Relenza and Tamiflu are both FDA approved for treatment of influenza. Both drugs have been carefully looked at to understand their safety profile in pregnancy and we are continuing to monitor them closely. If your doctor diagnoses influenza and prescribes Tamiflu or Relenza for you, do not wait to start the treatment. You will probably need to take the medicine for at least 5 days. Are Tamiflu and Relenza safe to use in pregnancy?
Historically staphylococcal super-infections have been particularly likely to be associated with these findings. Effectiveness of seasonal trivalent influenza vaccine for preventing influenza virus illness among pregnant women: a population-based case-control study during the — and — influenza seasons. Thus, a history of influenza vaccination should not preclude clinical suspicion of influenza infection. There have been to date no reports that outcomes are equivalent with or without neuraminidase Treatment of influenza in pregnancy and there are likewise no reports of worsened outcomes. Clin Infect Dis. Recommendations for treatment with antivirals are based on information from previous influenza pregnamcy. Obstet Gynecol ;— No part of Nurses perceptions of fairness publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Hypnotized naked woman. Antiviral Medications to Treat or Prevent Influenza (the Flu)
Clin Infect Dis Birth outcomes among women exposed to neuraminidase inhibitors during pregnancy. American College of Obstetricians and Gynecologists. Getting a flu vaccination Treatment of influenza in pregnancy the risk of infection and complications. Getting vaccinated also can help protect a baby after birth from flu. Some providers will prescribe treatment over the phone or Sex lessons fuck movie online telemedicine portals if they think your symptoms are likely due to influenza. This list is not all inclusive. Flu symptoms come on suddenly, and can include a fever, achiness, fatigue, headache, and cold symptoms such as a runny or stuffy nose, sore throat, a cough, and chills. Linking to a Treatment of influenza in pregnancy website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. People may be infected with the flu and have respiratory symptoms without a fever.
Swamy, MD and Laura E.
- Pregnancy suppresses the immune system, and strains the heart and lungs.
- When you become pregnant , everything that happens to you can affect not just your body, but that of your unborn child.
Influenza is a common infectious disease caused by a family of RNA viruses orthomyxoviruses capable of infecting a wide variety of bird and mammalian species. In humans, characteristic symptoms include fever, sore throat, myalgias, chills, cough, headache, fatigue and malaise. The viruses are inactivated by detergents, disinfectants and sunlight. There are three species of influenza viruses, labeled as influenza A, B and C, with the majority of human disease caused by influenza A.
They contain various glycoproteins on their surface, primarily hemagglutinins H and neuraminidases N. The specific combination of H and N glycoproteins are used to sub-type the viruses. There are 16 H and 9 N sub-types currently known, although H 1 through 3 and N 1 and 2 are responsible for the majority of human disease. Because these viruses can exist in multiple species and because there is constant exchange of genetic material between viruses, viral genetic material from a virus infecting one animal species can be transferred to viruses that infect other species.
For example, the new influenza strain that was responsible for the H1N1 influenza A pandemic was a combination of human, bird and pig influenza genes.
Because of the associated physiologic changes of pregnancy, pregnant women have been recognized for a century to be at increased risk of mortality and severe morbidity from concurrent influenza infection. The increases in minute volume and cardiac output, both of which significantly tax the cardiopulmonary reserve of the third trimester, as well as a shift away from T-cell-mediated immune responsiveness, are in large part responsible for this association.
To be sure, some of these reports focus on hospitalized cases and provide relatively little information about less severe cases managed as outpatients. The absolute best treatment for influenza in pregnancy is prevention via vaccination. Despite these recommendations, the uptake of influenza vaccination by pregnant women remains alarmingly low. The recent H1N1 pandemic did increase the uptake of influenza vaccine in pregnant women in the U.
While this is certainly an improvement, it leaves much to be desired, with the majority of pregnant women still not receiving appropriate vaccinations. It is thus important that obstetric care providers and their staff educate pregnant women about the potential impact of influenza infection during pregnancy and review the signs and symptoms for which they should promptly report for evaluation.
In addition, the majority of obstetric care practices now have some form of website clinic, hospital or both. These portals are widely accessed by pregnant women and should include the aforementioned recommendations.
There are, however, numerous barriers to optimal immunization during pregnancy. In addition, there is no good central vaccine record keeping system for adult vaccination e. The ever-present medico-legal concerns also serve as a disincentive for some providers. Because the vaccines are produced in chicken eggs, women who have known or suspected allergies to egg products should not be vaccinated.
Having said all this, however, there are several strategies that have increased vaccination compliance for pregnant women. Among them are standing orders and provider assessment and feedback systems. It is also important to recognize the reality of viral antigenic drift. Pregnant women need to be vaccinated against current circulating influenza strains!!
Thus, a history of influenza vaccination should not preclude clinical suspicion of influenza infection. In addition to antigenic drift, infection either just before, or within days after, vaccination can still result in clinical infection. It is important to remember that, although substantial attention was directed to the H1N1 influenza A pandemic, seasonal influenza is so named because it predictably occurs during influenza season every year.
