title: Committee opinion: no. 563: ethical issues in pandemic influenza planning concerning pregnant women.
abstract: Pregnant women traditionally have been assigned priority in the allocation of prevention and treatment resources during outbreaks of influenza because of their increased risk of morbidity and mortality. The Committee on Ethics of the American College of Obstetricians and Gynecologists explores ethical justifications for assigning priority for prevention and treatment resources to pregnant women during an influenza pandemic, makes recommendations to incorporate ethical issues in pandemic influenza planning concerning pregnant women, and calls for pandemic preparedness efforts to include clinical research specifically designed to address safety and efficacy of treatment interventions or prevention strategies used by pregnant women.
mesh_terms: D005260:Female; D006285:Health Planning / Q000941:ethics*; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control*; D058873:Pandemics; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000517:prevention & control*; D014611:Vaccination / Q000941:ethics*
references: Almond D, Mazumder B. The 1918 influenza pandemic and subsequent health outcomes: an analysis of SIPP data. Am Econ Rev 2005;95:258–62.
references: Harris JW. Influenza occurring in pregnant women: a statistical study of thirteen hundred and fifty cases. JAMA 1919;72:978–80.
references: Rasmussen SA, Dj Jamieson, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008;14:95–100.
references: Ethical issues with vaccination for the obstetrician–gynecologist. Committee Opinion No. 564. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:1144–50.
references: Fiore AE, Shay DK, Broder K, Iskander JK, Uyeki TM, Mootrey G, et al.. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008;57(RR-7):1–60.
references: Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al.. H1N1 2009 influenza virus infection during pregnancy in the USA. Novel Influenza A (H1N1) Pregnancy Working Group. Lancet 2009;374:451–8.
references: Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al.. Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. Pandemic H1N1 Influenza in Pregnancy Working Group. JAMA 2010;303:1517–25.
references: Louie JK, Acosta M, Jamieson DJ, Honein MA. Severe 2009 H1N1 influenza in pregnant and postpartum women in California. California Pandemic (H1N1) Working Group. N Engl J Med 2010;362:27–35.
references: Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)–United States, April 2009–August 2010. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2011;60:1193–6.
references: Creanga AA, Johnson TF, Graitcer SB, Hartman LK, Al-Samarrai T, Schwarz AG, et al.. Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol 2010;115:717–26.
references: 2009 pandemic influenza A (H1N1) in pregnant women requiring intensive care - New York City, 2009. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2010;59:321–6.
references: Debrium DA, Liaschenko J, marshall MF. Social justice in pandemic preparedness. Am J Public Health 2012;102: 586–91.
references: Blume J, peipert JE. Randomization in controlled clinical trials: why the flip of a coin is so important. J Am AssocGynecol Laparosc 2004;11:320–5.
references: Lu P, Bridges CB, Euler GL, Singleton JA. Influenza vaccination of recommended adult populations, U.S., 1989–2005. Vaccine 2008;26:1786–93.
references: Influenza vaccination in pregnancy: practices among obstetrician–gynecologists—United States, 2003–04 influenza season. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2005;54:1050–2.
references: Sj Schrag, Fiore AE, Gonik B, Malik T, Reef S, Singleton JA, et al.. Vaccination and perinatal infection prevention practices among obstetrician–gynecologists. Obstet Gynecol 2003;101:704–10.
references: Seasonal influenza and 2009 H1N1 influenza vaccination coverage among pregnant women—10 states, 2009–10 influenza season. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2010; 59:1541–5.
references: Maternal decision making, ethics, and the law. ACOG Committee Opinion No. 321. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;106: 1127–37.
references: Lyerly AD, Mitchell LM, Armstrong EM, Harris LH, Kukla R, Kuppermann M, et al.. Risk and the pregnant body. Hastings Cent Rep 2009;39:34–42.
references: Rasmussen SA, Jamieson DJ, Macfarlane K, Cragan JD, Williams J, Henderson Z. Pandemic influenza and pregnant women: summary of a meeting of experts. Pandemic Influenza and Pregnancy Working Group. Am J Public Health 2009;99(suppl 2):S248–54.
references: Marshall MF. Foregoing nutrition and hydration in the terminally ill obstetric patient. J Perinat Neonatal Nurs 1993;6(4):37–44.
references: Sperling D. Do pregnant women have (living) will? J Health Care Law Policy 2005;8:331–42.