CURRENT RECOMMENDATIONS FOR PREGNANT WOMEN WITH SWINE FLU

This “Swine Flu epidemic has so far been milder than originally expected –at least it has receded from the headlines. Still, by Friday, 5/22/09 the New York Times reported 12,022 cases of swine flu, including 86 deaths, had been reported to the World Health Organization from 43 countries. More than half of the cases were from the United States. Of the deaths, 75 were reported by Mexico.

Health officials continued to stress that anyone with underlying health conditions — like diabetes, asthma, emphysema or a compromised immune system — who is exposed to flu should seek medical attention.

But an "odd feature" of this H1N1 virus is — about one third of infected patients at two Mexican hospitals did not have fever when screened. Given that, many experts consider fever "the most important sign of the disease, its absence could increase the difficulty of identifying and controlling the epidemic,” say experts.
Moreover, the MMWR Dispatch advises pregnant women "in close contact" with those who have confirmed, probable, or suspected swine-origin influenza A (H1N1) infection should receive a 10-day course of zanamivir or oseltamivir, according to an MMWR Dispatch report on three pregnant women with H1N1, one of whom died. The report recommends that pregnant women with confirmed, probable, or suspected disease should receive antivirals for 5 days. Oseltamivir is "normally not recommended for use during pregnancy," according to its label, but the CDC says the drug is the preferred treatment for pregnant women during this outbreak. Oseltamivir should be started within 48 hours of symptom onset.

RATIONALE FOR THESE RECOMMENDATIONS:

Adverse pregnancy outcomes have been reported following previous influenza pandemics, with increased rates of spontaneous abortion and preterm birth reported, especially among women with pneumonia. Case reports and several epidemiologic studies conducted during inter-pandemic periods also indicate that pregnancy increases the risk for influenza complications for the mother and might increase the risk for adverse perinatal outcomes or delivery complications.

The currently circulating novel influenza A (H1N1) virus is sensitive to the neuraminidase inhibitor antiviral medications zanamivir (Relenza®) and oseltamivir (Tamiflu®), but is resistant to the adamantane antiviral medications, amantadine (Symmetrel®) and rimantadine (Flumadine®).

ANTI-VIRAL RECOMMENDATIONS FOR PREGNANT WOMEN.

Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use.

Recommendations for use of antivirals for pregnant women might change as data on antiviral susceptibilities become available. Nevertheless, as of now pregnant women who meet current case-definitions --should receive empiric antiviral treatment.
• Pregnant women who are close contacts with persons with suspected, probable, or confirmed cases of novel influenza A (H1N1) should receive chemoprophylaxis.
• Recommended duration of treatment is five days, and for chemoprophylaxis is 10 days.
• Oseltamivir and zanamivir treatment and chemoprophylaxis regimens recommended for pregnant women are the same as those recommended for adults who have seasonal influenza.

BREASTFEEDING?

Antiviral medication treatment or prophylaxis is not a contraindication for breastfeeding.
• Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness.
• Women who deliver should be encouraged to initiate breastfeeding early and feed frequently.
• Ideally, babies should receive most of their nutrition from breast milk.
• Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible.

If a woman is ill, she should continue breastfeeding and increase feeding frequency. If maternal illness prevents safe feeding at the breast, but she can still pump, encourage her to do so. The risk for novel influenza A (H1N1) transmission through breast milk is unknown. However, reports of viremia with seasonal influenza infection are rare. Expressed milk should be used for infants too ill to feed at the breast.

In certain situations, infants may be able to use donor human milk from a HMBANA-certified milk bank.

Instruct parent and caretakers on how to protect their infant from the spread of germs that cause respiratory illnesses like novel influenza A (H1N1):
• Wash adults and infants’ hands frequently with soap and water, especially after infants place their hands in their mouths.
• Keep infants and mothers as close together as possible and encourage early and frequent skin-to-skin contact between mothers and their infants.
• Limit sharing of toys and other items that have been in infants' mouths. Wash thoroughly with soap and water any items that have been in infants' mouths.
• Keep pacifiers (including the pacifier ring/handle) and other items out of adults' or other infants' mouths prior to giving to the infant.
• Practice cough and sneeze etiquette.

Please remember, as with all our articles we provide information, not medical advice.

For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.