Dr. Mary Beth Koslap-Petraco, PKIDs’ advice nurse practitioner, talks about the vaccines pregnant women need.
Dr. Mary Beth Koslap-Petraco, PKIDs’ advice nurse practitioner, talks about the vaccines pregnant women need.
The first story I read was heartbreaking. A mother-to-be at 38 weeks, in for a routine prenatal appointment. The heartbeat check turns up nothing. The baby has died, and she must undergo induction for a stillbirth. Weeks later, she learns that her baby tested positive for a Group B Streptococcus (group B strep or GBS) infection of the blood and lungs. The mother had tested positive for GBS in a previous visit, but because her membranes were intact, no one was concerned.
GBS is present in about 25% of pregnant women. According to the Centers for Disease Control and Prevention (CDC), this bacteria is the most common cause of life-threatening infection in newborns. Many women undergoing standard prenatal care also undergo testing for GBS. They can carry the bacteria in the vagina or rectum without having any symptoms, but if the bacteria pass to the womb, the outcome can be devastating.
The disease in infants can be early-onset or late. Early-onset disease afflicts newborns in the first week, most commonly causing a blood infection (sepsis) or lung infection (pneumonia), although meningitis (inflammation of the brain membranes) can also happen. Late-onset disease, in which meningitis is more common, occurs from the second week through the first three months of life. Early-onset GBS infection afflicts about 1200 babies each year in the United States, with outcomes that can vary from permanent deficits such as deafness and developmental disabilities to death. In many cases, detection and treatment can prevent transmission from mother to child.
July is GBS Awareness Month. Pregnant women, parents of newborns, and healthcare providers should be aware of the following to help prevent the possible devastating outcomes of infant GBS infection:
It’s important to note that GBS is not a sexually transmitted disease. These bacteria are simply often present in the digestive tract or the vagina or rectum of about 25% of women. A healthy adult carrier would likely never even notice their presence. That’s one reason the CDC shifted its guidelines from testing only pregnant women who had risk factors to testing all pregnant women. It’s another quick and straightforward way to prevent infection and death in infants.
For more information about GBS testing or to learn more about promoting July as GBS Awareness Month, visit Group B Strep International, an organization founded by parents of children who were born stillborn, full term, because of GBS infection. And remember…getting tested isn’t the only step in preventing GBS transmission from mother to child.
Image courtesy of tostadophoto.com
(courtesy of CDC)
The first and second U.S. deaths from the 2009 H1N1 pandemic were in a 22-month-old child and a 33-year old pregnant woman. These deaths were a sad sign of the toll this pandemic would take on young children and pregnant women. While pregnant women and young children have been considered at “high risk of flu-related complications” for years, 2009 H1N1 flu hit them really hard.
The risk from flu is greater for pregnant women because pregnancy can reduce the ability of the lungs and the immune system to work normally. This can be bad for both mother and baby. According to a study done during the first month of the 2009 H1N1 outbreak, the rate of hospitalizations was four times higher in pregnant women than other groups. Also, although pregnant women are about 1% of the U.S. population, they made up about 5% of U.S. deaths from 2009 H1N1 reported to the Centers for Disease Control (CDC) from April 14 – August 21, 2009.
Young children, whose immune systems are still developing, are also at-risk for flu-related complications. Each year about 100 flu-related deaths in children are thought to occur in the U.S. During the 2009 H1N1 pandemic, more than 300 deaths in children were reported to CDC. CDC believes that many more deaths in children may have gone unrecognized or unreported.
Experts think the 2009 H1N1 virus will be around again this flu season. In fact, one of the three parts of this season’s flu vaccine will protect against the 2009 H1N1 virus. While CDC is now encouraging everyone six months and older to get vaccinated against the flu, there is a special message for pregnant women and parents: “Don’t pass up this easy way to protect yourself and your children against the flu,” says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and CDC Director of the National Center for Immunization and Respiratory Diseases.
“Getting a flu vaccine during pregnancy can reduce the risk of getting the flu while pregnant and after,” says Dr. Schuchat. “And babies younger than six months can get very sick from flu, but are too young to get vaccinated. The best way to protect them is to have their caregivers and close contacts vaccinated.”
