H1N1 and Pregnancy
By Laura E. Stachel
The first cases of H1N1, the influenza virus also called “swine flu,” were reported in the United States in the spring of 2009. By July 2009, more than 43,000 confirmed cases of H1N1 were identified, and now the Centers for Disease Control (CDC) report that H1N1 is a worldwide pandemic.

Although H1N1 is relatively new, pregnant women appear to be at increased risk of developing complications. One study showed that pregnant women with H1N1 are four times more likely to be hospitalized than the general population and have a higher risk of complications and death. While most pregnant women with H1N1 will recover without serious complications, it is important to know how to reduce your risk of getting ill and when to seek medical attention.

This article reviews early symptoms of H1N1, recommendations for treatment and ways to prevent exposure.

Symptoms
Early symptoms of influenza A (H1N1) infection include respiratory problems such as cough, runny nose, sore throat and fever (temperature over 100.4 Fahrenheit). Other symptoms include muscle aches, chills, headache, fatigue, vomiting and diarrhea. These symptoms usually run their course in most women. However, some women can develop a life-threatening pneumonia.

Treatment
Pregnant women with exposure to H1N1 or showing symptoms of the virus should seek medical care. If H1N1 is suspected during pregnancy, the CDC recommends beginning anti-viral treatment—even while viral tests are pending. This is because treatment is most effective when initiated within the first days of exposure to the virus. Several anti-viral medications have proven effective including Tamiflu (zanamivir), an inhaled medication, and Relenza (oseltamivir), an oral medication. The CDC states that these drugs can be used during pregnancy and recommends the same regimens as those advised for other adults with seasonal flu. The benefits of these medications are greatest if they are started within 48 hours of the onset of symptoms. Experts advise that the risk of untreated flu during pregnancy outweighs potential concerns about the use of antiviral medications.

Pregnant women who have been exposed to people with suspected or diagnosed swine flu should immediately contact their doctor, who will likely recommend anti-viral medication for 10 days.

The fever associated with the flu may be harmful to fetal development. Therefore, if you are sick, drink plenty of liquids and use acetaminophen to reduce prolonged fever.

When to get emergency care

Seek emergency care promptly if you experience any of the following symptoms:
  • Difficulty breathing or shortness of breath
  • Pain and pressure in your chest or abdomen
  • High fever that won’t respond to acetaminophen
  • Sudden dizziness or confusion
  • Decreased or lack of fetal movement
  • Severe or persistent vomiting
  • Protecting yourself and your family
Take these steps recommended by the CDC to protect your health and reduce your risk of spreading or acquiring an infection.
  • Cover your nose and mouth with a tissue when coughing or sneezing, and discard the tissue right away.
  • Wash your hands with soap and water many times a day, especially after coughing or sneezing.
  • Use alcohol-based hand sanitizers when running water is not available.
  • Avoid close contact with people who have flu-like symptoms, including fever, muscle aches and cough.
  • To minimize your chance of infecting others, stay home for seven days if you develop symptoms of the flu, or wait until you have been symptom-free for 24 hours.
  • If a family member is ill, you should find someone else to provide care to minimize your chances of getting infected.
Vaccines
The vaccine for H1N1 is now available, and pregnant women are one of the groups given priority for this vaccine. For more information, see our article of Flu Vaccines in Pregnancy, or check the CDC website:
http://www.cdc.gov/h1n1flu/pregnancy/