The recent H1N1 swine flu virus was certainly deadly for the population as a whole, killing 305 Americans, but pregnant women were at a disproportionally higher risk for death. Pregnant women, even if they were healthy, were more likely to develop severe disease after infection with the virus. They were four times more likely to be hospitalized, with a much higher death rate. These facts were cited by researchers in their effort to correct what they believe is an urgent need to perform clinical testing on pregnant women (from a recent article in the New England Journal of Medicine). They claim that pregnant women are virtually excluded from medical research. Because clinical testing poses potential risks for participants, is it safe for pregnant women to be a part of this group, possibly risking not only their own health, but the health of their fetus?
Difficult Paradox
This argument is surely a difficult paradox, and the H1N1 flu pandemic proves an interesting case study. At the pandemic’s peak, the general consensus among health authorities was that pregnant women, due to their higher chance of developing post-infection diseases, should get vaccinated because the benefits outweigh the risks. But many pregnant women refused to get vaccinated because they were worried about the effects on their babies. The options were bleak – get vaccinated and potentially risk the baby’s health, or not get vaccinated and risk the baby’s health if the mother were to catch the swine flu. The same type of paradox exists when it comes to testing antidepressants. Is it more important to treat a mother’s depression with potential impact for the fetus, or is it more important to protect the fetus from the risks surrounding antidepressants?
Do the Benefits Outweigh the Costs?
The researchers in the article address these controversial issues by suggesting ways to circumvent the risks for testing moms-to-be, including waiting to study pregnant women until sufficient pre-clinical studies have been completed on non-pregnant women. Another option they suggest is studying pregnant women that have already been prescribed a certain drug. They claim that the complexity of examining the effects of medications on pregnant women should not deter efforts to obtain important scientific data that could potentially save lives in the future. Obviously, this is a difficult and complex issue which cannot yet be easily solved.
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