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Information about influenza for pregnant women

Most people who get influenza - including pandemic (H1N1) 2009 influenza - have a mild illness and do not need medical treatment or to see a doctor. Those at risk of severe illness include pregnant women, especially women in the middle and later stages of pregnancy.

Despite being at higher risk, most pregnant women will only have mild symptoms and recover within a week. However, pregnant women can get very sick quickly. If you are pregnant and develop a flu-like illness (especially fever with a cough and/or sore throat), don’t take chances. Seek medical care early.

Why are pregnant women thought to be at higher risk?

Pregnant women are known to be at higher risk of complications from normal, seasonal flu, and severe illness has been reported in some pregnant women during the current pandemic.

Pregnant women may be at higher risk of getting influenza, and at higher risk of severe illness from influenza. This is because of changes that occur to their body and immune system during pregnancy. They may be especially vulnerable to pandemic (H1N1) 09 influenza as this virus seems to affect younger age groups most.

Possible complications from influenza are pneumonia, difficulty breathing and dehydration, which are more likely to happen in the middle and late stages of pregnancy. There is a small chance that these complications will lead to premature labour or miscarriage. There is not enough information yet to know how likely these risks are.

What should I do if I am pregnant and get a flu-like illness?

Seek medical care early. Pregnant women can get very sick, very quickly with flu, and can suddenly get worse. If you see a doctor within 48 hours of becoming unwell with flu symptoms, you may be offered antivirals to help you get better quickly.

Telephone your local doctor (GP) or the Tasmanian flu hotline: 1800 358 362 (1800 FLU DOC).

Make sure your doctor knows you are pregnant. He or she will discuss the benefits and risks of antiviral medication with you, and make sure the right antiviral is prescribed. If you think you might be having side-effects from antivirals, phone your doctor immediately. (Note, antivirals do not work well if started more than 48 hours after the start of illness)

Protect other pregnant women. Stay home (except to seek medical care) and away from other pregnant women for seven days from the start of your illness and until your fever has gone. Do NOT go to antenatal classes. PHONE AHEAD if you have an appointment at your antenatal clinic or with your obstetrician, and let them know you think you have flu. If your appointment cannot be safely postponed, wash your hands before leaving home and wear a surgical face mask (available from most pharmacies).

Are antivirals safe for pregnant women?

Antivirals - Oseltamivir (Tamiflu) and zanamivir (Relenza) – are new drugs that have not been used widely by pregnant women. For pregnant women who have taken these medications, no harm to the foetus has been observed. Similarly, studies in animals have shown no harm to foetuses.

Experts believe the risk of antiviral treatment in pregnancy is extremely small - much smaller than the risk posed by pandemic H1N1 2009 influenza. The dosage of either Tamiflu or Relenza for pregnant women is the same as the standard adult dose.

What other medications are safe for pregnant women?

Paracetamol is safe to take as directed while pregnant and breast feeding. Take no more than two 500mg tablets every 4 hours, and no more than 8 tablets in a 24 hour period. Do not to take more than the recommended amount. Keeping note of the time you take medications is important.
Always check the instructions on/in the packet (or ask your pharmacist) before taking medications when you are pregnant or breastfeeding, to make sure the medicine is OK for you and your baby.

What if I feel really sick?

Seek emergency medical care if you:

have difficulty breathing, are short of breath or are wheezing
have pain or a feeling of pressure in the chest or abdomen (belly)
experience sudden dizziness, become confused or drowsy
have a persistent fever, despite taking paracetamol as directed
have severe or persistent vomiting
have stomach pains, cramps or vaginal bleeding
notice less or no movement of your baby
have convulsions (seizures or fits)
become dehydrated (passing only small amounts of urine).

Other ways to reduce your risk are:

Wash your hands often, especially before touching your face or anything that goes in your mouth. Use soap or alcohol-based hand rub - which is safe to use during pregnancy and can be purchased in small bottles that you can carry in your bag.
Try to avoid crowded places and keep a large step (1 metre) from others in public, especially anyone who is coughing or seems unwell with flu symptoms. Try to stay away from anyone you know who has a flu-like illness. Wear a surgical face mask if you need to be within a metre of someone who has flu and that person cannot wear a mask.
Stop smoking – smoking will increase your risk of severe illness from influenza.

Information about influenza for breastfeeding mothers

Is it ok to breastfeed if I have influenza?

Yes. Your breast milk will help protect your baby from infection. Through your milk your baby will receive protective antibodies you are developing against the virus.

Increase how often you feed if you are worried about your milk supply falling.
If you are tired, try breastfeeding while lying down resting, and/or express milk (by hand or with a breast pump) for someone else to feed to your baby while you sleep.
Increase your fluid intake if you are sick and breastfeeding – try to have a glass of water each time you feed.

How can I help protect my baby?

Wash your hands often. Use soap and water or alcohol-based hand rub, which is safe to use while you are breastfeeding, and can be purchased in small bottles that you can carry in your pocket or bag.
Hand hygiene is especially important after covering a cough or sneeze with your hand blowing your nose, touching a used tissue and before feeding or handling your baby.
Always cover your cough with a tissue (or the inside of your elbow if you can’t reach a tissue in time) and put used tissues in the rubbish straight away. If you are coughing a lot, wear a surgical face mask over your mouth and nose while you are in close physical contact with your baby. Surgical masks are available from most pharmacies.
If your baby uses a dummy or pacifier, don’t put it in your mouth before putting it in your baby’s mouth (this includes the ring and handle). Wash your hands before touching your baby’s dummy.
Continue to cuddle and care for your baby.

Are antivirals and pain relief safe to take while I am breastfeeding?

Women who are breastfeeding should continue to do so while receiving antiviral treatment. Tell your doctor you are breastfeeding so the right antiviral can be prescribed for you. Antiviral drugs are excreted into breast milk in very small (insignificant) amounts. Any potential harm is outweighed by the benefits of breastfeeding.

Paracetamol is safe to take for pain relief and to help control a fever. Always take only as directed. Take no more than two 500mg tablets every 4 hours, and no more than 8 tablets in a 24 hour period. Do not to take more than the recommended amount. Keeping note of the time you take medications is important.

Always check the instructions on/in the packet (or ask your pharmacist) before taking medications when you are pregnant or breastfeeding, to make sure the medicine is OK for you and your baby.