With more vaccines in development which could prevent infections during pregnancy, doctors and midwives will need to be prepared to discuss vaccines with their pregnant patients.
Pregnant women go to great lengths to minimise any potential risks to their child. They want to eat well, exercise just the right amount and stay healthy.
Visit an online discussion forum on pregnancy or parenting and these are the kinds of questions you will find. ‘Can I eat blue cheese?’, ‘What about sushi?’, ‘What medicines can I take?’, ‘Should I keep jogging while pregnant?’
So when a doctor or midwife recommends vaccination during pregnancy it can provoke conflicting instincts. On the one hand, there the desire to do whatever it takes to protect the child; on the other, is a natural caution about taking anything into the body.
Professor Paul Heath, a paediatric infectious disease consultant at St George’s University Hospitals, said maternal vaccination has the potential to protect mothers, foetuses and infants in their first weeks of life. And their positive impact could be even greater.
“To improve antenatal immunisation we need new strategies to encourage vaccination, ongoing professional education for healthcare providers, and to make maternal vaccination a routine item in women’s healthcare,” he said.
Mothers who receive a supportive recommendation from their doctor or midwife are more likely to be vaccinated, according to Professor Heath. Improving communication is of growing importance as researchers are working on vaccines against Respiratory Syncytial Virus (RSV) and Group B Streptococcus (GBS).
Pregnancy priorities: protecting babies
Early in pregnancy is seen as a good time to discuss the issue and highlighting how vaccination helps babies – rather than the benefits for mothers – appears to be most effective.
“Women are particularly concerned about preventing disease in their babies and are less concerned about themselves,” Professor Heath told Vaccines Today. “If there is a perception that the vaccine is really to protect the mother rather than their baby then they [mothers] may be less inclined to have the vaccine.”
This is a potential factor in increasing the uptake of influenza vaccine during pregnancy. “Flu vaccines can be portrayed as a vaccine to protect the mother,” he says. “In fact we know now that it protects both.”
In contrast, Professor Heath says good uptake of pertussis vaccination among pregnant women in the UK – where the vaccine is recommended by health authorities and health professionals – may stem from the fact that it has a direct benefit to babies.
Women considering a recommendation to vaccinate during pregnancy are likely to want plenty of background information on the diseases against which they should be immunised, as well as the benefits and risks associated with the vaccine itself.
“Parents are turning to health professionals for advice so it is important that doctors and midwives are armed with the evidence and tools they need to persuade patients that vaccination is a good thing to do; that it’s a safe thing to do,” he says.
The burden of certain diseases is not always well understood. For example, Professor Heath notes that, in the UK, RSV is the most common cause of hospitalisation in infants in the first year of their life.
He said it is hoped that a vaccine against RSV would become available in years to come and, if pregnant women are immunised, infants could benefit from protection for the first three to six months of their lives – the period when RSV infection can be most severe.
“Globally RSV is a huge burden associated with significant mortality and it is also a significant issue in developed countries.”
The big question will be: if a vaccine is developed, will people embrace it?
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