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

Use of Medical Countermeasures in Prophylaxis and Treatment during Emerging Infection and Bioterrorism Emergencies

Limited information about the effects of medications and vaccines during pregnancy can pose a dilemma for women and healthcare providers when making decisions about their use. Pregnant women may be reluctant to receive, or healthcare providers may be reluctant to prescribe, needed medications or vaccines because of fear of harming the fetus. However, if a pregnant woman has a serious acute infection or has been exposed to a potentially life-threatening infection, treatment or prophylaxis can be lifesaving for both mother and fetus. Physicians and women often overestimate the risk to the fetus of medication use during pregnancy.[21] As a result, needed interventions may be withheld or pregnancies perceived to be at risk may be terminated. Decisions about the treatment or prophylaxis of emerging infections must take into account the effect on the mother's health and the potential risks for the embryo or fetus.

In preparation for potential bioterrorism emergencies, the US government has stockpiled medications and vaccines, most of which are rated by FDA as 1 of the categories B through X, which indicates that they could pose a risk to the unborn fetus or that insufficient information exists to evaluate their potential fetal risk ( Table 2 ). Some of these products (e.g., ciprofloxacin, gentamicin, and doxcycline) are commonly used in routine healthcare, but others (e.g., smallpox and anthrax vaccines) are reserved for emergency preparedness and response activities and for deployed military personnel.

Some emergency response medications and vaccines fall outside of the FDA labeling system because they are not licensed by FDA. Some are newly developed and still in prelicensure clinical trials; others are no longer licensed and predate the classification system. In these instances, the Centers for Disease Control and Prevention (CDC) holds Investigational New Drug protocols, approved by the FDA, which permit distribution and use of these agents in emergency situations. These protocols include extensive educational materials for potential recipients about the risks and benefits of treatment and include special considerations for pregnant women.

Although limiting fetal exposure to treatments that may pose unknown risks is optimal, protecting the life of the mother is key in protecting the fetus. In an emergency setting with a high risk for life-threatening exposure to an infectious pathogen, recommendations likely will call for the use of vaccination and prophylactic medications, when they are available, for pregnant women, despite unknown risks to the fetus. Other measures that can protect persons who are unable or choose not to receive vaccination or prophylactic medications include limiting exposure to persons who may be infectious, avoiding public gatherings, and restricting travel to affected areas.

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