Prenatal Care and Swine Flu: Making a Plan on Antiviral Medication and More

Pregnancy raises the risk of contracting influenza and swine flu (H1N1) is no exception. According to the U.S. Centers for Disease Control, most pregnant women who become sick with flu-like symptoms should be treated with antiviral medications as soon as possible. The CDC notes that many pregnant women who develop swine flu "will go on to have a typical course of uncomplicated influenza." However, in some cases, "illness might progress rapidly." It also might be "complicated by secondary bacterial infections, including pneumonia." To ensure prenatal medical care is given promptly, it pays to do some planning --- just in case. Here are three "action items" to consider in preparing for the possibility of swine flu in pregnancy.

Do you have a "go to" doctor if you develop flu-like symptoms?

Today more and more women receive prenatal care from obstetricians and other specialists, rather than family physicians. Yet family physicians tend to be the doctors who most often treat colds, flu and similar illnesses. According to the Mayo Clinic, "The combination of H1N1 influenza (swine flu) and pregnancy is potentially risky. If you're pregnant and think you may have H1N1 flu, or you've had close contact with someone who has known or suspected H1N1 flu, contact your doctor immediately." Which doctor?

It's important for a pregnant woman to talk with her prenatal care physician and sort out how to proceed if she becomes sick with flu-like symptoms. No one would want to be already sick and get some kind of run-around --- with the family physician saying to consult with the OB/GYN, the OB/GYN doctor saying "go to the Emergency Room," and so on.

Try to find out ahead of time which doctor would take the lead if flu occurs. Then determine: is that plan satisfactory? To evaluate the plan, one of the most important things to consider is the patient's and doctor's views on using antiviral medications in pregnancy.

Antiviral medications

On WebMD, Denise J. Jamieson, MD, MPH, and a CDC obstetrician-gynecologist, notes that "clinicians who take care of pregnant women seem hesitant to start antivirals. It has been an issue of prompt antivirals vs. concerns about the fetus. But we are recommending that women be treated, because the benefits outweigh the risks of the drug."

WebMD also cites an editorial by Mark Phillippe, MD, "warning doctors to offer pregnant women aggressive treatment if they have flu symptoms." Phillippe is Chairman of Obstetrics, Gynecology, and Reproductive Sciences at the University of Vermont.

For pregnant women with flu-like illness, the CDC advises that "antiviral treatment is most effective when started as early as possible after the onset of symptoms (i.e. within the first 2 days)." Treatment should not be delayed for testing to identify the virus. However, the CDC recommends treating pregnant women with antiviral medications even if they have been sick for more than 48 hours.

The Canadian Medical Association Journal states that the swine flu virus, H1N1, is susceptible to oseltamivir (brand name: Tamiflu) and zanamivir (brand name: Relenza). The Journal reported that H1N1 does not respond to Flumadine or Symmetrel.

Research in Medpagetoday concluded that anti-flu drugs seemed safe for use during pregnancy. Nevertheless, as WebMD notes, it's understandable that "many women -- and many doctors -- are hesitant to start medications during pregnancy." But, as part of a prenatal care plan, this is an issue that may be resolved ahead of time. When flu-like symptoms strike pregnant women, WebMD states "the antiviral drugs Tamiflu and Relenza pose vastly less risk than the flu itself."

Be able to take action promptly

Two facts about swine flu and pregnancy make prompt action important. First, if swine flu strikes, illness can worsen rapidly. Secondly, antiviral medications have the strongest effect against the H1N1 virus within 48 hours after symptoms develop.

Doctor Jamieson says that "pregnant women should continue their everyday activities and not take any extra precautions other than avoiding people who have the infection and washing their hands frequently. But if they suspect they may have the flu, they do need to promptly call their health care provider."

Most of us are so used to being "connected" 24/7, it may be hard to imagine circumstances in which a pregnant woman would be unable to promptly and easily access her prenatal care provider or a hospital Emergency Room. A few situations might be that long drive through the countryside or desert without reliable cell phone service; that weekend sailing trip; a storm that knocks out power for an extended time. Such situations, of course, are hardly insurmountable. But, when it comes to prenatal care and flu treatment, there are some situations in which pondering a few "what if's" may be helpful.

More B. A. Rogers: Cell Phones, Staph, Superbugs, and My Sick Child and Your Toothbrush and Respiratory Infections.

Sources:

"Pregnant Women and Novel Influenza A (H1N1) Virus: Considerations for Clinicians," Centers for Disease Control.

Roger W. Harms, M.D., "Swine flu and pregnancy: Are special precautions necessary?," Mayo Clinic.

Daniel J. DeNoon, "Pregnancy Raises Swine Flu Death Risk," WebMD.

Michael Smith, "Anti-Flu Drugs Seem Safe in Pregnancy and Breastfeeding," MedPageToday.