Swine Flu (H1N1) in Pregnancy

Pregnancy can significantly impact the immunity of a woman leaving her susceptible to various ailments. Pregnant women are more likely to fall prey to seasonal flu as well as swine flu. More pregnant women get hospitalised every year with cases of swine flu than regular women.

Swine flu during pregnancy can pose a serious risk to the health of the mom and her baby. It can lead to increased pregnancy-related complications, maternal morbidity, and foetal mortality. However, many experts believe that the occurrence of swine flu during pregnancy may not be as scary a phenomenon as it seems. Preventive measures like a vaccine and timely treatment of the disease can help combat its symptoms.

What Is Swine Flu?

Swine flu or H1N1 is a respiratory infection that develops in humans and is triggered by an influenza strain (which also infects pigs, hence the name). It is extremely contagious and can spread from pigs to humans, in rare cases and easily from one individual to the other like the normal flu through close contact with an infected person.

The most common swine flu virus that circulates belongs to the H1N1 influenza subtype though the virus can also originate from other subtypes like H3N1, H1N2, H3N2. During 2009 swine flu outbreak humans were infected by the H1N1 subtype while since 2017 the dominant strain has been an H3N2 subtype.

Every year swine flu cases in India are likely to peak before the onset of monsoon season. The infection generally lasts for about a week with more severe infections persisting for an extended time. Most pregnant women have an uncomplicated recovery from the disease. Only in some rare cases, grave complications arise.

Symptoms of H1N1

The symptoms of H1N1 in pregnant women are very similar to the symptoms of seasonal flu. Swine flu can affect different pregnant women differently. The symptoms may manifest mildly in some cases but in some, it can lead to serious problems like preterm delivery and adverse pregnancy outcome like a miscarriage. Some of the symptoms may include:

• Shortness of breath
• Body aches
• Headaches
• High fever
• Chills
• A sore throat and barking cough
• Nasal secretion
• Tiredness
• Joint pain
• Abdominal pain
• Vomiting
• Diarrhoea

The symptoms usually develop within a week’s time of exposure. People are commonly contagious for about 1 to 7 days after development of symptoms though some people can remain infectious for a longer duration.

Why Are Pregnant Women at a Higher Risk of Getting Swine Flu?

Research does not offer any clear indication as to why pregnant women are more prone to getting infected with the influenza virus. Pregnancy can bring about changes in a woman’s immune system and may comprise her immunity to protect the growing foetus. A weak immune system may fail to defend her from the attack of viruses and subsequent infections like swine flu. Lowered immunity combined with the highly contagious nature of swine flu can be the reason why pregnant women are more likely to get it.

Moreover, there is a greater risk of pneumonia occurring during the later stages of pregnancy. Some experts suggest that the advancement of pregnancy and the developing foetus can put a strain on the lung function and breathing of the mother which may increase her chances of developing complications from the swine flu and contracting pneumonia. Most incidents of maternal deaths due to swine flu infection tend to occur during the third trimester.

Will You Get Swine Flu More Severely If You Are Pregnant?

It may be difficult to say with conviction that swine flu develops more severely in pregnant women. In most reported cases of pregnant women suffering from swine flu, the symptoms appeared to be mild. The patients who got a proper treatment got cured within a week or so. Doctors opine that the risk of complications in case of a pregnant woman contracts swine flu is not so high that it may require special handling or care. However, in certain rare instances, there is a possibility that if a pregnant woman in her advanced stage of pregnancy catches swine flu infection, she can develop complications like pneumonia or extreme dehydration. The risk is particularly thought to be highest during the third trimester of pregnancy.

How to Protect Yourself from Swine Flu during Pregnancy

Certain home remedies can help in dealing with the symptoms of the infection. Increasing the intake of fluids can prevent dehydration. Fresh juices and soups may also prove beneficial in replenishing your body with essential nutrients. Make sure you take plenty of rest as it will help your immune system to fight the infection effectively. You can also take some pregnancy safe pain relievers like paracetamol to ease out symptoms like body pain, headache, fever. However, consult a doctor first before taking any medicines when pregnant.