Seasonal flu shots have been given safely to millions of pregnant women and children over many years. Though there is no proof that thimerosal (a preservative) is harmful to a pregnant woman, their babies, or young children, some worry about it. So, as before, vaccine companies are making plenty of preservative-free flu vaccine as an option for pregnant women and small children.
Usually worse than the common cold, the flu can cause fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and weakness. Some people also have diarrhea and vomiting. Pregnant women and parents of children younger than two years of age should call their doctor or nurse right away if they, or their children, become sick. A doctor can prescribe flu antiviral drugs.
Vaccination continues to be the best protection. Get yourself—and all of your children 6 months of age and older—vaccinated against the flu to keep all family members healthy this flu season. One shot will last all flu season, even if you get it early in the season.
For more information, talk to your doctor or contact CDC at 1-800-CDC-INFO or www.cdc.gov.
The girls and women of Haiti are in trouble.
They have little protection. Some lost their husbands or loved ones (their protectors) in the earthquake, and some never had protection. Whatever the case, if they’re living in tents, there’s nothing to save them from the rape gangs. Fear keeps them from sleep.
They cannot escape disease. Rape, assault, and lack of decent medical care or basic nutrition put them at increased odds of getting infections. Add to that the cyclical challenge of mosquitos carrying malaria and their burden becomes overwhelming.
Pregnancy and childbirth, always difficult in this poor country, are made more so by the rough living conditions. Babies are being delivered in tents or on the street. If there are any complications, the outlook for a safe birth is grim.
Thieves roam the streets. A female with a bag of rice in her arms is no match for a group of hungry men. Caring for a family is at times a life-threatening chore for the girls and women of Haiti.
We sit in our office chairs, writing this as part of our Haiti Habit series of postings. They’re not just postings, though. They’re people in pain.
We can’t all fly to Haiti and lend a hand, but we can pick up the phone or go online and give a few bucks. A little bit from each of us makes for a pile of cash, and boy do they need it.
If you already support a charity working in Haiti, contact them for more information and donation opportunities. If not, here’s a list of charities to consider.
For most women, HPV (human papillomavirus) is an infection that comes and goes without sign or symptom.
For some women, it’s a horrible infection that causes cervical cancer.
Treatments for cervical cancer depend on many variables, including what stage of cancer one has.
Some of these treatments attempt to preserve fertility while maintaining high survival rates. Two such treatments are:
These treatments may affect the cervix in such a way that it could be more difficult to become pregnant or carry a pregnancy to full term, but they are still considered to be “fertility-preserving therapy” because other procedures are even more likely to affect fertility and pregnancy.
About the only way to prevent HPV infection is to have only one intimate partner during your lifetime, but that partner has to also have only one intimate partner—you. If that sounds unlikely to you, there are vaccines available that can reduce your chances of getting HPV (and therefore cervical cancer)—check with your doctor to see if it’s a good choice for you.
For many of us, the words “TB” and “tuberculosis” conjure up black-and-white images of sanatoriums and large, antiquated medical equipment. Or maybe we hear those words and think, “That can’t happen to us.”
But it does. One of our staff members recently caught up with an old friend of hers, a 30-something woman living in the U.S., and discovered she’d undergone treatment for latent TB. Being who we are, we couldn’t resist the opportunity for an interview!
When/how did you find out you had latent TB?
Two and a half years ago, I was registering to be an on-call chaplain. For that type of position, you have to have a yearly TB skin test, and mine came up positive. The test is a skin prick—if you’re positive, it reacts. I immediately felt something, and the pricked area swelled up like a bad spider bite.
What were the first thoughts you had?
I was freaking out a little, because TB has such a stigma attached to it. There’s a place in Seattle that is on the site of a former tuberculosis sanatorium—a friend of mine remembers standing outside, waving to her father in the window.
I think I might have contracted TB in the mission field. It’s fairly common for mission workers or hospital workers to have it. My sister has latent TB also, possibly from working in the inner cities.
What did you do first?
You’re required to report to your local health department if you have a positive skin test, so I did. They scheduled me for treatments.
What was the treatment process like?
I had to go to the health department twice a week to take 3 pills—they watch you take them. I only missed one treatment. It was a day that I had the stomach flu and a funeral, and the health department was calling me. They were very on top of things!
