Treatment/Prophylaxis

So far this fall in Northern California, we have seen less severe cases of H1N1 in pregnant women than we did in the summer.  There is a strong suspicion that it may be related to earlier recognition and most importantly, earlier antiviral treatment of Influenza-like Illness. 

CDC Recommendations for Pregnant Women (10/16/09 update)

Pregnant women are known to be at higher risk for complications from infection with seasonal influenza viruses, and severe disease among pregnant women was reported during past pandemics. Hospitalizations and deaths have been reported among pregnant women with 2009 H1N1 influenza virus infection, and one study estimated that the risk for hospitalization for 2009 H1N1 influenza was four times higher for pregnant women than for the general population. While oseltamivir (Tamiflu®) and zanamivir (Relenza®) are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women, the available risk-benefit data indicate pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy. Pregnancy should not be considered a contraindication to oseltamivir (Tamiflu®) or zanamivir (Relenza®) use. Because of its systemic activity, oseltamivir (Tamiflu®) is preferred for treatment of pregnant women. The drug of choice for chemoprophylaxis is less clear. Zanamivir (Relenza®) may be preferable because of its limited systemic absorption; however, respiratory complications that may be associated with zanamivir (Relenza®) because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems.

Anecdotal reports suggest that postpartum women, similar to pregnant women, might be at increased risk for severe complications and death from 2009 H1N1 influenza. These reports are consistent with the postpartum period being a time of transition to normal immune, cardiac, and respiratory function, a transition that is believed to occur quickly, but would be unlikely to occur immediately at delivery. Based on these reports, women should be considered to be at increased risk of influenza-related complications up to 2 weeks postpartum (including following pregnancy loss). Prompt empiric antiviral treatment is indicated for suspected or confirmed 2009 H1N1 influenza in women who are up to 2 weeks postpartum (including following pregnancy loss). Click for the complete document.

H1N1_Medications