set ACOG practice guidelines.
Take pharmacists, expected to be key H1N1 vaccinators. Silverman gets occasional phone calls from women who say a pharmacist won't fill the flu-shot prescription he wrote.
“They act like the doctor who prescribed it didn't know what he or she was doing,” says Silverman, who settles the standoff by getting the pharmacist on the phone. For every patient who calls, “I know there are at least two who just say, ‘Well, OK, I'm not going to do this,' and just walk away.”
The American Pharmacists Association is urging its members to follow the CDC's pregnancy guidelines but can't mandate that, and a few stores may still balk, says association chief of staff Mitchel Rothholz.