It was a 9-month course of treatment. The drugs make you feel lethargic, and they upset my stomach and gave me heartburn-like symptoms. I chose the twice weekly treatment because it was less inconvenient, and also, by the third day, I’d feel better, which was better than feeling bad every day for 9 months.
I could taste the pills for months afterward every time I drove by the health department. Pregnancy is a lot easier!
Were your friends or family concerned they might be infected?
My husband was concerned at first! Also, a relative of a friend with a son who has medical issues was very concerned about my husband being around her son, even though I’m not even symptomatic.
Another acquaintance of mine who also had latent TB began to have health problems and was concerned that my TB had activated hers, but it turned out she had other medical issues that were unrelated.
It was odd, people not understanding that people with latent TB are not contagious.
Did you have any specific concerns about TB and pregnancy?
You’re not supposed to get pregnant while on the drugs. But other than that, it hasn’t been a concern for me.
Do you ever worry you’ll develop active TB?
Taking the drugs made it less likely that I’ll get it. Night sweats, coughing—they tell you to watch out for those symptoms. I’m glad I did the treatment now, when I’m more physically capable, instead of having it be an issue at some later time when I’m not as healthy. But I don’t worry about it.
Is your life today affected by having latent TB?
No. I just keep my letter on hand stating that I’ve done the treatment so I can provide it when a convalescent center or someplace requires routine testing. I’m surprised at how TB is much more common than we think it is!
When a person has latent TB, it means that the body’s immune defenses hold the TB bacilli, preventing them from multiplying. However, any number of factors – age, cancer, steroids, to name a few – can suppress the immune system, allowing the bacilli to multiply, causing active TB disease. Treating latent TB reduces the chances of this happening by over 90%.
If you or anyone you know has been exposed to active TB disease (not latent TB), you should get tested for TB. To learn more and to help prevent the spread of TB, visit the World TB Day website.
Prenatal care intervention now reaches most American women for the duration of their pregnancies. However, nationally, maternal and infant health outcomes haven’t continued to improve, and some problems have worsened for reasons that continue to be preventable.
Because prenatal care usually doesn’t begin until week 11 or 12 of a pregnancy, preconception care as an intervention is gaining attention as a way of continuing to improve maternal and infant outcomes.
Preconception care attempts to identify and modify medical, behavioral and social factors that put a woman’s health and the health of her future pregnancies at risk for negative outcomes.
According to the American College of Obstetricians and Gynecologists (ACOG), preconception care screens for risks and provides health promotion, health education, and interventions to address identified risks to women in their reproductive years.
With preconception care, a woman has the opportunity to change and modify her behaviors or risk factors prior to becoming pregnant, thereby improving the chances for positive outcomes during the first weeks of pregnancy when the fetus is most susceptible to developing certain problems before many women even realize they are pregnant.
Preconception care can be of great benefit to women who are at risk for negative pregnancy outcomes resulting from infectious diseases. For example, ensuring that women are vaccinated for rubella provides protection against the mother transmitting congenital rubella syndrome to her infant.
Providing hepatitis B vaccination prevents transmitting hepatitis B infection to infants and protects the woman from risks that may come with hepatitis B infection, such as liver cancer, liver failure, cirrhosis or death.
Preconception screening and treatment for sexually transmitted diseases (STDs) reduces the risk of having an ectopic pregnancy, infertility, or chronic pelvic pain from sexually transmitted chlamydia and gonorrhea.
Preconception screening and treatment also reduces fetal risk for death or physical or developmental disabilities such as mental retardation and blindness that can occur as a result of fetal exposure to STDs.
Additionally, preconception screening for HIV/AIDS provides an opportunity for prompt treatment and information so that women or couples can make early decisions about pregnancy timing. These interventions have a record showing evidence-based effectiveness in improving pregnancy outcomes.
What does this mean for you? If you are a woman in your reproductive years, talk to your doctor about your reproductive life plan. Your doctor can work with you to evaluate your health risks and provide recommendations and information so that you can make choices to positively affect your health and future pregnancies for years to come!