Pregnant women are at increased risk every year whether or not there is an influenza pandemic in progress. Influenza symptoms are frequently sudden in onset and characteristically appear within days after infections. Fever frequently This degree of prostration is frequently helpful in distinguishing influenza from the common cold.
Other common symptoms include nasal congestion, sore throat, myalgias, cough, headache, fatigue and malaise. Individuals are capable of shedding the virus beginning the day before symptoms and continuing for days thereafter. Because the effectiveness of antiviral drugs see neuraminidase inhibitors, below is dependent on early initiation of treatment, pregnant women during influenza season exhibiting these symptoms should be identified early and considered for initiation of treatment.
Pregnant women who have other concurrent medical problems are at even greater risk for serious illness and should be high-priority candidates for influenza immunization! The primary portal of entry of influenza viruses is the respiratory tract and the viruses are only able to invade cells when their hemagglutinin protein is cleaved by host protease enzymes.
Because protease enzymes differ between genera and species, the hemagglutinin protein characteristically defines which species the virus can infect. Viruses whose hemagglutinin protein can only be cleaved by proteases found in the throat and upper respiratory tract characteristically result in clinically mild infections whereas those whose hemagglutinins can be cleaved by a wide variety of proteases are able to spread throughout the body.
Pregnant women suspected of having an influenza infection should not be seen during regular clinic hours for fear of transmitting the infection to others.
Arrangements should be made for either visits to alternative clinics or during alternative hours. It is important to remember that the rapid diagnostic influenza tests have very poor sensitivity and should not be the basis for diagnosing or excluding influenza. The real-time reverse transcriptase-polymerase chain reaction test is an ideal test for making the diagnosis. It should be minimally affected by recent antiviral therapy, as it does not require replicating virus for diagnosis.
Women with any suggestion of pneumonia or septic shock should be admitted to a hospital for further evaluation and treatment. In addition to a chest x-ray see following section , a complete blood count, electrolytes and serum chemistries should be obtained as a baseline for subsequent comparison. Pregnant women with any clinical suggestion of pneumonia or septic shock should have a chest x-ray performed. Chest x-ray findings with influenza pneumonia are variable and at least in part reflect the invasive characteristic of the specific viral subtypes see Pathophysiology, below.
Chest x-ray findings may be absent but often include some degree of interstitial prominence, patch consolidation or alveolar hemorrhage classically as small centribolular nodules. Historically staphylococcal super-infections have been particularly likely to be associated with these findings.
Remember as well that pregnant women often appear rather healthier than they really are. It is particularly important to assess maternal oxygen saturation in the setting of suspected influenza infection and to monitor it serially.
Particularly during influenza season, the diagnosis of influenza, when accompanied by a clinically consistent exposure and sudden onset of characteristic symptoms, is straightforward. However, bacterial, chlamydial or mycoplasma pneumonia can present similarly, so cultures for these infections should be considered, particularly if there is no response to antiviral medications. Every study that looked at separate outcomes for pregnant women in the recent H1N1 pandemic who were started on neuraminidase inhibitors within 48 hours of symptom onset found improved maternal outcomes.
Even starting within days after the onset of symptoms has been shown to be of some value. There have been to date no reports that outcomes are equivalent with or without neuraminidase inhibitors and there are likewise no reports of worsened outcomes. If you are seeing a pregnant woman with suspected influenza, you should be aggressive in starting neuraminidase inhibitors.
I would emphasize that this should be started as soon as the diagnosis is suspected, particularly if she has any additional risk factors.
Do not wait for confirmatory testing! In contrast to the adamantanes, essentially all the H1N1 and H3N2 influenza A as well as influenza B reported in recent influenza seasons have been sensitive to the neuraminidase inhibitors.
These drugs interfere with replication of influenza virus in the respiratory tract a process that reaches its peak hours after onset of symptoms , so it is important that these drugs be administered as quickly as possible. These medications have very few side effects usually gastrointestinal and are much less likely to stimulate drug resistance.
Information on the effects of influenza antiviral medications on the fetus is limited, although there remains no suggestion of harm. Given the clear risks associated with maternal influenza infection during pregnancy and the absence of obvious risks with antiviral medications, the CDC recommends that pregnant women with suspected influenza be given appropriate influenza medications.
Essentially all the H1N1 and H3N2 influenza A as well as influenza B reported in recent influenza seasons have been resistant to the adamantanes. These medications are used infrequently. They are only effective against influenza A, tend to rapidly induce viral resistance and have some potentially serious side effects in particular, serious allergic reactions and personality changes. For both reasons it is appropriate to treat influenza-associated fever during pregnancy.
Acetaminophen, rather than aspirin or non-steroidal anti-inflammatory drugs, is the preferred treatment. Although the increased oxygen affinity of fetal hemoglobin favors continued adequate fetal oxygenation, significant maternal hypoxemia can still lead to fetal compromise. ECMO has been reported to be of value in severely ill pregnant women, although at least a half-dozen of the now several dozen reported cases have died either during pregnancy or afterward.
