Pregnancy and Swine Flu KEMH FAQ 16 June 2009

PREGNANCY AND H1N1 Influenza 09 (Human Swine Influenza)

Women and Newborn Health Service
King Edward Memorial Hospital (KEMH)

PATIENT INFORMATION SHEET (rev 2. Effective from 16 June, 2009)
How is H1N1 Influenza 09 (Human Swine Influenza) spread?
H1N1 Influenza 09 (Human Swine Influenza) virus is spread the same way normal
seasonal flu spreads. Flu viruses are spread mainly from person to person through
coughing or sneezing. Sometimes people may become infected by touching
something with flu viruses on it and then touching their mouth, nose or eyes.
What are the signs and symptoms of H1N1 Influenza 09 (Human Swine
Influenza)?
The symptoms of H1N1 Influenza 09 (Human Swine Influenza) in people are similar
to the symptoms of normal seasonal flu and include:
•
Fever (usually temperature over 38°C )
•
Sore throat
•
Runny Nose
•
Cough
•
Body/muscle aches
•
Joint aches
•
Headache
•
Chills
•
Fatigue
•
Diarrhoea and vomiting (sometimes)
You may not experience all of these symptoms but will usually have some of them.
Severe illness (pneumonia and respiratory failure) and very rarely, deaths have been
reported in some pregnant women with H1N1 Influenza 09 (Human Swine Flu)
infection.
Like seasonal flu, H1N1 Influenza 09 (Human Swine Flu) makes existing chronic
medical conditions worse and the more severe complications have usually occurred in
these patients.
What special precautions can I take to avoid getting normal flu or Swine Flu?
Take the usual precautions to prevent influenza.
• Get vaccinated against normal seasonal flu. This is recommended at all stages
of pregnancy and especially if you have other medical conditions. Whilst the
current vaccine is not protective against human swine flu, it will protect you
against normal seasonal flu.

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• Wash your hands regularly with soap and water for at least 15–20 seconds.
This will help remove any viruses you have picked up from the environment.
Alternatively use an alcohol-based hand rub. Use of these hand rubs is safe in
pregnancy.
• Avoid contact with those you know are unwell and crowded spaces.
• Stop smoking. Those who smoke have an increased risk of respiratory
complications from normal seasonal flu and this is likely to be the case with
human swine influenza.
Should I avoid travelling interstate or overseas while pregnant to avoid swine
flu?
Human Influenza H1/N1 (swine flu) is now starting to spread in WA and in Australia
so you may be exposed here just as you would be interstate or overseas. Bear in mind
that while travelling through crowded airports and on aircraft, you will be in close
contact with many people, some of whom may have respiratory viruses, including
seasonal and swine flu. If you decide to travel, you should practice good hygiene as
mentioned above to avoid infection. If you become unwell overseas or interstate, you
should seek medical attention immediately. You should also discuss with your doctor
any issues you have about travelling while pregnant, particularly if you have other
medical problems that may put you at increased risk of complications due to
influenza.
Does swine flu pose special risks in pregnant women?
Pregnant women do not seem to be at an increased risk of catching human swine flu
compared to the general population. However, during pregnancy, you may have an
increased risk of complications from any type of flu, especially in the third trimester.
These complications usually involve infection of the mother’s lungs (pneumonia),
early labour or early (premature) rupture of membranes.
How is Human Swine Flu treated in pregnancy?
Your doctor will decide if you need to take antiviral medicines. The benefits and
potential risks will be discussed with you. The decision to start antiviral medicines
and which one to use is affected by a number of factors. These include if you are
planning on becoming pregnant or are pregnant, how far along in your pregnancy you
are, whether you have symptoms of flu, whether you are well but have had close
contact with a known case of human swine flu, and whether you have other medical
conditions that might increase your risk of flu related complications.
There is limited information about the effect of antiviral drugs on pregnant women or
their babies, but animal studies and use by pregnant women so far have shown
antiviral drugs do work and have no serious side effects. Any possible side effects
will be explained to you if you receive antivirals. If you think that you are
experiencing side-effects to antiviral drugs, you need to contact your doctor
immediately.

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How long am I infectious if I have swine flu?
People who have the swine flu virus can be contagious for up to seven days after the
onset of the illness if they are not taking antiviral agents.

