Pregnancy and A/H1N1

[Shiloh]

Is the statement I bolded accurate? Is there enough data out there to support this claim?

Source: http://www.iomtoday.co.im/news/Swine...for.5367065.jp

Monday, 15th June 2009
Published Date: 15 June 2009
[B]
HEALTH officials are reassuring expectant mums after a pregnant woman died from swine flu.

The Public Health Directorate says it wants to allay the 'increasing concerns' raised by pregnant women in the Island.

The patient from Scotland who died of swine flu had other co-existing medical problems. People with underlying chronic health problems are
prone to complications of flu such as pneumonia, a spokesman explained.

There have been some deaths especially in the US due to swine flu in people with chronic health problems. But the vast majority of patients who developed swine flu have made an uneventful recovery without suffering any complications.

'While it is known that pandemic influenza can be severe in pregnant women and can lead to premature delivery, the chances of this are very low,' the spokesman said.

The current consensus of opinion from scientific experts is that if a pregnant woman develops swine flu, she should be treated with antivirals.


Advice to pregnant women ? avoiding swine flu

? There is no cause for any immediate concern ? the likelihood of picking up swine flu is very low.

? If you develop swine flu, the chance of suffering any complication is low.

? Follow general hygiene precautions such as frequent hand washing. If you have a cough or sneeze cover your nose and mouth and dispose of your tissues safely.

? Avoid close contact (defined as one metre distance) with anyone with flu symptoms.

? If you have had contact with a case of swine flu, the Public Health Directorate will contact you to provide you with tablets to prevent swine flu.

? If possible you should avoid providing direct care for family/friends who have swine flu and you should seek advice from your GP or Public Health if this is unavoidable.

? Work: The majority of pregnant women can continue to work as normal. Your workplace should have hygiene precautions in place to minimise the risk of transmission of swine flu. If your job involves providing health and personal care your employer should make arrangements for you to avoid working where there are known cases of swine flu. Advice can be obtained from your employer, occupational health service or from Public Health.

Advice to pregnant women ? If you develop symptoms

? Please make sure you have a supply of paracetamol to control your fever and a thermometer to check your temperature.

? If you have returned from an affected area (which at present includes the UK) and develop flu symptoms, contact your GP by phone immediately.

? Antiviral drugs are most effective the earlier you take them but DO NOT take them unless advised by a doctor or nurse. While there is not much experience with using antiviral drugs in pregnancy, no serious side effects have been reported.

? Breastfeeding: If you are breastfeeding your baby and develop flu, continue to breast feed the baby. The breast milk offers protection to the baby from many infections. Do not stop breast feeding because you have been or are taking medicines for your flu.

? If in doubt seek advice from your GP or midwife.

[Gert van der Hoek]

Re: Pregnancy and A/H1N1

Public release date: 15-Jun-2009


Pregnant women at high risk of complications from H1N1 influenza

With the H1N1 flu outbreak now elevated to pandemic level, a new article http://www.cmaj.ca/cgi/rapidpdf/cmaj.090866 in CMAJ (Canadian Medical Association Journal) reports that oseltamivir (Tamiflu&#174 and zanamivir (Relenza&#174 are relatively safe drugs for use in pregnant and breast-feeding women.

Pregnant women, especially those in the third trimester, are at high risk of serious complications from the H1N1 A influenza virus.

The study was conducted by researchers from the Motherisk Program at The Hospital for Sick Children (SickKids) in Toronto and the Japan Drug Information Institute in Pregnancy in Tokyo, Japan.

For treatment or prevention during the current pandemic, "oseltamivir appears to be the drug of choice because there are more data on its safety in pregnancy," writes Dr. Shinya Ito, Head of the Division of Clinical Pharmacology and Toxicology at SickKids.

Zanamivir can be used, although there is less data available about its safety in pregnant women. Neither drug appears to affect the growth and development of the fetus, although ongoing data collection is important.

The groups at high risk of flu-related complications from the novel H1N1 influenza are the same as those for seasonal flu – pregnant women, children under 5 years, the elderly and others such as those with chronic lung conditions.

Only small amounts of oseltamivir and zanamivir are excreted into human milk. If an infant is breastfed by the mother on these drugs and needs treatment, the recommended dose of oseltamivir or zanamivir should be given to the infant.

http://www.eurekalert.org/pub_releases/2009-06/cmaj-pwa061509.php

[Gert van der Hoek]

Re: Pregnancy and A/H1N1

Pregnant Women and Novel Influenza A (H1N1) Considerations for Clinicians

May 7, 2009 4:35 PM ET

Background

Human infections with a novel influenza A (H1N1) virus that is easily transmissible among humans were first identified in April 2009. The epidemiology and clinical presentations of these infections are currently under investigation. There are insufficient data available at this point to determine who at higher risk for complications of novel influenza A (H1N1) virus infection. However, it?s reasonable to assume that the same age and risk groups who are at higher risk for seasonal influenza complications also should be considered at higher risk for novel influenza A (H1N1) 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 excess 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 novel influenza A (H1N1) virus 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 novel influenza A (H1N1) virus infection should be tested, 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 novel influenza A (H1N1).

