Swine Flu and Pregnancy

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There has been a lot of panic recently about the spread of swine flu among pregnant women in Egypt. Most of the reports have confirmed a high mortality rate as compared to non-pregnant women. This has been based on calculating the number of pregnant women dying from swine flu as compared to the total number of infected pregnant women. I would like first of all to clarify one important issue; we have an accurate figure of pregnant women who died from swine flu. However, there is no record of the total numbers who caught the disease and fully recovered. A lot of cases have not been tested, thus not confirmed, and a lot of the positive cases have not registered. In conclusion I would like to reassure pregnant women that the mortality from swine flu is not as high as we think, but we still need to be very cautious with the disease. In this article I will try to cover some aspects of the disease, how to avoid, what to look out for and how to treat.


What is Swine flu?

Swine flu (H1N1) is a highly contagious type of flu, with symptoms similar to seasonal flu. Swine flu has spread so quickly because it is a new virus, so most of us have not built up any immunity to it. The H1N1 virus is called swine flu because it is thought to originate from pigs.

Swine flu was first reported in Mexico in April 2009. Two months later, the World Health Organisation (WHO) raised a worldwide pandemic alert. This means that the disease has spread to many countries around the world.

Is (H1N1) especially dangerous for pregnant women?

Your immune system is weaker when you’re pregnant, so you’re more vulnerable to illness in general. During pregnancy, any type of flu can get bad very quickly and be complicated by infections such as pneumonia or can affect the fetus causing sever distress up to mortality.

Many moms-to-be who get the flu have no complications. But statistically, you’re more likely to develop a severe case when you’re pregnant. 

Pregnant women who are otherwise healthy have already been severely affected by the 2009 swine flu virus. Compared to the general population, more pregnant women have been hospitalised with H1N1, and some have died. Only about 1 percent of the general population is pregnant, but 6 percent of confirmed fatal swine flu cases so far have been in pregnant women.

In general, moms-to-be are more likely to develop complications from the flu viruses that arrive every year during flu season (called “seasonal flu”), and they’ve been more prone to complications during previous pandemics. For example, higher rates of flu-related deaths, miscarriage, and premature birth were reported for pregnant women during the pandemics of 1918-1919 and 1957-1958.

How can I avoid catching swine flu?

You can reduce your risk of infection by avoiding unnecessary travel and keeping away from crowds. Wherever possible, try to avoid contact with people who have flu-like symptoms or you know have swine flu (Directgov 2009c). You can wear masks in crowded places or if there are any concerns of being close to infected people.

A vaccine for swine flu has been produced. Pregnant women will be a priority in the early stages of the vaccination programme (NHS Choices 2009a). The vaccine is given to pregnant women in two doses, with a three-week interval. It is recommended that all pregnant women have the swine flu vaccine when available. It may be better to avoid taking it the first three months of pregnancy (BMJ 2009b). As there is some concern it may increase the risk of miscarriage.

You need to follow the general hygiene advice; Wash your hands frequently, including immediately before eating, after sneezing, and after going to the bathroom. Wash hands properly by rubbing both sides of your soapy hands for at least 15 seconds and rinsing with plenty of water. When soap and water aren’t available, use alcohol-based gel sanitizers that contain at least 60 percent alcohol or disposable hand wipes.

Don’t cough or sneeze into your bare hands. That puts the virus is all over your hands, where it can easily spread to others. Instead, cover your mouth with your arm and cough or sneeze into your sleeve or cover your nose and mouth with a disposable tissue and throw it away after using. (Many experts say the sleeve method is better than using a tissue, because handling a tissue can contaminate your hands and spread illness.) If you inadvertently use your bare hands, wash them right away.

Don’t touch your eyes, nose, or mouth. You may think your hands are clean, but if your hands have touched a doorknob, a cup, a refrigerator handle, or any other item that someone else has touched with a virus-covered hand, your hands carry the virus and can infect you.

Viruses and bacteria can live two to eight hours on hard surfaces. Wipe down surfaces at home such as toys, bedside tables, doorknobs, telephones, and bathroom and kitchen counters with a disinfectant, following directions on the label. Keep at least 6 feet away from people who are sick, including anyone in your household who is sick.

Eat a healthy diet , including plenty of fresh fruit, vegetables and wholegrain foods that will give you the minerals and antioxidant vitamins that help to fight infections (BDA 2009). Vitamin C, ginger, honey, anis and rinsing mouth with salt and water have been suggested to boost immunity however; there is no solid evidence.

I’m pregnant. Am I more at risk of catching swine flu?

Pregnant women are not known to be more at risk of catching swine flu. However, if you do catch the flu you have a greater risk of developing complications (RCOG/DH 2009). This is because your immunity to infection is slightly lowered to stop your body rejecting your unborn baby. This also makes it particularly important that you are careful to protect yourself.

What symptoms should I watch for?

Swine flu symptoms in children and adults are pretty much the same as those for seasonal flu: fever, cough sore throat, runny or stuffy nose, body aches headaches, chills and fatigue, sometimes, diarrhea and vomiting

If you develop the flu, you probably won’t have all those symptoms, but you’re likely to have some combination of them. But generally if you have fever, cough, and sore throat, it’s likely you have swine flu. If you don’t have all three symptoms, or a recent history of those symptoms, you probably don’t have swine flu.

When should I worry?

The flu can get worse quickly when you’re pregnant, and you’re more vulnerable to complications such as such as pneumonia. Get emergency medical help immediately if you notice any of these symptoms:

Difficulty breathing, shortness of breath, turning blue, bloody or coloured sputum, pain or pressure in your chest or abdomen, sudden dizziness, confusion and severe or persistent vomiting. If you notice your baby’s not moving as much. Finally, a high fever that doesn’t respond to paracetamol.

What should I do if I feel like I’m getting the flu?

If you get sick with flu-like symptoms, stay home, limit contact with others, and call your doctor. Your doctor will decide whether testing or treatment is needed. Tests may include a nasal swab (best done in the first four or five days after you get sick). 

If you’re alone, have someone check on you often. If you come into close contact with someone who has swine flu or is being treated for exposure to swine flu, call your doctor to talk about whether you need treatment to reduce your chances of getting the flu.

Could swine flu affect my developing baby?

We know that with ordinary seasonal flu, your baby is well protected against the virus within your uterus (womb). Swine flu is a new strain of flu, so we don’t yet know everything about it, but the risk of infection for your developing baby is not thought to be high (RCM 2009).

Fever in early pregnancy is known to slightly increase the risk of neural tube defects, such as spina bifida (defect in the vertebral column & spinal cord of the baby, which has major consequences), so it’s important to control a high temperature. A very small number of pregnant women with swine flu develop complications, such as pneumonia, that can lead to miscarriage or their baby being born early. These risks are greater during the second and third trimesters of pregnancy.

The vast majority of pregnant women with swine flu make a full recovery and go on to have a healthy baby at full-term

How long do people stay contagious?

People who have the swine flu virus can be contagious for up to seven days after the onset of the illness. Children, especially younger ones, may be contagious for longer (CDC 2009a).

How can swine flu be treated?

Fever is one of the symptoms of swine flu, so if you have a high temperature it’s important to control it. Try your best to cool yourself down with a fan or tepid sponge. You can safely take paracetamol-based cold remedies (RCOG 2009). However, if you are pregnant, you should not take aspirin or anti-inflammatory drugs such as ibuprofen (NHS Choices 2009c). You need to drink plenty of fluids and bed rest until temperature settles.

Your doctor will decide whether you need antiviral drugs or not. Antiviral drugs don’t cure the disease but they will relieve the symptoms and help you to recover faster. They will also reduce the likelihood of you developing complications. It’s recommended that pregnant women are offered antiviral treatment if it’s suspected they have swine flu, even before it’s been confirmed (RCOG/DH 2009).

Most pregnant women will be prescribed the antiviral drug Relenza. This antiviral is inhaled, so reaches the throat and lungs and does not build up in your blood stream (NHS Choices 2009d). If you have a health condition that makes it difficult for you to inhale a preparation, such as asthma, you will be offered Tamiflu (DH 2009b). In Egypt the Relenza is not available thus Tamiflu should be prescribed one tablet twice daily for 5 days.

Pregnant women can receive treatment at home unless they develop pneumonia/ severe chest infection, then they need to be hospitalised.  Antibiotics may be prescribed as penicillins or cephalosporins, which are safe during pregnancy if there is accompanying chest infection. However, there is no evidence for their role in treating swine flu per say.
The risk of taking antiviral treatments in pregnancy is extremely small, and much smaller than the risks posed by the symptoms of swine flu (NHS Choices 2009a).

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