From the CDC website- Pregnant Women and Swine Influenza

Interim Guidance—Pregnant Women and Swine Influenza: Considerations for Clinicians
April 28, 2009 1:45 PM ET

Background
Human infections with a swine influenza A (H1N1) virus that is easily transmissible among humans were first identified in April 2009 with cases in the United States and Mexico. The epidemiology and clinical presentations of these infections are currently under investigation. There are insufficient data available at this point to determine who is at higher risk for complications of swine influenza A (H1N1) virus infection. However, in 1988 a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later after infection with another variant of swine influenza virus. Pregnant women are also known to be higher risk for seasonal influenza complications and during prior pandemics, and it is reasonable to assume that pregnant women are also at higher risk for swine influenza complications.

Evidence that influenza can be more severe in pregnant women comes from observations during previous pandemics and from studies among pregnant women who had seasonal influenza. An excess of influenza-associated deaths among pregnant women were reported during the pandemics of 1918–1919 and 1957–1958. Adverse pregnancy outcomes have been reported following previous influenza pandemics, with increased rates of spontaneous abortion and preterm birth reported, especially among women with pneumonia. Case reports and several epidemiologic studies conducted during interpandemic periods also indicate that pregnancy increases the risk for influenza complications for the mother and might increase the risk for adverse perinatal outcomes or delivery complications.

Clinical Presentation
Pregnant women with swine influenza would be expected to present with typical acute respiratory illness (e.g., cough, sore throat, rhinorrhea) and fever or feverishness. Many pregnant women will go on to have a typical course of uncomplicated influenza. However, for some pregnant women, illness might progress rapidly, and might be complicated by secondary bacterial infections including pneumonia. Fetal distress associated with severe maternal illness can occur. Pregnant women who have suspected swine influenza A (H1N1) virus infection should be tested (http://www.cdc.gov/swineflu/specimencollection.htm), and specimens from women who have unsubtypeable influenza A virus infections should have specimens sent to the state public health laboratory for additional testing to identify swine influenza A (H1N1).

Treatment and chemoprophylaxis
The currently circulating swine influenza A (H1N1) virus is sensitive to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir, but is resistant to the adamantane antiviral medications, amantadine and rimantadine. Pregnant women who meet current case-definitions for confirmed, probable or suspected swine influenza A (H1N1) infection should receive empiric antiviral treatment. Pregnant women who are close contacts with persons with suspected, probable or confirmed cases of swine influenza A (H1N1) should receive antiviral chemoprophylaxis. These recommendations for treatment and chemoprophylaxis are the same ones used for others who are at higher risk of complications from influenza.

As is recommended for other persons who are treated, antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of influenza symptoms, with benefits expected to be greatest if started within 48 hours of onset based on date from studies of seasonal influenza. However, some data from studies on seasonal influenza indicate benefit for hospitalized patients even if treatment is started more than 48 hours after onset. Recommended duration of treatment is five days, and for chemoprophylaxis is 10 days. Oseltamivir and zanamivir treatment and chemoprophylaxis regimens recommended for pregnant women are the same as those recommended for adults who have seasonal influenza. Recommendations for use of antivirals for pregnant women might change as additional data on the benefits and risks of antiviral  therapy in pregnant women become available.

Oseltamivir and zanamivir are “Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to women who have received oseltamivir or zanamivir. Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Pregnant women might be at higher risk for severe complications from swine influenza, and the benefits of treatment or chemoprophylaxis with zanamivir or oseltamivir likely outweigh the theoretical risks of antiviral use.  Because of its systemic activity, oseltamivir is preferred for treatment of pregnant women.  The drug of choice for prophylaxis is less clear.  Zanamivir may be preferable because of its limited systemic absorption; however, respiratory complications and medication delivery system challenges that may be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems.

Several studies have shown that fever during pregnancy is associated with an increased risk of birth defects and other adverse outcomes.  For this reason, fever in pregnant women should be treated. Acetaminophen appears to be the best option for treatment of fever during pregnancy.

Other ways to reduce risk for pregnant women
The risk for swine influenza A (H1N1) might be reduced by taking steps to reduce the chance of being exposed to respiratory infections. There is no vaccine available yet to prevent swine influenza A (H1N1). These actions include frequent handwashing, covering coughs, and having ill persons stay home, except to seek medical care, and minimize contact with others in the household who may be ill with swine flu. Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable swine influenza cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on the face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time.

Breastfeeding considerations
Women who are breastfeeding can continue while receiving antivirals. However, women who are ill with swine influenza A (H1N1) should take steps to reduce the risk to their infants, such as frequent hand washing and possibly wearing a mask (see below). The risk for swine influenza transmission through breast milk is unknown.  However, reports of viremia with seasonal influenza infection are rare.

Efforts to identify the risk for pregnant women from swine influenza A (H1N1) during 2009 are underway.  Enhanced surveillance for hospitalized patients with swine influenza A (H1N1) has been initiated. Additional information about swine influenza is available.

[nsrchofbaby]

Wow, that's scary. Makes me wish I was due sooner to better protect my baby and myself. If I caught it, I could live with being quarantined for my baby's protection but I don't know how I would feel if I took an antiviral during pregnancy that later proved to be fatal or detrimental to my baby's health.

[rdh1981]

Wow, that is a lot of information. The school I teach at was shut down today, because we have two cases of kids with type A. Thankfully they are not in my class and nor do I have contact with them. To be on the safe side I called my OB and they told me just take normal precautions like good hygiene and if I start to feel bad then go straight to the ER.  I am trying to remain calm but this really bothers me.

I say close down the borders and everyone stay home with a can of Lysol in each hand!

[rdh1981]

Oh, I forgot to mention that I am 24 weeks pregnant that is why I called my OB!

[cure65roses]

On the news tonight they interviewed a dr. who said there are 3 categories of people who should be especially concerned:

1.  children under 5
2.  senior citizens
3.  pregnant women

[Linzola1]

That is scary! I am not pregnant but I have a baby under 5 (10 months) I am a grem a fobe and neverwas until this started... Can you believe Iwas at the mall with DH picking up his tux foraweddingand a lady came up to Julian and touched his little hand! OMG I flipped washed his hands, used a baby wipe nad hand sanitizer! Crazy people! She is like you are over reacting ... ARGH

[nsrchofbaby]

Oh great, so I not only have to worry about myself but my little girl once she's born in the next month! It's frustrating. I think some research group just released a prediction of up to 1700 cases in the US in the next 4 weeks! I think I'll just stay home from now on. Ha, as though anyone could afford that in this economy. Linzola, you sooooo did not overreact! Even if this new flu didn't exist, I don't know why complete strangers feel it's okay to just touch other people's children!

[Lance06]

They are taking EXTRA precautions here at work. They have hand sanitizer at all the printers, faxes, bathrooms...etc.

Anyone traveling out of the country, to mexico has to get approval and checked out.

We just had 2 employees get back from vacation in mexico a week ago. they both ahd to get checked out......

we were all given anticeptic wipes fro our phones too!! crazyness

Its pretty bad here in NY!