Pregnancy and swine flu

Q & A with Ruth Tuomala, M.D., an obstetrician-gynecologist who specializes in infectious diseases at Brigham and Women's Hospital, Boston, Mass.

Say you're pregnant and have a kid at home, and his or her school closes because of the swine (H1N1) flu. What should you do? Quarantine yourself?
That might be the ideal medical thing to do, but you have to balance that with what is practical. Every pregnant woman should start thinking about what she would do in that circumstance, how she would protect herself, and her fetus, while still taking care of her family. So talk with your partner, your extended family, and your obstetrician about what you will do, as a family, if one of you is exposed to the disease. Who, for example, can you call on to help care for your children?

Why is avoiding the disease so important for pregnant women? Does pregnancy make them more susceptible to it?
Being pregnant doesn't make it more likely that you'll become infected. But if you are infected, pregnancy makes complications of the flu—any flu—more likely and often more serious. And women in their third trimester have reduced lung function because the baby takes up so much room. That may make pregnant women more susceptible both to influenza viral pneumonia and to secondary bacterial pneumonia.

If the mom does get infected, is that a threat to the fetus?
Not directly; that is, the mom won't pass the disease to the fetus, and it won't harm the fetus as, say, chicken pox can. But if a mom develops pneumonia or gets extremely sick she is more likely to have premature birth.

Is it still worthwhile for pregnant women to get vaccinated against regular, seasonal flu?

It's unlikely that the vaccine now available, which was developed before the current crisis, protects against swine flu. And while in general pregnant women should get vaccinated against seasonal flu, in many parts of the country that disease has already run its course. You may want to check with your state health department to see if cases of seasonal flu are still being reported.

Since bacterial pneumonia can be a complication of influenza infection, should pregnant women get the pneumonia vaccine?
Probably not, since the pneumonia vaccine protects against only one particular bacterium (pneumococcus), which is not the one that usually strikes people after they've developed the flu.

What steps should pregnant women take to prevent swine flu?
The same things everyone else should do, only more scrupulously. Wash your hands. Don't touch your mouth or nose or eyes. Cover your mouth when you cough or sneeze. And be a little more cautious overall. Maybe, for example, this isn't when you need to bring cupcakes to your kid's school. And if swine flu has been reported in your community, consider avoiding crowded public places, including supermarkets and malls. And if you're around people who may have been exposed, consider wearing a mask.

If you've been exposed to the disease, should you take an antiviral drug like Tamiflu (oseltamivir) and Relenza (zanamivir)?
Probably. While the preventive use of antivirals isn't recommended for the general population, it is for high-risk individuals who've been exposed to swine flu, and that includes pregnant women. While those drugs haven't been studied extensively in pregnant women, what we know so far hasn't raised alarms. Antivirals are also worth taking if you already have fly symptoms, especially if you take them within about 48 hours.

Are some antivirals safer or more effective than others in pregnant women?
Relenza may be a good choice during early pregnancy, since you breathe it in by mouth and it is thus less likely to get into the blood stream and reach the fetus. On the other hand, it may be harder to get an adequate dose with Relenza in the second half of pregnancy, when women's lung function often declines. But Tamiflu also works well, and if that is the antiviral that is available in your community you should not hesitate to use it.

Are the signs and symptoms of swine flu different in pregnant women?
No, they're the same as in other people, which are essentially the same as for seasonal flu: a fever over 100°F, a nonproductive (dry) cough, severe headaches, muscle aches, and fatigue. The flu can also cause gastrointestinal symptoms such as diarrhea and vomiting. But for pregnant women, the disease may become more severe.

What about breastfeeding?
You can take antivirals while breast-feeding. But if you are ill with swine flu, you need to be extra cautious about transmitting the disease to your baby. While that's unlikely to happen through breast milk itself, holding your baby close obviously increases the risk to the baby. So if you opt to continue breastfeeding, you should use good hygiene such as hand washing, washing the breast prior to breastfeeding, and perhaps wearing a mask while breastfeeding. (Read more breast-feeding guidelines from the CDC.)

—Joel Keehn, senior editor