Women are dying needlessly in the US during pregnancy. The United States has the worst maternal mortality rate compared to countries of similar wealth, and it ranks 55th in the world according to the World Health Organization.
By Chasity Jennings-Nunez, MD, FACOG
The US maternal mortality rate, the likelihood of dying in pregnancy, is 18 deaths/100,000 live births. While that might not seem alarming when compared to 600-900 deaths/100,000 live births in countries like Afghanistan and Nigeria, it is 9 times higher than Norway, Italy or even Belarus. For Black women, childbirth is an even more deadly prospect. With a maternal mortality rate of 41/100,000, Black women in America are 4 times more likely then women in Bosnia to die during pregnancy.
While the causes of death during pregnancy vary from cardiovascular problems to hemorrhage to stroke and others, what is consistent is that the vast majority of deaths are preventable. The stark differences in how the COVID-19 pandemic has affected poor communities and communities of color has energized a national discussion of healthcare disparities and disease prevention.
COVID-19, the Flu and Pregnancy
COVID-19 infection has many of the same characteristics as influenza (“the flu”). Studies suggest that individuals infected with both the flu and COVID-19 are more than twice as likely to die than those infected with COVID-19 alone. Black and Latino persons with COVID-19 are 4.5 times more likely than White persons to be hospitalized and Black persons are twice as likely to die. We are now in flu season, and the concern about a “twindemic” of COVID-19, complicated by our usual flu season, is extremely high given limited hospital and medical resources.
Pregnant and postpartum women are at higher risk for severe complications from the flu than the general population. Pregnant women are about 2.5 times more likely to be hospitalized with the flu than non-pregnant women of similar age.
The Flu Shot is the best preventative measure for pregnant women
The single best preventative measure avail if for a pregnant woman during flu season is to get the flu vaccine—the flu shot. The flu vaccine reduces the risk of flu-associated hospitalizations by 40%. Unfortunately, according to figures published on the CDC website, only a little over 50% of women get a flu shot during pregnancy. That figure is lower for Black women and those women of lower socioeconomic status (less education, lower income). The most common reasons cited by women for not getting a flu shot were a belief that it is not effective, a concern for the baby and, in some cases, mistrust of the medical system.
Is the Flu Shot Safe for pregnant women?
The flu shot is safe for the fetus and can be given during any trimester. There is no evidence that the preservatives in the vaccine or the vaccine itself are associated with abnormalities or autism. There is evidence, however, that the flu vaccine saves lives. In addition to providing protection for the pregnant woman, immunity also passes to the fetus via the placenta, and this protects the baby during the first several months of life. Infants are unable to get their own flu vaccine until 6 months of age, so this passive immunity from the mother is crucial to prevent infection and complications for a baby born during flu season.
The injectable flu vaccine does not contain live virus. While some people may develop mild flu-like symptoms after getting it, the vaccine does not cause the flu. Even if you haven’t had the flu in the past, each flu season brings new risk. The most common side effect from the flu vaccine is soreness and redness at the site of the injection. Less commonly, headache, a low fever, or muscle aches can occur. The effectiveness of the flu shot can vary from year to year and also depends on the health and age of the person getting the vaccine.
Getting a flu shot is safe and easy. This year it is extremely important for everyone, especially high-risk individuals. Pregnancy puts even a healthy woman into the high-risk group. Flu shots are available now, so ask your OB provider. You can also call 2-1-1 for information on low cost or free flu vaccines in your area.
Dr. Chasity Jennings-Nunez, is a San Gabriel resident and works for Ob Hospitalist Group as the Site Director for Obstetrics at Adventist Health Glendale.
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