Swine Flu and Pregnancy
Donald Aulds, M.D.
Swine flu, also known as Novel Influenza A and H1N1, is a human infection that is transmitted from human to human. The infection produces the typical acute respiratory symptoms such as cough, sore throat, runny nose and fever. Other symptoms associated with the flu include aching, headaches, fatigue, diarrhea and nausea, and vomiting. Most of the infections follow an uncomplicated course, but a few will progress to pneumonia and respiratory distress. In pregnant women, the illness may be easily missed as being a common cold with the occasional advancement to pneumonia. In the complicated cases, death has been reported. In fact, the Centers for Disease Control and Prevention recently reported that pregnant women are four times more likely to be hospitalized with swine flu than the general population.
In the last one hundred years, there have two pandemic episodes with Influenza A viruses, the pandemics of 1918-19 and 1957-58. After these infections, there was reportedly an increase in miscarriages and premature birth in the pregnant women who developed pneumonia. Because treatments for influenza were limited during the two previous pandemics and there was poor reporting of adverse reactions to the virus, the incidence and risk for these complications are unknown. It has been suggested that the pregnant woman may have a slightly higher risk of infection due to the fact that her immune system is already altered by the effects of the pregnancy.
What is the course of therapy available for the pregnant woman?
On June 30, the Center for Disease Control in Atlanta published its guidelines for management of the pregnant woman in light of the swine flu:
- Testing should be started as soon as the woman is suspect of possibly having swine flu.
- Treatment should not be withheld for the testing to be completed.
- The Food and Drug Administration has just approved two antiviral medications for use with patient who are pregnant and suspected of having flu – Relenza and Tamiflu.
- Relenza is given by nasal inhalation while Tamiflu is given orally. Relenza seems to produce less chance of gastric upset. Both products appear to provide greater benefit than risk.
- If a pregnant person is in close contact with a person suspected of having the swine flu or has laboratory-confirmed swine flu, it is recommended to start the pregnant women on Relenza.
- Acetaminophen (Tylenol) appears to be the best option for therapy of fever during pregnancy.
What can be done to reduce the risk of catching the swine flu?
According to the latest data presented by the CDC, there is currently no vaccine available to reduce the risk of the transmission of swine flu. However the U.S. government just recently announced that it is in the process of purchasing and importing a vaccine for swine flu. The following suggestions may be helpful for reducing risk:
- Frequent hand washing – this has been shown to be one of the most effective ways for prevention. Antibacterial soaps do not reduce the transmission of viruses since viruses do not respond to antibiotics.
- Minimize direct contact with people known to have the flu.
- Anyone who may have the flu should stay home.
- An ill person should cover his/her mouth when coughing.
- Avoid large crowds in areas known to have confirmed cases of swine flu.
- Women who are breastfeeding should not discontinue breastfeeding unless instructed by the pediatrician taking care of the baby.
If outbreaks of swine flu reappear in our communities, a pregnant woman should discuss the best approach with her obstetrician and report any symptoms to her physician’s office.