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4.  Pregnancy does not predispose women to an increased
riskof acquiring influenza infection.
 Pregnant women are especially vulnerable to develop
severe complications& death frominfluenza compared
with the general population, as well as higherrate
of obstetrics complications .
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 Pregnant women, both healthy pregnant women & those
with chronic medical conditions, are at increased riskof
influenza related complications & hospitalization.
 This risk increases with gestation , the highest riskfor
severe complications appeared to be in the second &
especially the third trimesters of pregnancy.

6. Riskto the women
 Maternal Complications of influenza include:
1. Miscarriage and stillbirth
2. Premature birth
3. Birth defects
4. Maternal pneumonia
5. Maternal death

7. The flu is a serious dangerforpregnant women
 Pregnant women hospitalised at five times the rate of
non-pregnant women & seven times more likely to be
admitted to ICU than theirnon-pregnant
counterparts.
 “If someone has the flu in pregnancy they have five
times the riskof losing that pregnancy through
miscarriage, stillbirth orneonatal death.

8.  Maternal influenza infection within the first trimester
of pregnancy has been associated with congenital
anomalies .
 Feverthat often accompanies influenza virus infection
has been shown to increase the riskforcongenital
anomalies. (e.g neural tube defects )
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Riskto the growing baby

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Riskforyoung babies
 infants born to women who were hospitalized for
respiratory illness during influenza season at any time
during pregnancy were more likely to be born small
forgestational age and to have lowermean
birthweight than infants born to women who were
not hospitalized.

10.  Infants less than 6 months old are at increased risk
forinfluenza-associated complications , a high rate
of excess hospitalization and even death than
other age groups .
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 Influenza vaccines are not approved foruse in
children <6 months old.
 Thus, influenza vaccination during pregnancy and
influenza vaccination of household contacts and
caregivers of infants <6 months old can prevent
influenza in these vulnerable infants who are
too young to receive influenza vaccination.

12. Influenza vaccination during pregnancy is a key strategy to
prevent influenza and influenza-related complications
in pregnant women and theirinfants 12

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22.  Pregnant women might be reluctant to take antiviral
medications, and health care providers might be
reluctant to prescribe such treatment forinfluenza
during pregnancy.
 Treatment delay often was associated with adverse
outcomes in pregnant women .
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23.  Available information on influenza antiviral medications
during pregnancy is reassuring,howeveradequate well-
controlled studies of pregnant women are not available .
 These medications are considered to be pregnancy
category C by FDA , benefit outweighs risk

24.  “While no controlled clinical studies have been
conducted on the use of oseltamivirin pregnant women
data on use in pregnancy has been collected frompost-
marketing & observational studies…
 These data in conjunction with animal studies do not
indicate direct orindirect harmful effects with respect
to pregnancy, embryonal/foetal orpostnatal
development…

25.  Pregnant women are considered to be at higherrisk
of influenza complication by the Advisory Committee
on Immunization Practices, and thus, empiric
treatment is recommended.
 Treatment decisions, especially those involving
empiric treatments, should be informed by knowledge
of influenza activity in the community.
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26.  Yourdecision to treat should be based on yourclinical
evaluation ratherthan on diagnostic testing because
of the limited sensitivity of rapid influenza diagnostic
tests and the time required to complete more
definitive testing.
 Decisions to start antiviral treatment should not wait
forlaboratory confirmation of influenza .

27.  Ideally, antiviral treatment should begin within 48 hours
of the onset of symptoms. Forthat reason, pregnant
women with symptoms of influenza should be
encouraged to seekcare early in theirillness.
 However, treatment of pregnant women appears to be of
clinical benefit, even when that treatment is started more
than 48 hours aftersymptomonset.

28.  Currently, the majority of circulating influenza viruses
are resistant to the adamantanes and WHO
recommends neuraminidase inhibitors as the first-line
treatment forpeople requiring influenza antiviral
therapy.
 Oral oseltamiviris preferred fortreatment of pregnant
women because it has the most studies available to
suggest that it is safe and beneficial.

30.  Pregnant women and Postpartumwomen, 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 two weeks
postpartum(including following pregnancy loss).
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31.  Treatment with antiviral medications is recommended
forpregnant women orwomen who are up to 2 weeks
postpartum(including following pregnancy loss) with
suspected orconfirmed influenza and can be taken
during any trimesterof pregnancy.
 Pregnancy should not be considered a
contraindication to oral oseltamiviruse.
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Informing pregnant and up to 2 weeks postpartum (including following
pregnancy loss) women of signs and symptoms of influenza and the need
for early treatment , as soon as possible after onset of symptoms.

