pregnant + A(H1N1): will your kid turn into swine?

Dr Haris described it as the long wait.

I believe I wouldn't want to wait for it, but its arrival to our Malaysian shore appear rather inevitable, just like a government change by the next General Election, hopefully.

Just today, as SN Amali giving her very detailed talk on personal protection equipment on H1N1 at the auditorium, the news of our A&E unit admitting a person with suspected H1N1 spread like wild fire across the hospy. Everyone is donning the 3-ply mask, which is not exactly helpful in preventing them from getting the virus, but creating a false sense of security.

From the O&G side,

RCOG came out with the basic prevention statement, and running on treatment of Zanamivir as stocks available.

The Royal College of Obstetricians and Gynaecologists (RCOG) recommends the following measures to prevent contracting swine influenza:

· Cover your nose and mouth when coughing or sneezing and use a tissue
· Dispose of used tissues promptly and carefully
· Wash your hands with soap and water to reduce the spread of the virus
· Clean hard surfaces like door handles using a normal cleaning product
· Make sure your children follow this advice
· Stay at home if you have symptoms

While ACOG is providing a link to CDC on recommendation for pregnant women, and 3 patients confirmed A(H1N1), with 1 of the mother died of ARDS post delivery.

A summary of the recommendation:

• pregnant mothers are higher risk for morbidity
• higher risk if asthmatics
• ACOG recommend trivalent inactivated influenze vaccine, if available.
  
• Treatment best started within 48hrs, but even after that starting medication will reduce morbidity/ mortality
• Mothers with fever - paracetamol is a must to avoid adverse fetal outcomes secondary to hyperthermia.
• Among 3 patients with +ve A(H1N1), fetal wellbeing is not affected.
  
• As little known effect of medication but if benefits of antiviral treatment outweigh potential fetal risk,
  
• confirmed or suspected mothers - to start 5days of Tamiflu (oseltamivir)
• close contacts with cases - 10days of Oseltamivir chemoprophylaxis

As for Tamiflu or oseltamivir, little known about human and fetal effect. (source, source)

• pregnancy category C
• technically and biologically its molecular weight of 312 for the free base of oseltamivir, able to be excreted in milk and cross placenta, but no data on the excretion/transfer of oseltamivir into human milk.
  
• no data on human pregnancy, but usage in animal revealed a variety of minor skeletal abnormalities and variants.
  

Anyway, do not be too worried, because your chance of getting it is 0.89%, and chances are you will not die from it if you are an average person.