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Pregnancy Raises Swine Flu Death Risk

Healthy Pregnant Women at Risk of H1N1 Swine Flu Death, Hospitalization

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."

Jamieson says that a pregnant woman who develops flu-like symptoms should call her doctor right away. She should not go directly to her doctor's office to avoid exposing other pregnant women to swine flu. If her doctor prescribes Tamiflu or Relenza, she should start treatment as soon as she can.

"The safest thing she can do for herself and her pregnancy is to take the medication order to prevent an overwhelming infection," Phillippe says. "And when the swine flu vaccine comes out, pregnant women need to be among the high-risk groups that receive the vaccine first."

Especially outside the U.S., media have trumpeted advice that pregnant women should avoid crowds and basically hide out during the flu pandemic. That is NOT what women should do.

"Pregnant women should continue their everyday activities and not take any extra precautions other than avoiding people who have the infection and washing their hands frequently," Jamieson says. "But if they suspect they may have the flu, they do need to promptly call their health care provider."

The CDC report appears in the July 29 online issue of The Lancet.


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