What Pregnant Women Should Know About H1N1 Virus
- Pregnant women and recently pregnant women are a priority group for the H1N1 (Swine) flu vaccine. More…
- You should get vaccinated against both seasonal and H1N1 flu. More…
- There are some steps you can do to protect children under 6 months old. More…
- If you have H1N1 flu, you should stay home, follow your doctor’s orders, and watch for signs that you need immediate medical attention. More…
- Antiviral medications can be given to pregnant women. Take direction from your doctor regarding medications and treatment. More…
- Breastfeed your infant because breast milk passes on antibodies from the mother to a baby. More…
- Follow available guidance if you are pregnant and work in schools and child care settings. More…
- If you are a health care worker, pregnant, and must continue to work, follow these guidelines. More…
- Emergency medical care may become necessary. Know the signs. More…
- Antiviral dosage recommendations have been issued for post-exposure prevention and treatment of H1N1 flu. More…
Protect Your Unborn Child
If you are pregnant, you should get vaccinated against H1N1 as soon as possible. Your vaccination can potentially protect your unborn child from infection. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has recommended that H1N1 vaccination efforts focus on five groups. One of those groups is pregnant women and recently pregnant women. Use our Flu Shot Locator to get vaccinated where you live. Note that pregnant women should not receive the nasal-spray flu vaccine LAIV (FluMist®)
- Severe illnesses among pregnant woman and infants have been reported in the current H1N1 outbreak. Severe illness in the mother can be stressful to the fetus.
- Changes to a pregnant woman’s immune system can make her more sensitive to the flu and result in serious complications if she is infected with H1N1.
- A diagnosis of infection in the fetus or infant can be challenging. The effects of the flu on a fetus are also difficult to predict.
After Pregnancy
Anecdotal reports suggest that women who have given birth, similar to pregnant women, might be at increased risk for severe complications and death from 2009 H1N1 influenza.
- Based on these reports, women should be considered to be at increased risk of influenza-related complications up to 2 weeks after giving birth (including following pregnancy loss).
- Women who are up to 2 weeks postpartum (including following pregnancy loss), and who are suspected or confirmed to have 2009 H1N1 influenza, should receive antiviral treatment as soon as possible. See CDC's Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season.
Vaccinations: Seasonal and H1N1
There are separate vaccines for seasonal flu and H1N1 flu viruses. You should get vaccinated against both viruses.
- Pregnant women and recently pregnant women are one of the priority vaccination groups recognized by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP).
- You should get the seasonal flu shot and the H1N1 flu shots as soon as possible. Use our Flu Shot Locator to get vaccinated where you live. Note that pregnant women should not receive the nasal-spray flu vaccine LAIV (FluMist®)
- Flu vaccines are available in different settings, such as vaccination clinics organized by local health departments, healthcare provider offices, and schools, and other private settings, such as pharmacies and workplaces.
CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.
Protect Your Newborn
Flu vaccine has not been approved for use in babies under 6 months old. However, there are some things you can do to help protect your baby:
- Keep your infant out of crowded areas and away from people who are sick.
- Avoid sharing of toys and other items that have been in infants' mouths.
- Wash thoroughly with soap and water any items that have been in infants' mouths.
What To Do If You Get Sick
Don’t panic. If you have flu-like symptoms, contact your doctor. Doctors are getting guidance on the proper medications and treatment to use with pregnant women that will not harm your baby.
- If you are sick, stay home (except to get medical care) and limit contact with others.
- Treat a fever right away with acetaminophen (Tylenol®). It is the best over-the-counter treatment of fever in pregnancy.
- Drink plenty of fluids to replace those you lose when you are sick.
- If you are not sick but have close contact with someone who has H1N1 flu or is being treated for exposure to H1N1 flu, ask your doctor whether you need treatment with antivirals to reduce your chances of getting the flu.
Treatment Recommendations
Doctors have been directed to treat pregnant women with suspected H1N1 virus as soon as possible. Your doctor will decide if treatment with antiviral drugs is needed.
- Antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications.
- Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body.
- Treatment with the antiviral drug oseltamivir (Tamiflu ®) or zanamivir (Relenza®) should start within 48 hours after symptoms begin to get the most benefit. Treatment should continue for 5 days.
Questions and Answers: Use of Antiviral Medicines for the Treatment and Prevention of Flu among Women who are Pregnant or Postpartum for the 2009-2010 Season
Guidance on Breastfeeding
Do not stop breastfeeding if you are sick. Mothers who are breastfeeding should continue to nurse their babies while being treated for the flu. Babies who are breastfed do not get as sick and are sick less often from the flu, than do babies who are not breastfed.
Breastfeeding protects babies. Breast milk passes on antibodies from the mother to a baby. Antibodies help fight off infection.
