H1N1 virus and pregnancy?

[Kuko 4000]

A friend of my friend has been thinking about having a baby for some time now, but she is a bit scared of the H1N1 virus. In fact a little more than a bit scared, her words:

"We have no facts. Only assumptions. Just this weekend a mother and a baby under six months old died. Pregnant women get sick easily because their heart goes through a lot, etc."

I'm now trying to find something from the web, is this a reliable source for information?

http://www.cdc.gov/h1n1flu/guidance/pregnant.htm

We don’t know if this virus will cause pregnant women to have a greater chance of getting sick or have serious problems. We also do not know how this virus will affect the baby.

We do know that pregnant women are more likely to get sick than others and have more serious problems with seasonal flu. These problems may include early labor or severe pneumonia. We don’t know if this virus will do the same, but it should be taken very seriously.

We live in Finland and there is about 110 confirmed cases of H1N1. AFAIK, no casualties. I have reminded her that the common influenza kills 1000-1500 people per year here. Could anyone offer some reliable info about pregnancy and H1N1, and / or reasonable approaches to her fears. For what it's worth, I don't think she should worry too much, but I'm trying to get more info.

 

[Deetee]

Becoming pregnant is a major risk factor for many things, some of which can kill you. The tiny additional risk that may be entailed regarding swine flu is irrelevant in the grand scheme of things.
I wouldn't be too put off by the supposed risks.

PS Should she become pregnant it is still safe to get flu vax when available, but they recommend ones without thimerosal in pregnancy. [But are they making these for swine flu?]

 

[Tapio]

I've heard the same concern from several already pregnant, as well as soon-to-give-birth moms as well.

Finlands national "swine-flu" info-website claims (citing CDC) that it may be more dangerous for pregnant women than the average flu. No mention about vaccines, only "recommendation to start preventive medication as soon as infection is suspected".

Oh, and confirmed cases are up to nearly 150...that's about 50 new infections discovered in a week.

ETA: At least in Finland we don't have a suitable vaccine yet. It's estimated to be ready for use in early fall...

 

[Ivor the Engineer]

Well it depends on which organisation you believe.

Several UK health organisations had a bit of a PR cock-up yesterday with three different ones recommending different things.

One (the Department of Health, DoH) said pregnant women should carry on as normal and follow the same advice as everyone else. Another said pregnant women should avoid crowded places. And a third said women should put off becoming pregnant until swine flu has subsided.

It was awkward watching the poor doctor who (presumably after the two groups giving advice which was different to the DoH were given a telling off) was trying to claim all three were giving the same advice all along.

The politician on the radio this morning lied far more fluently.

 

[casebro]

The Spanish flu epidemic would be a good place to look for relationships to pregnant women. But I'm thinking that sentence is the only place I've seen 'pregnant' and 'Spanish flu epidemic' in one place.

 

[rjh01]

It depends on how you define risk as to what advice to take. If you want to play it super safe then stay indoors and never see anyone or go out. Get everything home delivered.

Or you can carry on as if nothing has happened. You are more likely to get killed in a road accident then get killed with swine flu.

 

[Kuko 4000]

Thanks for your replies.

My advise to them was to call (not write) to a couple of official authorities and ask for their take on the situation, to recap the guidelines of how to prevent flu most effectively, and to learn more about the risks of pregnancy and the seasonal influenza in hope that they could form a clearer big picture.

They ended up calling to their local health care centre (my recommendation was the "union of doctors" main offices) and got pretty much the response that I expected, which was: wouldn't worry about it now, but keep up to date with how things progress.

 

[Dymanic]

The Spanish flu epidemic would be a good place to look for relationships to pregnant women. But I'm thinking that sentence is the only place I've seen 'pregnant' and 'Spanish flu epidemic' in one place.

And in how many places did you look? References to particularly high rates of mortality and complications (including miscarriage) appear in a lot of the literature from the time of the Spanish Flu pandemic. It may be partly an artifact of the W-shaped age distribution curve -- more young adults affected means more women of child-bearing age affected -- but there's more to it than that; one author states that in Chicago, 46 percent of all the pregnant women hospitalized for influenza died.

Public health officials have to choose their words very carefully. I don't, so I'll put it plainly: the increased risk which pregnant women face from influenza (pandemic influenza in particular) is very well established.

Try here:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1088249

(see footnote 21)

 

[Kuko 4000]

but there's more to it than that; one author states that in Chicago, 46 percent of all the pregnant women hospitalized for influenza died.

Public health officials have to choose their words very carefully. I don't, so I'll put it plainly: the increased risk which pregnant women face from influenza (pandemic influenza in particular) is very well established.

That's a shocking percentage. Was this in 1919?

21 John W Harris, ‘Influenza occurring in pregnant women, a statistical study of thirteen hundred and fifty cases’, J. Am. med. Assoc., 1919, 72 (3 April): 978–80, p. 798. See also Paul A Buelow, ‘Chicago’, in van Hartesveldt, op. cit., note 2 above, 119–45, on p. 131, who states that 46 per cent of all hospitalized pregnant women died from 'flu and pneumonia in Chicago.

How are the numbers today, I guess times have changed?

 

[Dymanic]

That's a shocking percentage.

Yep.

Was this in 1919?

Not quite sure. I take it to mean over the entire course of the pandemic.

How are the numbers today, I guess times have changed?

Well, they've changed in that we haven't seen a pandemic of that scale since, but higher rates of mortality and morbidity among pregnant women have been observed during the less severe pandemics that came later, as well as during ordinary flu seasons. The fetus is essentially a foreign body as far as the maternal immune system is concerned, and would be rejected if the response were not damped down -- but you'd expect to see this come at a cost in overall immune fitness.

 

[kellyb]

There's also research indicating that babies born in pandemic years are at an increased risk for developing schizophrenia later in life, and animal studies have elucidated a possible or probable mechanism.
Personally, I'd wait.
But DeeTee's also right that in the grand scheme of things, the risk is probably hardly significant at all.