More:

http://www.cdc.gov/h1n1flu/clinician_pregnant.htm

[Gert van der Hoek]

Re: Pregnancy and A/H1N1

H1N1 big risk to pregnant women, according to stats

Updated Wed. Jun. 10 2009 6:41 PM ET

The Canadian Press

TORONTO -- There are mounting and troubling signs that H1N1 flu and pregnancy don't mix well.

Six pregnant women in Manitoba are reportedly on ventilators because they are severely ill with the virus. And at least two pregnant women in the United States have died of H1N1 flu complications after delivering babies by C-section.

A pregnant teenager in the Dominican Republic died, as did a pregnant woman in Scotland. A woman in St. Theresa Point, a First Nations community in Manitoba, miscarried after contracting H1N1 flu.

Humankind's relationship with the new H1N1 virus is still in its infancy. But people who've studied the issue of pregnancy during flu pandemics don't like the signs they are seeing.

Dr. Denise Jamieson, an obstetrician-gynecologist with the U.S. Centers for Disease Control's division of reproductive health, says she finds the evidence to date "very unsettling."

"I am concerned about this," Jamieson said in an interview from Atlanta.

"There does seem to be increased severity in pregnancy. We don't have hard and fast numbers but there are enough reports that are concerning."

Data released by the CDC last month said at that point, 17 per cent of Americans hospitalized for severe H1N1 flu infections were pregnant women.

More:

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090610/Preg_Swine_090610/20090610?hub=Health

[hornblower]

Re: Pregnancy and A/H1N1

http://www.cdc.gov/FLU/ABOUT/QA/thimerosal.htm

Case reports and limited studies indicate that pregnancy can increase the risk for serious medical complications of influenza. One study found that out of every 10,000 women in their third trimester of pregnancy during an average flu season, 25 will be hospitalized for flu related complications.

Additionally, influenza-associated excess deaths among pregnant women have been documented during influenza pandemics. Because pregnant women are at increased risk for influenza-related complications and because a substantial safety margin has been incorporated into the health guidance values for organic mercury exposure, the benefits of influenza vaccine with reduced or standard thimerosal content outweighs the theoretical risk, if any, of thimerosal.

____

http://www.marchofdimes.com/pnhec/188_10596.asp

Complications of flu, such as bacterial pneumonia and dehydration, can be serious and even fatal. Pregnancy can increase the risk of these and other complications. Pregnant women are more likely to be hospitalized from complications of the flu than non-pregnant women of the same age. Pregnancy can change a pregnant women's immune system and affect her heart and lungs. These changes can increase the risk for complications from the flu.


____

My own comment:

Serious maternal infection is associated with premature rupture of membranes (PROM). Depending on when during the gestation period PROM occurs and the severity of the maternal illness, often PROM leads to natural or induced premature labour/delivery which of course puts the infant at significant risk.


The phrase "chances of this are very low" is IMO a meaningless platitude.


The current CDC guidelines for pregnant health care workers:

http://www.cdc.gov/h1n1flu/guidance/pregnant-hcw-educators.htm

"Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage."

Workers in other fields are counselled to take normal infection prevention precautions.

[The Mountains Voice]

Re: Pregnancy and A/H1N1

Is the statement I bolded accurate? Is there enough data out there to support this claim?


'While it is known that pandemic influenza can be severe in pregnant women and can lead to premature delivery, the chances of this are very low,' the spokesman said.

NO! FALSE!!!

http://www.ctv.ca/servlet/ArticleNew...610?hub=Health

Excerpt......

There are mounting and troubling signs that H1N1 flu and pregnancy don't mix well........................ Humankind's relationship with the new H1N1 virus is still in its infancy. But people who've studied the issue of pregnancy during flu pandemics don't like the signs they are seeing.

Dr. Denise Jamieson, an obstetrician-gynecologist with the U.S. Centers for Disease Control's division of reproductive health, says she finds the evidence to date "very unsettling.".....

....Data released by the CDC last month said at that point, 17 per cent of Americans hospitalized for severe H1N1 flu infections were pregnant women.

A report a couple of weeks back in the World Health Organization's journal, Weekly Epidemiologic Record, noted of 30 H1N1 flu patients hospitalized in California, five were pregnant women. Of those, two developed severe complications -- spontaneous abortion and premature rupture of membranes..........

.......Studies done after the disastrous 1918 Spanish flu -- which took its heaviest toll on young adults -- showed astonishing death rates among pregnant women, said Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota.

Skowronski's review paper suggests there were also very high rates of spontaneous abortions during that pandemic -- 26 per cent in pregnant women who became infected and 52 per cent among those who went on to develop pneumonia from their infection.

"Premature rupture of membranes" sounds like it could POSSIBLY be Cytokine Storm related - a sudden hemoragic like inflammation resulting in rupture???