Recommendations for Use of Antiviral Medicines in the Treatment and Prevention of Influenza in Pregnant Women
The US Centers for Disease Control and Prevention has published recommendations for obstetricians (specialists for the treatment and care of pregnant women) related to use of antiviral medicines in the treatment and prevention of a pandemic influenza. These recommendations will be regularly updated and are related to pregnant women and women in postnatal period (2 week after childbirth) and women with a pregnancy loss (2 weeks after loss).
Pregnant women are at higher risk for severe complications and death from influenza, including both pandemic A/H1N1 influenza and seasonal influenza. Changes in the immune, respiratory and cardiovascular systems that occur during pregnancy result in pregnant women being more severely affected by certain pathogens, including influenza virus.
Postpartum women, who are in transition to normal immune, cardiac and respiratory function, should be considered to be at increased risk of influenza-related complications up to 2 weeks postpartum (including following pregnancy loss).
The treatment with antiviral medicines is recommended for pregnant women or women who are up to two weeks postpartum (including following pregnancy loss) with suspected or confirmed influenza and can be taken during any trimester of pregnancy. The duration of antiviral treatment is 5 days.
Hospitalised patients with severe infections (such as those with prolonged infection or who require intensive care unit admission) might require longer treatment courses.
The treatment should be initiated as early as possible because studies show that treatment initiated early (i.e. within 48 hours of illness onset) is more likely to provide benefit. However, some studies of hospitalised patients with seasonal and pandemic influenza have suggested benefit of antiviral treatment even when treatment was started more than 48 hours after illness onset.
The treatment should not wait for laboratory confirmation of influenza because laboratory testing may delay treatment and because a negative rapid test for influenza does not rule out influenza.
For treatment of pregnant women or women who are up to two weeks postpartum (including following pregnancy loss) with suspected or confirmed influenza, oseltamivir is currently preferred because of its systemic absorption.
Since rapid access to antiviral medicines is essential, health care providers who care for pregnant and postpartum (including following pregnancy loss) women should develop methods to ensure that treatment cen be started quickly after symptom onset. Recommendations that will support early treatment initiation include:
- Informing pregnant and postpartum (including following pregnancy loss) women of signs and symptoms of influenza and the need for early treatment after onset of symptoms. Symptoms are similar to those in the general population and include fever, cough, rhinorrhea, sore throat, headache, shortness of breath, myalgia, vomiting, diarrhea and conjuctivitis.
- Ensuring rapid access to telephone consultation and clinical evaluation for pregnant and postpartum women (including following pregnancy loss) women.
- Considering empiric treatment of pregnant women and women who are up to 2 weeks postpartum (including after pregnancy loss).
Post-exposure antiviral chemoprophylaxis can be considered for pregnant women and women who are up to two weeks postpartum (including following pregnancy loss) who have had close contact with someone likely to have been infectious with influenza. Close contact is defined as having cared for or lived with a person who has confirmed, probable or confirmed influenza, or having been in a setting where there was a high likelihood of contact with respiratory droplets and/or body fluid of such a person. Examples of close contact include sharing eating or drinking utensils or physical examination.
Pregnant women and women who are up to two weeks postpartum (including following pregnancy loss) who are given post-exposure chemoprophylaxis should be informed that the chemoprophylaxis lowers but does not eliminate the risk of influenza and that protection stops when the medication course is stopped. Those receiving chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.
Early treatment is an alternative to chemoprophylaxis for some pregnant and postpartum (including following pregnancy loss) women who have had contact with someone likely to have been infectious with influenza. Clinical judgment is an important factor in treatment decisions.
Fever in pregnant women should be treated because of the risk that it appears to pose to the fetus. Paracetamol appears to be the best option for treatment of fever during pregnancy.
You may find dosing recommendations under the following link: Recommendations for use of antiviral medicines.