A (H1N1) and the pregnant woman

  • Health
  • Sunday, 16 Aug 2009

Pregnant women are at high risk of getting Influenza A(H1N1) complications. Find out what precautions can be taken, and how it could affect a pregnancy.

AS of Aug 12, 2009, there have been 44 deaths in the country related to Influenza A(H1N1). Among the recent deaths are a 10-month-old girl, a one-year-old boy and an 18-year-old pregnant woman.

According to the Health Ministry, those in the high-risk group are:

·Children younger than five years old;

·People aged 65 years and older;

·Children and adolescents (below 18 years) on long-term aspirin therapy;

·Pregnant women;

·Adults and children with asthma, chronic obstructive pulmonary disease, organ failure, cardiovascular disease, hepatic, heamatological, neurologic, neuromuscular or metabolic disorders such as diabetes mellitus;

·Adults and children who have immunosuppression; and

·Residents of nursing homes and other chronic care facilities.

Obstetrician and gynaecologist Dr Gunasegaran PT Rajan, answers some questions on Influenza A(H1N1) and the pregnant woman.

Why are pregnant women in the high risk group?

Pregnant women are in the high risk group because of altered immunity, so they are more prone to succumbing to viruses, not just A(H1N1), but any virus. A lot about the virus itself is unknown, so we are not sure why it seems to be attacking some people more than others. Then there is the foetus – that’s another reason why the pregnant woman is at higher risk.

What sort of symptoms should the pregnant woman be concerned about?

Among the many symptoms, fever is one of those that can be potentially disastrous for pregnant women. High fevers can pose problems to mothers – they could have a miscarriage, they can go into premature labour, or have a poor outcome at birth; to babies, it can result in deformities,or cause cerebral palsy.

The first priority is to control the fever when they are pregnant because babies can go into distress.

As for the mother, the complications are very similar to somebody who is not pregnant, which is chest congestion, pneumonia, and acute respiratory distress syndrome.

What sort of precautions should a pregnant woman take?

Precautions that pregnant women can take are the same as those taken by everyone else:

·Avoid crowded places

·Avoid contact with anybody who is potentially at risk and those who have been exposed

·Avoid going to high-risk places

·Wash your hands

·Have proper nutrition and ensure they’re taking vitamins and plenty of fluids

·Work from home if possible

Even with regular clinic visits, we are now advising them to have it done every three weeks instead of two weeks if they are low risk pregnancies. Some of the consultations can even be done via phone or email for those with low-risk pregnancies.

What happens to a pregnant woman who has the Influenza A(H1N1)?

We have to be very careful, especially in the first trimester, when organogenesis occurs (the baby’s organs are being formed).

The trend now is that the minute a pregnant woman is diagnosed, she gets treated. If she’s admitted, the doctors at hospital will treat her. If she’s at home and having sore throat and other flu symptoms plus fever for two days, she should get treated at any hospital.

The test that they’re doing now is the first line of screening. If it’s flu A, you need to send another sample to IMR (Institute of Medical Research) for confirmation, and while waiting for that, you will get treated.

If she is in the third trimester and she gets the A(H1N1) flu, doctors are more likely to deliver the baby. We want to act fast and not risk anything.

What if the pregnant woman is fine but her husband or children have Influenza A(H1N1)?

We sometimes give prophylaxis for prevention. This is for those who don’t have symptoms but they have been exposed (they’re living with somebody who has H1N1). They too should come forward to be tested.

Are all these anti-viral drugs safe for the unborn baby?

When we give drugs to the mother, we have to think twice what it will do to the child. These drugs – oseltamivir and zanamivir – have largely unknown long-term side-effects. However, current evidence does not say that there are any serious defects. There is greater benefit than harm to the baby.

Is the pregnant woman still at risk after delivery?

If a woman is post-delivery, she is still potentially at risk.

If a woman gets A(H1N1) in the post-delivery period, she should continue breastfeeding. There is the question of whether she will pass on the flu to her baby. During breastfeeding the mother’s antibodies are passed on to the baby, so breastfeeding should be continued, but she should observe the same hygiene practices – wear a mask, wash her hands frequently, minimise contact, don’t share toys among the children in the family, and isolate herself and the baby from other family members.

A(H1N1) is serious. It’s not just a lot of hype. The good news is it’s not as deadly as SARS (Severe Acute Respiratory Syndrome), but the rate of spread is much faster.

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