We are currently in the middle of a pretty intense flu season. I am sure most of you know someone who has been diagnosed with the flu or have been diagnosed yourself. I know I have prescirbed Tamiflu to many patients in the last couple of week. This may be a good time to review influenza in the setting of pregnancy.
What are the effects of influenza on pregnant women?
Pregnant women can have a similar clinical course to the general population; however they are at higher risk for having a much more severe symptoms. Why is this? Well, there are natural changes to the body that occur in pregnancy that predispose pregnant women to more intense manifestation. These include increased heart rate and oxygen consumption and a decrease in lung capacity. In simple terms, when pregnant the body uses oxygen more rapidly and there is a baseline increase in resting heart rate. So if sick with a respiratory infection the heart rate will be even higher and the ability to get the oxygen that is being used more rapidly decreases… making one feel worse and more short of breath. In addition, pregnancy women have a slightly decreased efficacy of their immune system, thus potentially making it harder to fight off infection. In 2009, during the infamous H1N1 outbreak, there were a few maternal deaths in the triangle that were attributed to pneumonia from influenza.
How can pregnant women prevent getting influenza?
For almost 15 years, the CDC had recommended pregnant women receive the flu vaccine. This can be given at any point during the pregnancy and has been. The shot is recommended over the nasal spray as the effects of the live virus (nasal spray) are not well known (the 2017-2018 nasal vaccine has been shown to be ineffective anyways). The shot is made of INACTIVE virus. Multiple studies have shown the safety of inactive virus vaccine injections. There are no more adverse events in pregnant women than in the general population. Most of the vaccines have an egg products in them; however, there are egg free options for those who are allergic. In addition, while thimerasol (a preservative used in some vaccines) is considered safe in pregnancy, there are thimerasol-free vaccines, including the flu vaccine offered at Kamm McKenzie.
In addition to protecting pregnant women, influenza vaccination during pregnancy can protect an infant for several months after birth. By providing immunity to the baby via the placenta and then in breast milk, the severity of an infant infection and deaths from influenza are markedly decreased. Remember, babies cannot get vaccinated themselves until they are 6 months old. Another interesting fact is that infants whose mothers were vaccinated for influenza during their pregnancy have fewer hospitalizations for ALL respiratory infections during their first three months of life, not just the flu.
What can pregnant women do who are exposed to the flu or who are diagnosed with the flu?
Pregnant women exposed to influenza can notify their primary care provider or our office of a possible exposure. We can call in Tamiflu, which can decrease the chances of developing full blown flu.
Pregnant women who may have the flu should most certainly be treated with Tamiflu. We recommend you be seen at your primary care provider’s office or at an urgent care to be tested for flu. Sometimes, people are candidates for treatment either without testing or with negative testing. PLEASE PLEASE PLEASE do not come to our office if you have fevers/chills/respiratory symptoms that may indicate the flu. We do not want our other pregnant patients put at higher risk of exposure.
If you are diagnosed with flu and are breastfeeding, your baby can still get breast milk. It is best to pump and have a healthy caregiver give the baby a bottle while you are acutely ill as to try to minimize the risk of your baby getting sick.
In summary, please get the flu vaccine each year, especially when pregnant. All other caregivers in your home should as well. If you think you have the flu DO NOT come to the office. We would prefer to triage this over the phone. It is often best get testing at an urgent care or with your primary care provider. Lastly, if you were directly exposed to the flu we can prescribe medication that decreases the chances of you getting sick.
Stay healthy my friends.