Is It Safe to Take Swine Flu Vaccine in Pregnancy?

In case you have not taken a swine flu shot before, your doctor may recommend it around 26 weeks of gestation to safeguard against the development of swine flu and other conventional flu strains. The vaccine is considered safe and has no negative impact on pregnancy. In case of an outbreak, your doctor may suggest taking the vaccine earlier. A vaccine can lower the risk of severe complications like pneumonia, preterm labour, and miscarriage.

Celvapan and pandemrix are the two vaccinations available that offer protection from swine flu. Both the vaccines work in different ways to provide protection and relief from the influenza virus. A patient may require two doses of celvapan vaccine administered at three weeks apart. Pandemrix vaccine may show positive results with simply one dose.

Does Swine Flu Pass from Pregnant Woman to Her Unborn Baby?

In case of an acute infection, there is a likelihood that the virus may infect the placenta, but there is no conclusive data in this regard. If the flu is detected early on in pregnancy, any risk to the unborn baby is highly unlikely. Early detection and timely treatment are crucial. The risk increases as the pregnancy progress, particularly, if the mother develops a high fever. It increases the chance of the baby being born with neonatal defects. In case the infection becomes critical it increases the likelihood of harming the growing foetus. Complications like the development of pneumonia may lead to preterm delivery, low birth weight, and miscarriage.

If a pregnant woman delivers while suffering from swine flu, the newborn baby should be separated from the mother immediately after birth to avoid the infection from being passed on to him. Only after the mother recovers from all the symptoms of her infection including fever, cough, nasal secretions, should she be allowed to breastfeed her baby.

Treatment for H1N1 in Pregnancy

Swine flu virus can be prevented by taking vaccines. In case you suspect that you have the flu while pregnant, see your doctor at earliest. Your doctor may inquire about your likely exposure to an infected environment or individual. He may also conduct a quick nasopharyngeal swab test to determine whether it is influenza A or B virus.

In case the test shows positive for type B the possibility of swine flu can be ruled out. In case the test confirms that the virus is of type A, it is usually indicative of the regular flu or swine flu. Doctors may conclusively diagnose swine flu by identifying the specific antigens connected with the virus type. Such a test is carried out in specialised laboratories. Your doctor or hospital can send your samples to a specialised laboratory if necessary.

It is important to control the fever during pregnancy for which the doctor may prescribe paracetamol. He may also put you on some antiviral medication which are safe in pregnancy.

Can Antiviral Medication Harm Your Unborn Baby?

There is no scientific evidence available clearly establishing the harmful effects of antiviral medication on an unborn child. Animal testing in this regard did report some hostile effect of the use of Tamiflu drug. But the data is limited and non-conclusive to draw any definite conclusions. In any case, the potential benefits of treating the infection with medications far outweigh any likely theoretical risks to the developing foetus.

Tips to Avoid Swine Flu while Pregnant

Swine flu can affect your pregnancy and hence it is best to take precautionary measures. Here are some useful tips to avoid swine flu during pregnancy:

• Avoid any close contact with a person who seems to have flu-like symptoms like coughing, sneezing, and sore throat during pregnancy to stop individual-to-individual transmission.

• Frequent washing of hands and maintaining basic bodily and personal hygiene may help in preventing the infection.

• Refrain from touching your nose, eyes, mouth often lest you will inadvertently spread the infection.

• Do not spend too much time in public places or crowded settings where the possibility of catching an infection is high.

• Pregnant women should focus on eating a well-balanced diet which includes green vegetables, fruits, protein, minerals, and vitamins, as it helps in strengthening the immune system and keeping all infections at bay.

• Cover your mouth with a clean disposable tissue or handkerchief while coughing.

• Regularly clean and disinfect hard surfaces around your house like tables, counters, slabs as the viruses can survive up to 8 to 10 hours on them waiting to be absorbed.

The best way to deal with swine flu is by taking preventive measures to stop its occurrence in the first place. Getting a swine flu vaccine may go a long way in controlling the spread of infection.