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44. Early Treatment is Important forPregnant Women
 If a pregnant woman becomes sickand is suspected of
having influenza, it's important that she receives
prompt antiviral treatment.
 Pregnant women with confirmed orsuspected influenza
should be treated with oseltamiviras soon as possible,
regardless of pregnancy trimester.
 Pregnant women are recommended to receive the same
antiviral dosing as nonpregnant women.

45.  Fortreatment of pregnant women orwomen who are
up to 2 weeks postpartumwith suspected or
confirmed influenza, oral oseltamiviris currently
preferred.
 Also ,women can continue to breast-feed while being
treated with antivirals.
 The standard duration of antiviral treatment is 5 days .
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46.  Considerempiric treatment of pregnant women and
women who are up to 2 weeks postpartum(including
following pregnancy loss) at home based on clinical
evaluation formild uncomplicated illness , especially
if hospitalization is not indicated .
 Health care providers should develop methods to ensure
that treatment can be started quickly aftersymptom
onset , rapid access to antiviral medications is

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48.  Hospitalized patients with severe infections e.g those
with prolonged infection orwho require intensive care
unit admission) might require longertreatment courses.
 Some experts have advocated use of doubled doses of
oseltamivirforsome severely ill patients
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50.  Feverin pregnant women should be treated because of
the riskthat it appears to pose to the fetus , it has been
shown to increase the riskforcongenital anomalies.
 Acetaminophen (Paracetamol ) appears to be the best
option fortreatment of feverduring pregnancy
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The American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine.
February 2017.

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53.  Oseltamiviris recommended by the World Health
Organization (WHO) foruse in the clinical management of
pandemic and seasonal influenza of varying severity, and as
the primary antiviral agent fortreatment of avian H5N1
influenza infection in humans.
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56. What should I do if I come into
close contact with someone
who has the flu while I am
pregnant?
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57. Post exposure Chemoprophylaxis
 Post-exposure influenza antiviral chemoprophylaxis can
be considered forpregnant women and women who are
up to 2 weeks postpartum(including following
pregnancy loss) who have had close contact with
someone likely to have been infectious with influenza.
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Post exposure Chemoprophylaxis
 Post exposure Antiviral chemoprophylaxis is not
generally recommended if more than 48 hours
have elapsed since the last contact with an
infectious person.

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Pregnant women and women who are up to 2 weeks
postpartum(including following pregnancy loss)
receiving post exposure chemoprophylaxis should be
informed that chemoprophylaxis lowers but does not
eliminate the riskforinfluenza, that susceptibility to
influenza returns once the antiviral medication is
stopped .

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Patients receiving post exposure chemoprophylaxis
should be encouraged to seekmedical evaluation as soon
as they develop a febrile respiratory illness suggestive of
influenza because influenza virus infection still can occur
while a patient is on antiviral chemoprophylaxis .

62.  An emphasis on close monitoring and early initiation of
antiviral treatment is an alternative to chemoprophylaxis
forsome pregnant women and women who are 2
weeks postpartum(including following pregnancy
loss)who have had contact with someone likely to have
been infectious with influenza.
 Clinical judgment is an important factorin treatment
decisions. 62

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Indiscriminate use of antiviral chemoprophylaxis might
promote resistance to antiviral medications orreduce
antiviral medication availability fortreatment of
persons at higherriskforinfluenza complications or
who are severely ill.

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CDC does not recommend widespread orroutine use of
antiviral medications forchemoprophylaxis so as to limit
the possibilities that antiviral resistant viruses
could emerge.
Antiviral chemoprophylaxis is currently NOT recommended
by the WHO.

65.  Chemoprophylaxis with antiviral medications is not a
substitute forinfluenza vaccination (Oseltamiviris not
a substitute forthe flu shot) .
 Annual influenza vaccination is the best way to
prevent influenza because vaccination can be given
well before influenza virus exposures occur, and can
provide safe & effective immunity throughout the
influenza season. 65

66. Road Map

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While influenza vaccination is the first and best way to
prevent influenza illness, a history of influenza
vaccination does not rule out the possibility of
influenza virus infection in an ill patient with clinical
signs & symptoms compatible with influenza.
A history of influenza immunisation does not exclude
influenza as a possible diagnosis.

71.  All pregnant women should be counseled about the
early signs and symptoms of influenza infection
and advised to immediately call forevaluation if
clinical signs orsymptoms develop while these
women are pregnant orare in the first two weeks
afterdelivery orpregnancy loss.
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