Prams brief.

              O K L A H O M A F A C T S
VOLUME 1 × ISSUE 2
Influenza Vaccination and Pregnant Women
Seasonal influenza (or flu) is a risk
factor for severe illness during
pregnancy. Certain changes in the
immune system, heart, and lungs
during pregnancy can make preg-nant
women prone to severe illness
from flu as well as flu-related hospi-talizations.
1 Premature labor and
delivery are also risks for pregnant
women with the flu.1
The flu shot is safe and can be
administered before, during or after
pregnancy.1,2 Pregnant women
who get an influenza vaccine pass
their immunity to their babies. This
protection lasts for several months
after birth.2
According to 2009-2010 Oklahoma
Pregnancy Risk Assessment Moni-toring
System (PRAMS) flu supple-ment
data, 49.1% (95% Confidence
Interval (CI)=44.0-54.2) of women
› Only 49.1 % of new mothers in
Oklahoma were vaccinated
during the 2009-2010 influenza
season.
› Over half (53.8%) of mothers
between ages 18-24 did not
receive a flu shot during preg-nancy
or postpartum.
› Women with more than a high
school education had higher
rates of vaccination (55.9%)
compared to those who did not
complete high school (34.6%).
› 56.3% of married women
received a flu shot.
› Less than one in five (17.9%)
women who did not receive a
recommendation by a health
care provider for a flu shot
were vaccinated during or
after pregnancy.
› 60.9% of women with Medi-caid/
SoonerCare did not
receive a flu vaccination.
› Pregnant and postpartum
women with Medicaid/
SoonerCare and most types of
private insurance can receive
a flu shot from their prenatal or
primary care provider. Flu
shots also are provided at local
county health departments, for
free or at low cost.
with recent live births were vacci-nated
during or after pregnancy.
Provider recommendations were
associated with the likelihood of
receiving a flu vaccine. Without a
recommendation by their prenatal
health care provider, only 17.9% of
new mothers were vaccinated.
With an offer or recommendation,
64.4% of mothers received a flu
vaccination.
Figure 1 highlights the variability in
flu vaccinations among recently
pregnant women of specific race/
ethnicity. American Indian mothers
had the highest rates of flu vaccina-tion.
Hispanic and Black, non-
Hispanic women were vaccinated at
the lowest rates. Hispanic women
were the least likely among all new
mothers to report no vaccination
(Continued on page 2)
December 2011
ACKNOWL EDGEMENT S
Special assistance for this piece was
provided by Melody Rohani (Oklahoma
Health Care Authority), Alicia Lincoln
(Oklahoma State Department of Health,
Maternal and Child Health Service), and
the Georgia Center for Health Policy.
Funding for PRAMS is provided by the
Centers for Disease Control and Preven-tion
(CDC) and the Maternal Child
Health Bureau, Department of Health
and Human Services, MCH Title V Block
Grant.
PRAMS is a population-based surveil-lance
system about maternal behaviors
and experiences before, during and after
pregnancy. Approximately 250 mothers
are selected to participate in Oklahoma
each month. Mothers are sent as many
as three mail questionnaires seeking
their participation, with follow-up phone
interviews for non-respondents. Infor-mation
included in the birth registry is
used to develop analysis weights that
adjust for probability of selection and
non-response. In September 2009-April
2010 an additional series of questions
regarding influenza vaccinations were
added to the main PRAMS survey.
These data were then weighted as a
separate data set to reflect the birth
population for the state during flu sea-son.
The sample size for 2009-2010
influenza supplement data was 1,432.
The Oklahoma State Department of
Health (OSDH) is an Equal Opportunity
Employer. This publication was issued
by the OSDH, as authorized by Terry
Cline, PhD, Commissioner of Health,
Secretary of Health and Human Ser-vices.
1,200 copies were printed by
OSDH in December 2011 at a cost of
$348. This publication is available for
download at <http://www.health.ok.gov>.
during or after pregnancy (Figure
1). Differences in race/ethnicity
were statistically significant (p <
0.05).
Parity also was significant. Moth-ers
with more than one child were
significantly less likely to receive a
flu shot (44.2%) compared to
women who recently gave birth to
their first child (55.7%).
Higher education levels also in-creased
the likelihood of flu vacci-nation
among pregnant and post-partum
women. Nearly 56% of
women with greater than a high
school education were vaccinated
compared to 34.6% of women with
less than a high school education.
Insurance status during prenatal
care was another area of significant
difference, as 66.4% of women us-ing
private insurance and 39.1% of
women with Medicaid/SoonerCare
received the flu shot. Approxi-mately
50% of women using pri-mary
private insurance and secon-dary
Medicaid/SoonerCare cover-age
received a flu shot (labeled as
“Both” on Figure 2) during or after
“My doctor said to wait [to
get a flu shot], then I forgot”
- PRAMS Mom
pregnancy. Women without insur-ance,
with military or Indian Health
Services (IHS)/tribal health care
had the lowest rates of vaccination
(37.6%; labeled as “Other” on Fig-ure
2).
Reasons given by women who did
not receive a flu vaccination were
(they could choose more than one):
>  Doctor didn’t mention it (71.4%
not vaccinated vs. 28.6% vacci-nated)
>  Worried about side effect for
me (54.3% not vaccinated vs.
45.7% vaccinated)
>  Worried shot may harm the
baby (48.1% not vaccinated vs.
51.9% vaccinated)
>  Do not normally get it (28.9%
not vaccinated vs. 71.1% vacci-nated)
References:
1. CDC. Pregnant women and Influenza (flu),
2010. Available at: http://www.cdc.gov/flu/protect/
vaccine/pregnant.htm
2. CDC. Pregnancy and Influenza Vaccine Safety,
2011. Available at: http://www.cdc.gov/
vaccinesafety/Concerns/gnancy_influenza.html
*Indicates mother had both Medicaid/SoonerCare and private insurance coverage
** Includes Uninsured, IHS/tribal, and/or military health care