So you’re pregnant, and you don’t want to get flu, but you also want to know that whatever goes into your body isn’t going to hurt your baby. Here’s info on H1N1 and the vaccine to help you make the best decision for you and your baby.
Is vaccination safe for pregnant women and their unborn babies?
Killed virus vaccines, such as the flu vaccines in shot form, are so safe that any risk to the unborn baby is nearly unmeasurable. FluMist, however, is live and cannot be given to pregnant women. (It can be given to other members of the family who are eligible to receive it.)
What about thimerosol?
As a pregnant woman, you can ask for a thimerosol-free vaccine, because providers are being directed to reserve thimerosol-free doses for pregnant women (and younger children) who are concerned about thimerosol. It should be noted that many studies conducted by independent bodies have shown that thimerosol does not pose any danger.
Should I get both the H1N1 and seasonal flu vaccines?
Pregnant women can get both vaccines. It’s recommended that you get each vaccine when it becomes available. The seasonal flu vaccine will be available sooner than the H1N1 vaccine, which should come out mid-October.
Should I wait until later my pregnancy to get vaccinated?
Pregnant women can receive the flu vaccines at any time during pregnancy, including the first trimester. In fact, it’s recommended that pregnant women receive the vaccine early on, since respiratory issues later in pregnancy can be more serious.
You can start the 2-dose H1N1 vaccination series during pregnancy and finish it after your baby is born. Babies ages 0-6 months cannot get the flu vaccine, so if the mother gets the vaccine during pregnancy, it can help protect her baby.
The vaccine is safe for women planning on natural childbirth. Disease is a natural process, but so is building immunity.
Alternative/online education could be an option for pregnant teens enrolled in schools experiencing outbreaks (because teens are generally considered higher risk for H1N1 as it is). If you are a pregnant young adult attending college, you can continue attending even if cases of H1N1 are reported. You should definitely get vaccinated and wash your hands – a lot.
Patients receiving treatment for infertility can get the flu vaccines. There is zero evidence that flu vaccine harms development of the unborn baby’s brain.
Pregnant healthcare workers need the H1N1 vaccine. If the flu is very active around them, their job description may need to be adjusted.
What should I do if I’m pregnant and get exposed to H1N1?
If you are exposed to a KNOWN case of H1N1, tell your provider; you may need medication. If 5 kids in your child’s school have it, this is not the same as being directly exposed.
Check with your provider to see if immunization is right for you and your family.
What’s H1N1 doing right now?
The flu virus has been circulating in the southern hemisphere, which is winding down its winter flu season. The good news is that it hasn’t mutated. In the U.S., we can expect to see H1N1 cases along with the regular seasonal flu.
Is there a vaccine?
This year, people ages 6 months or older will be able to get an H1N1 vaccine in addition to the regular seasonal flu vaccine. The H1N1 vaccine has gone through trials to determine safety and appropriate dosage. The testing process involves administering the vaccine, waiting 3 weeks, then taking a blood sample to measure antibodies to see if the dosage of vaccine was adequate.
You will probably need 2 doses of H1N1 vaccine for it to be effective. The H1N1 vaccine will have multiple formulations, as does the seasonal flu vaccine:
• 10-dose vial (which contains thimerosol)
• Single-dose vials (thimerosol-free)
• Preloaded syringes (thimerosol-free)
Some people are saying the H1N1 vaccine was developed too quickly. Is that true?
People who are concerned that the H1N1 vaccine was developed too quickly can take comfort in knowing the H1N1 vaccine preparation process is the same as it is for the seasonal flu vaccine and it is made by the same manufacturers. So far, any reactions in the trials for H1N1 vaccine have been the same as for the regular seasonal flu vaccine (soreness, redness). Any serious events that might occur may not appear during the vaccine trial time period because they are so rare.
Who should get the H1N1 vaccine?
People who should get the H1N1 vaccine are:
• Pregnant women
• Household contacts and caregivers for babies 0-6 months
• Healthcare and emergency medical services personnel
• People ages 6 months through 24 years
• People ages 25-64 years of age who have health conditions putting them at higher risk of complications from influenza
As with the seasonal flu vaccine, people with egg allergies cannot get the H1N1 vaccine. Check with your provider to see if immunization is right for you and your family.