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Pregnancy Raises Swine Flu Death Risk

Healthy Pregnant Women at Risk of H1N1 Swine Flu Death, Hospitalization
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Pandemic Flu Deaths in Pregnant Women Not New continued...

In the current swine flu pandemic, Jamieson says, it's too soon to know much about fetal outcome. But she says women with swine flu do seem to be at high risk of premature delivery.

But the major risk is to the pregnant woman herself. That risk is based on her pregnancy and not on other risk factors. "Pregnant women are at risk just by virtue of being pregnant," Jamieson says.

Why? It's not entirely clear, but there are two likely mechanisms:

•         As pregnancy evolves, a woman's diaphragm is pushed upward and she has decreased lung capacity. This makes respiratory disease more dangerous.

•         During pregnancy, a woman's immune system shifts away from the kinds of immune responses most effective in battling viral infections. This makes her more susceptible to some viral diseases such as flu.

CDC to Pregnant Women with Flu: Take Tamiflu or Relenza

All of the pregnant women who died of pandemic H1N1 swine flu had another thing in common: They, or their doctors, waited too long to start them on anti-flu drugs.

Tamiflu and Relenza both fight swine flu. These drugs work far better when started within two days of the first flu symptoms.

Many women -- and many doctors -- are hesitant to start medications during pregnancy. But when flu symptoms strike, the antiviral drugs Tamiflu and Relenza pose vastly less risk than the flu itself.

"Clinicians who take care of pregnant women seem hesitant to start antivirals," Jamieson says. "It has been an issue of prompt antivirals vs. concerns about the fetus. But we are recommending that women be treated, because the benefits outweigh the risks of the drug."

Mark Phillippe, MD, chairman of obstetrics, gynecology, and reproductive sciences at the University of Vermont, recently wrote an editorial warning doctors to offer pregnant women aggressive treatment if they have flu symptoms. He was not involved in the CDC report.

"I certainly agree with the CDC recommendation," Phillippe tells WebMD. "The risk of becoming seriously ill and of dying is significantly higher for pregnant women than for the rest of the population. The big advantage we have over previous pandemics is we have an opportunity to save lives by early treatment. Based on the case reports so far, most of the women who died had a delay in treatment."

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