- If possible, only adults who are not sick should care for infants, including providing feedings.
- If you are too sick to breastfeed, pump and have someone give your milk to your baby.
- Your doctor might ask you to wear a facemask to keep from spreading this new virus to your baby. (see Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission).
- Be careful not to cough or sneeze in the baby’s face
- Wash your hands often with soap and water, especially before handling your baby.
Pregnant Women at Work: Schools and child care workers
Pregnant women working in school settings (e.g. teachers, day care workers) should follow the same prevention guidance as other school workers and the general public.
CDC recommends that you stay home for at least 24 hours after your fever (100°F or 37.8°C) is gone except to get medical care or for other things you have to do and no one else can do for you. (Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol®.) You should stay home from work, school, travel, shopping, social events, and public gatherings.
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand sanitizer to clean your hands (hands should be washed if visibly soiled). If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.
- Avoid touching your eyes, nose, or mouth. Germs spread this way.
- If you are well but have a sick family member at home with H1N1 flu, call your doctor for advice. You might need to take antiviral medication to prevent illness.
- Information for Pregnant Women Working in Education, Child Care, and Health Care Settings Concerning 2009 H1N1 Influenza Virus
Health Care Workers in Direct Patient Care
If you are pregnant, must continue to work, and are in direct contact with H1N1 flu patients:
- Use non-sterile gloves and gowns, plus eye protection.
- After removing gloves, wash hands frequently with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer to clean your hands (hands should be washed if visibly soiled). If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.
- Wear a fitted respirator or equivalent.
- Information for Pregnant Women Working in Education, Child Care, and Health Care Settings Concerning 2009 H1N1 Influenza Virus
For additional guidance for health care providers please visit Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel.
When to Get Emergency Medical Care
The flu might progress quickly in pregnant women, and be complicated by bacterial infections, such as pneumonia. If you have any of the following signs, you should seek emergency medical care right away:
- Difficulty breathing or shortness of breath
- Turning blue
- Bloody or colored sputum
- Pain or pressure in the chest or abdomen
- Sudden dizziness, confusion
- Severe or persistent vomiting
- Decreased or no movement of your baby
- High fever that is not responding to Tylenol® or other acetaminophen
Considerations for Clinicians: Pregnant Women and H1N1
Pregnant women who have suspected H1N1 flu virus should be tested for influenza. Do not delay treatment with antiviral medications while waiting for the results.
- Fetal distress associated with severe maternal illness can occur. Case reports of adverse pregnancy outcomes and maternal deaths have been associated with severe illness.
- Treatment with the antiviral drug oseltamivir (Tamiflu ®) or zanamivir (Relenza®) should start within 48 hours after symptoms begin to get the most benefit. Treatment should continue for 5 days.
- Post exposure antiviral treatment (chemoprophylaxis) is an option for pregnant women who are in close contact with people who are suspected or have confirmed cases of H1N1 flu.
- Antiviral treatment (chemoprophylaxis) is recommended for 10 days after the last known exposure to the H1N1 flu virus.
Table 1. Antiviral medication dosing recommendations for treatment or chemoprophylaxis of 2009 H1N1 infection.
(Table extracted from IDSA guidelines for seasonal influenza. 
)
Agent, group | Treatment (5 days) | Chemoprophylaxis (10 days) | |
Oseltamivir | |||
Adults | 75-mg capsule twice per day | 75-mg capsule once per day | |
Children ≥ 12 months | 15 kg or less | 60 mg per day divided into 2 doses | 30 mg once per day |
16-23 kg | 90 mg per day divided into 2 doses | 45 mg once per day | |
24-40 kg | 120 mg per day divided into 2 doses | 60 mg once per day | |
more than 40 kg | 150 mg per day divided into 2 doses | 75 mg once per day | |
Zanamivir | |||
Adults | Two 5-mg inhalations (10 mg total) twice per day | Two 5-mg inhalations (10 mg total) once per day | |
Children | Two 5-mg inhalations (10 mg total) twice per day (age, 7 years or older) | Two 5-mg inhalations (10 mg total) once per day (age, 5 years or older) | |
Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
CDC 2009 H1N1 Influenza Vaccine and Pregnant Women: Information for Healthcare Providers
FDA Use of Influenza A (H1N1) 2009 Monovalent Influenza Vaccine in Pregnant Women
Messages for Pediatricians' Offices and Clinics Caring for Children
This 3.5-minute script available in English and Spanish can be used by health care providers to deliver information to their patient's families when they call the office after hours. The message, developed for recording on the office telephone answering service, includes basic H1N1 flu information, advice on when to seek emergency care, tips on keeping your child healthy, and resources for additional information.