Delivery can reduce the metabolic and mechanical burden of severe disease by removing fetal oxygen consumption and decreasing intra-abdominal pressure. A number of reports describe iatrogenic preterm birth, frequently by cesarean delivery, in the setting of severe maternal disease.
There are no controlled trial data to guide us on this issue. Ideally, women with an acute influenza infection should be delivered in a separate area away from other laboring women.
During pandemics, information about such arrangements should be widely publicized. Postpartum women should also be cared for in areas removed from other pregnant and puerperal women. This raises the common sense question of whether we would, or would not, be smarter than human biology to try to tocolyse such women. Although being pregnant does not increase the likelihood of a woman acquiring influenza, it does increase by four- to five-fold her risk of developing a serious infection that could require hospitalization.
However, both patients and their families should be educated to watch carefully for any suggestion of respiratory de-compensation, particularly for the first several days of the illness. As noted above, we recommend universal influenza vaccination for all pregnant women, irrespective of trimester.
While this can effectively prevent influenza illness in pregnant women by inducing protective concentrations of hemagglutinin inhibition antibodies , it also provides clear protective benefits to newborns through the first six months of life. Vertical transmission may have occurred in a handful of cases but it is exceedingly rare and there is no evidence that congenital or neonatal influenza has ever been acquired from influenza vaccination.
The major problems for newborns of influenza-infected women are the sequelae of prematurity. An asymptomatic infant born to a mother who is either symptomatic or who has recovered from an influenza illness during pregnancy does not require special treatment but should be monitored closely for evidence of evolving neonatal influenza.
This generally involves separating the mother if she is symptomatic from her baby, although the duration of isolation is uncertain.
Although there is no evidence of harm, there are very few data on antiviral medication levels in breast milk. However, as with vaccination and treatment during pregnancy, the increased risks associated with maternal influenza infection during the first few weeks postpartum and the absence of obvious risks with antiviral medications suggest that women with suspected influenza who are within 2 weeks of delivery and who are breastfeeding should be given appropriate influenza medications.
The baby should be fed the breast milk by an uninfected caregiver until the CDC clinical criteria described above have been fulfilled.
Am J Obstet Gynecol. N Engl J Med. Good recent update on impact of influenza on the fetus as well as the lack of fetal impact from vaccination [outcomes clearly improved]. Clin Infect Dis. Demonstrates equivalent efficacy of influenza vaccine in pregnant vs non-pregnant adults. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.
The CDC recommends that pregnant women with flu-like symptoms be treated immediately with antiviral medications. See the hottest baby name trends. Please consult your medical provider for any other symptom that is severe or concerning. This can make catching the flu dangerous for pregnant women. Seasonal influenza and pregnancy. Keep me logged in. Both drugs have been carefully looked at to understand their safety profile in pregnancy and we are continuing to monitor them closely.
Treatment of influenza in pregnancy. Why is the flu especially dangerous pregnant women?
Assessment and Treatment of Pregnant Women With Suspected or Confirmed Influenza - ACOG
These recommendations provide guidance for obstetric health care providers about prescribing antiviral medications for treatment and prevention of influenza during the season. These recommendations are consistent with current recommendations for antiviral treatment from the Advisory Committee on Immunization Practices, the Infectious Diseases Society of America Uyeki et al.
These recommendations also build off recommendations from a meeting of experts convened by CDC in , to review the evidence on treatment and prevention of influenza during pregnancy Rasmussen et al. Obstet Gynecol ; BJOG ; Oseltamivir for the treatment of H1N1 influenza during pregnancy. Clin Pharmacol Ther ; Oseltamivir in pregnancy and birth outcomes. BMC Infect Dis ; Neuraminidase inhibitors during pregnancy and risk of adverse neonatal outcomes and congenital malformations: population based European register study.
BMJ ;j Maternal and neonatal outcomes after antepartum treatment of influenza with antiviral medications. Severe H1N1 influenza in pregnant and postpartum women in California. N Engl J Med ; Am J Obstet Gynecol.
Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. Population pharmacokinetics of oseltamivir in non-pregnant and pregnant women.
Br J Clin Pharmacol ; Pandemic influenza and pregnant women: Summary of a meeting of experts. Am J Public Health ;99 S Preparing for influenza after H1N1: special considerations for pregnant women and newborns. Outcomes of infants exposed to oseltamivir or zanamivir in utero during pandemic H1N1 Am J Obstet Gynecol ; e JAMA ; Birth outcomes among women exposed to neuraminidase inhibitors during pregnancy.
Pharmacoepidemiol Drug Saf ; Safety of neuraminidase inhibitors against novel influenza A H1N1 in pregnant and breastfeeding women. CMAJ ; Clin Infect Dis The safety of oseltamivir in pregnancy: an updated review of post-marketing data.
Infant outcomes among pregnant women who used oseltamivir for treatment of influenza during the H1N1 epidemic. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Influenza Flu. Section Navigation. Minus Related Pages.
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