Yesterday the latest issue Of Emerging Infectious Diseases came out. In it was an interesting article called
Prophylaxis and Treatment of Pregnant Women for Emerging Infections and Bioterrorism Emergencies This article is a great overview on the current state of the art in using prophylatic treatment in pregnant women. For those who are unclear, prophylatic treatment is not aimed at curing a patient that is already sick. Its intent is to prevent exposed persons from becoming sick to begin with. This is often done with one of many medications. Such treatment is important because in a biological attack it may be days of weeks before symptoms appear. By that time available treatments may be much less effective. In addition each infected person then has the opportunity to infect untold numbers of other people before symptoms alert us to a potential problems.
Use of prophylaxis in pregnant women is hampered among other things by the lack of hard data. Because of ethical issues surrounding safety of the fetus, drug trials are not performed on pregnant women. The issue is also complicated by the nature of pregnancy itself. Hormones and other aspects of a pregnant woman's body are constantly in flux. The above article goes into much more detail on these and other concerns. Including is the simple fact that there is just so much that is not know about how a pregnant woman's body will react to the medications normally used in these situations.
In homeland security we may need to relook at our prophylaxis planing. It is likely that pregnant women may need more individualized prophylatic treatment as opposed to other segments of the impacted population.
We also need to plan for such decisions in advance, like everything else we may need to provide in an emergency. I urge you to read this article and others. Discuss them with your disaster medical team. Work through the logistics etc. before an emergency thrusts these decisions on you, and the people you protect.