Prophylaxis and Treatment of Pregnant Women for Emerging Infections and Bioterrorism Emergencies

Joanne Cono; Janet D. Cragan; Denise J. Jamieson; Sonja A. Rasmussen

Disclosures

Emerging Infectious Diseases. 2006;12(11) 

In This Article

Abstract and Introduction

Emerging infectious disease outbreaks and bioterrorism attacks warrant urgent public health and medical responses. Response plans for these events may include use of medications and vaccines for which the effects on pregnant women and fetuses are unknown. Healthcare providers must be able to discuss the benefits and risks of these interventions with their pregnant patients. Recent experiences with outbreaks of severe acute respiratory syndrome, monkeypox, and anthrax, as well as response planning for bioterrorism and pandemic influenza, illustrate the challenges of making recommendations about treatment and prophylaxis for pregnant women. Understanding the physiology of pregnancy, the factors that influence the teratogenic potential of medications and vaccines, and the infection control measures that may stop an outbreak will aid planners in making recommendations for care of pregnant women during large-scale infectious disease emergencies.

A primary goal of public health response to emerging infections and bioterrorism attacks is to limit illness and death by providing the safest and most effective medical prophylaxis and treatment measures (medical countermeasures) in a timely manner to persons at greatest risk. Information on the effectiveness and safety of some medical countermeasures is limited for the general population, and even less information is available for pregnant women.[1] Physiologic changes during pregnancy may change the safety profile and efficacy of medications and vaccines for pregnant women. The potential effect of many of these measures on the fetus is unknown. These factors could influence a clinician's willingness to prescribe and a woman's decision to accept potentially life-saving treatments.

The circumstances under which exposure to medications or vaccines during pregnancy occurs must be taken into account. For example, when a pregnant woman has a serious acute infection, such as severe acute respiratory syndrome (SARS), anthrax, or a pandemic strain of influenza, appropriate timely treatment must be provided to preserve her health. When multiple therapeutic interventions of similar efficacy are available, consideration can be given to choosing the therapy that will best safeguard maternal health and the well-being of the embryo or fetus. In contrast, when a pregnant woman has been exposed to a serious infection but is not acutely ill, the choice of whether to provide prophylaxis or empirical treatment depends on several factors including the nature and certainty of the exposure, likelihood and potential severity of her infection, and gestational age at which exposure occurred. Inadvertent exposure to a medication or vaccine also may occur during pregnancy. An estimated half of pregnancies in the United States are unplanned;[2] thus, a woman infected with or exposed to a serious acute infection might receive emergency prophylactic or treatment measures during the early weeks of gestation before a pregnancy is recognized. In this situation, opportunity to weigh the risks and benefits to a pregnancy before exposure to the medication or vaccine is missed; instead, consideration must focus on any effects these measures may have had on the fetus.

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