摘要：Pandemic Influenza: Special Considerations for Pregnant Women was a meeting convened by the Centers for Disease Control and Prevention in 2008 to obtain input from experts and key partners regarding clinical management of pregnant women and related public health actions to be taken during a pandemic. Meeting goals were to discuss issues specific to pregnant women, identify gaps in knowledge, and develop a public health approach for pregnant women in the event of a pandemic. The meeting focused on 4 main topics: prophylaxis and treatment with influenza antiviral and other medications, vaccine use, nonpharmaceutical interventions and health care planning, and communications. Participants reviewed the available evidence to guide action in each of these areas and identified areas of critical needs for future research. PREGNANT WOMEN CONSTI tute a significant population in the United States: more than 6 million pregnancies occurred in 2004. 1 Plans for an influenza pandemic should address several issues specific to pregnant women to ensure that they receive appropriate guidance and health care. 2 Experience with previous pandemics and with seasonal influenza has led health care professionals to anticipate that pregnant women will be at increased risk for influenza-associated morbidity and mortality in a future pandemic. 3 – 8 The public health response should take into account the effects of maternal influenza infection and its associated fever, medications for prophylaxis and treatment, and influenza vaccine on both mother and fetus. Pregnant women or their health care providers may be reluctant to adopt public health recommendations during a pandemic because of concerns about fetal effects of medications or vaccines. Recommendations regarding nonpharmaceutical interventions may present special challenges to pregnant women because these may conflict with routine prenatal care and delivery recommendations. In addition, health care facilities need to develop plans to minimize exposure of well pregnant women to ill people, while continuing to ensure that women receive necessary obstetric care. 2 Finally, communicating recommendations in a pandemic to the diverse population of pregnant women and their health care providers will be challenging. 2 The Centers for Disease Control and Prevention, in partnership with the Association of Maternal and Child Health Programs and the March of Dimes, convened Pandemic Influenza: Special Considerations for Pregnant Women, a meeting designed to integrate scientific evidence and expert opinion, on April 3 to 4, 2008, in Atlanta, Georgia. The meeting goals were to discuss special considerations, identify important knowledge gaps, and obtain input from experts and key partners to guide the development of public health recommendations specific to pregnant women in the event of an influenza pandemic. In attendance were a wide variety of experts in obstetrics, maternal–fetal medicine, family medicine, preventive medicine, pediatrics, midwifery, teratology, pharmacology, influenza, infectious diseases and vaccines, public health, emergency response, health education, and communications and representatives from key partner groups (see the box on the next page). Organizations Represented at the Pandemic Influenza: Special Considerations for Pregnant Women Meeting: Atlanta, GA, April 3–4, 2008 American Academy of Family Physicians March of Dimes American Academy of Pediatrics National Association of County and City Health Officials American College of Nurse-Midwives American College of Obstetricians and Gynecologists National Institutes of HealthOrganization of Teratology Information Specialists American Pharmacists Association Society for Maternal-Fetal Medicine Association of Maternal and Child State health departments Health Programs Universities Association of State and Territorial Health Officials World Health Organization Association of Women's Health, Obstetric and Neonatal Nurses Council of State and Territorial Epidemiologists Food and Drug Administration Open in a separate window Discussion focused on 4 topics: prophylaxis and treatment with antiviral and other medications, vaccine use, nonpharmaceutical interventions and health care planning, and communications. Although this meeting focused on pregnancy issues, participants noted that guidance for postpartum and breastfeeding mothers and their infants was also needed. The meeting focused specifically on planning for an influenza pandemic, and thus its discussions should not be extrapolated to nonpandemic conditions. The findings presented here are not formal recommendations, but the discussion points outlined may serve as a basis for future recommendations.