What should I do if I am pregnant and I get an influenza-like illness?
Western Australia is entering a phase where there will be general community spread
of the virus that won’t be traced to travel from at risk areas or contact with known
H1N1 Influenza 09 (Human Swine Flu) cases. As a result, if you now develop
influenza-like symptoms it is important you are assessed for whether you have normal
seasonal influenza or H1N1 Influenza 09 (Human Swine Flu). This will normally
involve collection of nose and throat swabs. Telephone your local doctor (GP), your
obstetrician or Health Direct Australia on 1800 022 222 for further advice.
Depending on your particular circumstances and medical assessment you may be
offered antivirals straight away or may need to await the results of testing.

It is important you take enough rest and keep up your intake of fluids to replace those
lost through fever. For relief of symptoms, paracetamol may be used.

Practise good personal hygiene to prevent spread of infection.
• Wash your hands regularly with soap and water for at least 15–20 seconds,
especially after you cough or sneeze. Alternatively use an alcohol-based hand
rub. Use of these hand rubs is safe in pregnancy.
• Cover your hands and mouth with a tissue when you cough or sneeze.
• Throw the tissue into a rubbish bin after you use it.

If you have any of the following symptoms, seek emergency medical care
immediately:

• Difficulty breathing, wheezing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• A high fever (e.g. greater than 38oC)
• Confusion
• Severe or persistent vomiting
• Stomach pains, cramps or vaginal bleeding
• Decreased or no movement of your baby

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If I get swine flu, will this affect my admission to hospital for delivery of my
baby?
No. If you are confirmed as having swine flu, you simply need to let the admission
midwife of the hospital where you are planned to deliver know so that arrangements
can be made to prevent transmission of the virus to staff or other patients. These
measures would apply even if you had normal seasonal flu.
If you have swine flu and are due to deliver at a hospital other than KEMH, you will
not automatically be transferred to KEMH for delivery. If however, you develop
complications from swine flu and need the specialist care that KEMH offers for
yourself and your baby, this will be arranged by your doctor in consultation with the
doctors at KEMH.

Is it ok to breastfeed if I am sick with normal seasonal flu or swine flu?
Continue to breastfeed your baby. Breast milk passes on antibodies from mother to
baby and provides protection for your baby. These antibodies are very useful in
helping to fight off infection. If you are taking antiviral medicine, it is recommended
you continue to breastfeed normally. If you are too sick to breastfeed, you may
choose to express using a breast pump and have the expressed milk fed to your baby.
If I have swine flu and I am breastfeeding, is there anything that can be done to
protect my baby?

It is important that you take the normal precautions to avoid getting influenza. In
addition, take extra care to wash your hands often with soap and water and try not to
cough or sneeze in the baby’s face while feeding your baby, or any other time you and
your baby are close. If you are ill, or coughing and sneezing, consider wearing a mask
although how beneficial this will be is unknown. Even with use of these general
measures, because of the natural intimate contact that occurs, there is a real chance
your baby will be infected.

There is limited information on the use of antiviral agents in infancy (less than 12
months of age) to either prevent or treat influenza. Similar to the use of these
medicines during pregnancy, there needs to be a careful assessment of the potential
benefit of using these antivirals versus the potential risk of rare side effects.

Currently, most experts are not recommending use of these antiviral agents to protect
normal babies, and their use for treatment is generally only for those infants requiring
hospitalisation. However, if your baby has a chronic medical condition, (especially
involving the lungs and/or heart, or resulting in suppression of your baby’s immune
system) and you have swine flu, you will need to discuss with your doctor the
possible use of antivirals for protection of your baby.

It is important that you continue to breastfeed as your baby will be receiving the
protective antibodies you are developing against the swine flu virus.

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What sort of symptoms might my baby develop with Swine Flu?

The symptoms infants develop with influenza (both normal seasonal or human swine
flu) can vary but usually include some or all of the following:
• fever of more than 38oC
• cough
• runny nose
• changed breathing pattern
• lethargy or listlessness
• may not be taking fluids.

Most swine flu infections in children have been mild resembling normal seasonal
influenza. Medical assessment is recommended if you are at all concerned



For more information:
The Commonwealth Government has set up a telephone hotline for Swine Influenza.
Members of the public seeking general information on Swine Influenza should call
180 2007.
Other Links
Commonwealth website Health Alert - Swine Flu

Health Department of Western Australia Web Site:

http://www.health.wa.gov.au/swine_flu/home/

How to perform good hand washing and use alcohol based liquids:

http://www.ossec.dpc.wa.gov.au/documents/preventfluandotherinfectionspamphlet.pdf

The following link has general information on swine flu available in other languages

http://www.humanswineflu.health.vic.gov.au/resources.htm

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