Maternal and Child Health Journal

, Volume 16, Issue 2, pp 479–485 | Cite as

Prenatal Care Providers and Influenza Prevention and Treatment: Lessons from the Field

  • Patricia W. Mersereau
  • Christine M. Layton
  • Lucia Rojas Smith
  • Juliette S. Kendrick
  • Elizabeth W. Mitchell
  • Jacqueline B. Amoozegar
  • Jennifer L. Williams


To better understand the knowledge, attitudes, and behaviors of providers regarding influenza infection and vaccination in pregnancy, fourteen focus groups were conducted among 92 providers in Atlanta, GA; Dallas, TX; and Portland, OR in late 2009. NVivo 8.0 was used for analysis. Most providers had no experience with pregnant women severely affected by influenza. Many perceived the 2009 H1N1 pandemic to be limited and mild. Providers knew that pregnant women should receive the 2009 H1N1 vaccine and reported plans to vaccinate more patients than the previous season. Most knew CDC guidelines for antiviral treatment and prophylaxis, but some reported hesitancy with presumptive treatment. Although awareness of influenza’s potential to cause severe illness in pregnant women was observed, providers’ experience and comfort with influenza prevention and treatment was suboptimal. Sustained efforts to educate prenatal care providers about influenza in pregnancy through trusted channels are critical.


Antiviral medications H1N1 virus Influenza vaccine Pandemic Pregnancy Prenatal care providers 



The authors would like to thank Kitty MacFarlane, CDC, for her contributions toward funding and planning the project; Kelly Brumbaugh, CDC, for her contributions in planning, implementation, and analysis of the project; and Colleen Carr and Laurie Brockman of Danya International for the focus group logistics. We also wish to thank Molly Lynch of RTI International for her involvement in planning and analyzing the project and Joey Horne of RTI International for her analytic support.


  1. 1.
    Beigi, R. H. (2007). Pandemic influenza and pregnancy: a call for preparedness planning. Obstetrics and Gynecology, 109(5), 1193–1196.PubMedCrossRefGoogle Scholar
  2. 2.
    Hewagama, S., Walker, S. P., Stuart, R. L., Gordon, C., Johnson, P. D., Friedman, N. D., et al. (2010). H1N1 influenza A and pregnancy outcomes in Victoria, Australia. Clinical Infectious Diseases, 50(5), 686–690.PubMedCrossRefGoogle Scholar
  3. 3.
    Ie, S., Rubio, E. R., Alper, B., & Szerlip, H. M. (2002). Respiratory complications of pregnancy. Obstetrical and Gynecological Survey, 57(1), 39–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Goodnight, W. H., & Soper, D. E. (2005). Pneumonia in pregnancy. Critical Care Medicine, 33(10 Suppl), S390–S397.PubMedCrossRefGoogle Scholar
  5. 5.
    Rasmussen, S. A., Jamieson, D. J., & Bresee, J. S. (2008). Pandemic influenza and pregnant women. Emerging Infectious Diseases, 14(1), 95–100.PubMedCrossRefGoogle Scholar
  6. 6.
    Siston, A. M., Rasmussen, S. A., Honein, M. A., Fry, A. M., Seib, K., Callaghan, W. M., et al. (2010). Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. JAMA, 303(15), 1517–1525.PubMedCrossRefGoogle Scholar
  7. 7.
    Jamieson, D. J., Honein, M. A., Rasmussen, S. A., Williams, J. L., Swerdlow, D. L., Biggerstaff, M. S., et al. (2009). H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet, 374(9688), 451–458.PubMedCrossRefGoogle Scholar
  8. 8.
    Louie, J. K., Acosta, M., Jamieson, D. J., & Honein, M. A. (2010). Severe 2009 H1N1 influenza in pregnant and postpartum women in California. New England Journal of Medicine, 362(1), 27–35.PubMedCrossRefGoogle Scholar
  9. 9.
    CDC. (2009). Novel influenza A (H1N1) virus infections in three pregnant women—United States, April-May 2009. MMWR Morb Mortal Wkly Rep, 58(18), 497–500.Google Scholar
  10. 10.
    SteelFisher G. K., Blendon R. J., Bekheit M. M., Mitchell E. W., Kendrick J. S., Williams J., et al. 2010. Motivators and barriers related to getting the H1N1 flu vaccine among pregnant women. Am J Obstet Gyncol, (in press).Google Scholar
  11. 11.
    Lynch M. M., Mitchell E. W., Williams J. L., Brumbaugh K., Jones-Bell M., Pinkney D. E., et al. 2010. Knowledge, attitudes, and beliefs about influenza A pandemic (H1N1) 2009 among pregnant and recently pregnant women: implications for public health communication. (submitted).Google Scholar
  12. 12.
    Elder, J. P., Ayala, G. X., & Harris, S. (1999). Theories and intervention approaches to health-behavior change in primary care. American Journal of Preventive Medicine, 17(4), 275–284.PubMedCrossRefGoogle Scholar
  13. 13.
    Perkins, M. B., Jensen, P. S., Jaccard, J., Gollwitzer, P., Oettingen, G., Pappadopulos, E., et al. (2007). Applying theory-driven approaches to understanding and modifying clinicians’ behavior: what do we know? Psychiatric Services, 58(3), 342–348.PubMedCrossRefGoogle Scholar
  14. 14.
    CDC. (2010). Seasonal influenza and 2009 H1N1 influenza vaccination coverage among pregnant women—10 states, 2009–10 influenza season. MMWR Morb Mortal Wkly Rep, 59(47), 1541–1545.Google Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2011

Authors and Affiliations

  • Patricia W. Mersereau
    • 1
    • 2
  • Christine M. Layton
    • 3
  • Lucia Rojas Smith
    • 3
  • Juliette S. Kendrick
    • 4
  • Elizabeth W. Mitchell
    • 5
  • Jacqueline B. Amoozegar
    • 3
  • Jennifer L. Williams
    • 5
  1. 1.SciMetrika, LLCResearch Triangle ParkUSA
  2. 2.National Center on Birth Defects and Developmental DisabilitiesSciMetrika Contractor for the Centers for Disease Control and PreventionAtlantaUSA
  3. 3.RTI InternationalResearch Triangle ParkUSA
  4. 4.Division of Reproductive HealthCenters for Disease Control and Prevention, National Center on Chronic Disease Prevention and Health PromotionAtlantaUSA
  5. 5.National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations