Pregnancy & Baby Care Newsletter

Swine Flu (H1N1) & Pregnancy – Looking after Yourself

Advice to Pregnant Women… No need to panic!

H1N1 influenza virus pandemic, otherwise known as “Swine Flu” is causing a great deal of concern to pregnant women and their families.  Recent announcement of escalating infection rates and scientific papers referring to increased susceptibility of pregnant women have done nothing to calm nerves. In this article we summarise current official advice from the UK Government, the RCOG and WHO so you too can be informed, vigilant and calm about this pandemic.

The advice provided here is generic and based on various publications available in the UK, the US and scientific journals. For specific country advice, please refer to your local information websites and authorities.

The World Health Organization (WHO) announced 11 June 2009 that it had raised the pandemic phase to Level 6 because the H1N1 flu virus is spreading in at least two regions of the world. Now all regions of globe have been affected.

This WHO declaration was followed by various Government statements confirming their preparedness for the pandemic and issuing guidance on the prevention of spread and treatment of serious cases.

The following are considered at risk factors for a more serious disease from H1N1 Flu

• cardiovascular disease,
• respiratory disease including asthma,
• diabetes
• Cancer
• Pregnancy
• Obesity
• Depressed immunity

Pregnant women are among the “at risk group” for more serious illness although medical literature has little information on reasons and rates of excess morbidity among pregnant women during recent influenza epidemics.

Data available from past influenza epidemics (1975, 1976, 1978, 1979, and 1977) shows that pregnant women were more affected with respiratory diseases compared to non-pregnant women.

It is thought that this increased susceptibility to the influenza virus during pregnancy is due to the woman’s immunological adaptation to pregnancy. It is known that pregnancy suppresses the woman’s immunity in order for the body to accept the baby who is 50% “foreign” to the woman’s immunity system.

The Department of Health (UK), the Royal College of Obstetricians & Gynaecologists and the Royal College of Midwives (July 2009) have issued guidelines to healthcare providers and the public on the best ways to prevent infection and treatment of acute viral infections and prevention of complications.

The preparation for the pandemic situation has gone for years and this puts the UK and other nations in a good position combating the influenza pandemic.

Pregnant women and their families should be reassured that, fortunately, current figures across the globe and in the UK indicate that the current H1N1 influenza virus is mild and only people with pre-existing problems have been badly affected. There have been 29 deaths in UK at the time of writing this article and more than 700 people across the globe.

The recent publication ( 29^th July 2009) in the Lancet by Jameison and others, reiterate the susceptibility of pregnant to the H1N1 virus and the importance of awareness and acting early when the following symptoms appear.

• shortness of breath, either during physical activity or while resting
• difficulty in breathing
• turning blue
• bloody or coloured sputum
• chest pain
• altered mental status
• high fever that persists beyond 3 days
• low blood pressure.

In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.

Prevention – follow these simple but important precautions

Following simple precautions as issued by the authorities from time to time should ensure a safe and trouble free pregnancy and childbirth.

• Good personal and household hygiene: Frequent washing of hands or cleaning with a disinfecting hand rub.
• Parents should also ensure that they wash their babies’ hands.
• Tissues should be used to cover the mouth and nose when sneezing and coughing as described in the ‘Catch it, Bin it, Kill it!’ campaign.
• Parents are also advised to limit the sharing of children’s toys, and to wash or wipe toys after use.

If you think you have Flu

The following are the symptoms – currently being used to diagnose the Flu

• Fever, (pyrexia) or body temperature of 38°C or more. (or a history of high fever)
  • (Get a thermometer if you haven’t got one. A disposable may be better otherwise clean it thoroughly between uses!)

AND

• TWO OR MORE of the following symptoms:
  • cough;
  • sore throat;
  • runny nose;
  • limb or joint pain;
  • headache;
  • vomiting or diarrhoea

OR

• severe and/or life-threatening illness suggestive of an infectious process.

If you have a high fever and any two of the symptoms listed above, contact your midwife or GP by phone!

Resist the temptation to go to the Surgery or hospital.

In the meantime, LOOK AFTER YOUSELF by

• taking paracetamol tablets, to reduce the temperature and ease the pains.
• Drinking plenty of fluids
• Have a friend or relative to liaise with your doctor and midwife, if you cannot do this yourself.
• Keep a watch on your baby’s movements

Once the diagnosis of H1N1 has been made,

Your doctor or in the UK, The National Pandemic Flu Service ( telephone : 0800 1 513 100 ) will arrange a prescription of your anti-viral medicines.

You will be advised to keep in touch with your doctor and midwife.

The use of anti-viral medicines during pregnancy

It is important to start anti-viral treatment as early as possible, preferably within 48 hours of developing symptoms. This minimise infection spread, shorten the duration of the illness and risk of complications.

Therefore the sooner you get assessed and prescription provided the better.

There are two anti-viral medicines available on the market and in the UK. The recommended medicine for pregnant women is Relenza^R (zanamivir). This is administered as an inhaler, going straight into the lungs and avoiding the blood stream and the chance of crossing into the baby bloodstream.

The other ant-viral medicine is Tamiflu^R (oseltamivir) with is taken orally. Because this provides higher blood levels, it is not currently recommended as first line treatment for pregnant women unless the doctors feel is necessary for a more serious clinical situation.

Pregnancy Care and Giving Birth

Discuss these arrangements with your midwife and obstetrician. In the UK there are clear guidelines on how the situation will be handled – therefore do not panic. Your midwife will consider all options including home delivery.

The Department of Health, relevant Royal Colleges and community organisations have been tasked to prepare and deliver services to pregnant women and mothers in case of severe pandemic.

It is therefore critically important to for pregnant women to keep in touch with their local care providers including midwife and doctor for updates.

It would be a good idea that each woman has an identified “friend” who would liaise with health care providers on their behalf should they become too ill or need medicines collected.

Joe Kabukoba, MD MRCOG Dip Med Ed

Consultant Obstetrician & Gynaecologist

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Sources:

Jamieson DJ et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; published online July 29, 2009

http://www.dh.gov.uk/en/Publichealth/Flu/Swineflu/index.htm

http://www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/DH_099965

http://www.nhs.uk/AlertsEmergencies/Pages/Pandemicflualert.asp

http://www.direct.gov.uk/en/Swineflu/DG_177831

http://www.breastfeedingnetwork.org.uk/pdfs/Cough_and_Cold_Remedies_and_Breastfeeding_March_2009.pdf