Swine flu advice for pregnant women

Pregnant women are at greater risk from swine flu because their immune system is suppressed during pregnancy.

This means that pregnant women are more likely to catch flu and, if they do, they are at greater risk of developing complications (see below).

However, during pregnancy, the immune system still functions and the risk of complications is very small. Most pregnant women will only have mild symptoms.

Symptoms and risks

If you are pregnant and you catch swine flu, the symptoms are likely to be similar to those of normal flu. You will usually have a fever (a high temperature of or above 38C/100.4F), plus two or more of the following symptoms:

• unusual tiredness
• headache
• runny nose
• sore throat
• shortness of breath or cough
• loss of appetite
• aching muscles 
• diarrhoea or vomiting

Most pregnant women will have only mild symptoms and recover within a week. However, there is evidence from previous flu pandemics that pregnant women are more likely to develop complications.

Possible complications include:

• pneumonia (an infection of the lungs)
• difficulty breathing 
• dehydration 

In pregnant women, these are more likely to happen in the second and third trimester.

If a pregnant woman develops a complication of swine flu, such as pneumonia, there is a small chance this will lead to premature labour or miscarriage. There is not yet enough information to know precisely how likely these birth risks are.

It is therefore important to be well prepared and to take precautions against swine flu.

Vaccination and pregnancy

Pregnant women are advised to take the seasonal flu jab, whatever the stage of pregnancy. This includes pregnant women not in high-risk groups.

This year’s seasonal flu jab offers protection against the swine flu virus, as well as other strains of flu virus.

There is no evidence that inactivated vaccines, such as the seasonal flu vaccine, will cause any harm to pregnant women or their unborn baby. Every year, the seasonal flu vaccine is given to pregnant women who are at risk of flu.

The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency has given a clear recommendation that the GlaxoSmithKline vaccine Pandemrix can be given safely to all pregnant women.

Special precautions

If you are pregnant, you can reduce your risk of infection by avoiding unnecessary travel and avoiding crowds where possible.

Pregnant women should also follow general measures to prevent swine flu, as described below. Good hygiene is essential.

You can reduce, but not eliminate, the risk of catching or spreading swine flu by:

• always covering your nose and mouth with a tissue when coughing or sneezing
• throwing away dirty tissues promptly and carefully
• maintaining good basic hygiene, for example
• washing hands frequently with soap and warm water to reduce the spread of the virus from your hands to your face, or to other people
• cleaning hard surfaces, such as door handles, frequently using a normal cleaning product

If you think you may have swine flu, call your doctor for an assessment. Your doctor will advise you what to do if they think you have flu.

Unless you have swine flu symptoms, carry on attending your antenatal appointments to monitor the progress of your pregnancy.

Antivirals

If you are pregnant and diagnosed with swine flu, you may be given a course of antiviral medication.

If you have an uncomplicated illness due to influenza and do not have an underlying disease, you can take either Relenza or Tamiflu. Relenza is recommended as a first choice.

Relenza is inhaled using a disk-shaped inhaler. It is recommended for pregnant women because it easily reaches the throat and lungs, where it is needed, and does not reach significant levels in the blood or placenta. Relenza should not affect your pregnancy or your growing baby.

However, Tamiflu should be offered instead of Relenza if you:

• have a condition such as asthma or chronic obstructive pulmonary disease
• have difficulty taking an inhaled antiviral
• develop a severe or complicated disease due to influenza (where you will probably be treated in hospital)

An expert group reviewed the risk of antiviral treatment in pregnancy. It is much smaller than the risk posed by the symptoms of swine flu.

Some people have had wheezing or serious breathing problems when they have used Relenza. Relenza is therefore not recommended for people with asthma or chronic obstructive pulmonary disease (COPD). Other possible side effects of Relenza include headaches, diarrhoea, nausea and vomiting.

In a small number of cases, nausea is a side effect of Tamiflu.

If you take an antiviral and have side effects, see your healthcare professional to check that you are OK.

Painkillers

You can also take paracetamol to reduce fever and other symptoms. This is safe to take in pregnancy.

However, pregnant women should not take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Nurofen).