Pregnant

Pregnancy and 2009 H1N1 Flu: Protect Yourself, Protect Your Baby

Pregnant women can get seriously ill with the 2009 H1N1 influenza virus (sometimes called "novel H1N1 flu" or "swine flu"). Learn how to protect yourself and your baby and what to do if you have symptoms of the flu.

A pregnant woman who gets any type of flu has a greater chance for serious health problems. Compared with people in general who get 2009 H1N1 flu, pregnant women with 2009 H1N1 flu are more likely to be admitted to hospitals. Pregnant women are also more likely to have serious illness and can die from 2009 H1N1 flu. To protect yourself and your baby, make sure to get both the 2009 H1N1 flu shot and the seasonal flu shot.

If you are pregnant and have flu symptoms, call your doctor right away. Treatment should begin as soon as possible. Treatment works best when started early (within 48 hours after symptoms start).

Read more about the 2009 H1N1 Influenza and Pregnant Women

• What Should Pregnant Women Know About 2009 H1N1 Flu (Swine Flu)?
• 2009 H1N1 Influenza Shots and Pregnant Women: Questions and Answers for Patients
• Protect Yourself and Others
• What to do if You Have Symptoms of 2009 H1N1 Influenza
• Treatment during Pregnancy
• Feeding Your New Baby
• Pregnant Women at Higher Risk of Flu at Work

Flu Shots and Pregnant Women

Pregnant women should get both the 2009 H1N1 flu shot and the seasonal flu shot because they can get seriously ill from any type of flu. Pregnant women should get the "flu shot"—a vaccine made with killed flu virus. This one is given with a needle, usually in the arm. Both 2009 H1N1 and seasonal flu shots are "killed" vaccines, so you cannot catch the flu from getting these shots. The other type of flu vaccine—a nasal spray—is not approved for pregnant women.

There is no evidence that thimerosal (a mercury preservative in vaccine that comes in multi-dose vials) is harmful to a pregnant woman or a fetus. However, because some women are concerned about thimerosal during pregnancy, vaccine companies are making preservative-free seasonal flu vaccine and 2009 H1N1 flu vaccine in single dose syringes for pregnant women and small children. CDC advises pregnant women to get flu shots either with or without thimerosal.

• Learn more about the 2009 H1N1 flu vaccine and pregnant women

Protect Yourself and Others

Take these everyday steps to protect your health

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, call your doctor. Stay home for at least 24 hours after your fever is gone (without using a fever-reducing medicine like Tylenol®) except to get medical care or for other critical needs. Keep away from others as much as possible to keep from making them sick.
• Read more about What Should Pregnant Women Know About 2009 H1N1 Flu (Swine Flu)?

*Read information on hand sanitizers

What to do if you have Symptoms of Flu

If a pregnant woman thinks she has flu, she should call her doctor right away. If needed, he or she will prescribe an antiviral medicine that treats the flu. The medicine is most helpful if it is started soon (within the first 48 hours) after the pregnant woman becomes sick. If lab testing for flu was done, treatment should not wait for test results to come back. Start treatment right away.

Talk with your doctor about how to reach him or her quickly by telephone if you think you have the flu.

Call your doctor immediately if you think you have any of these symptoms.

• fever **
• cough
• sore throat
• runny or stuffy nose
• body aches
• headache
• chills
• fatigue
• sometimes diarrhea and vomiting

**Not everyone with flu will have a fever.

• Learn how flu spreads and how to care for your family
• Read general information about 2009 H1N1 Flu and how other family members can protect themselves

Treatment during Pregnancy

Oseltamivir (Tamiflu®) or zanamivir (Relenza®) can be used to treat 2009 H1N1 flu. To get these medicines, a doctor needs to write a prescription. These medicines fight against the flu by keeping flu viruses from making more viruses in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness. At this time, Tamiflu® is the best medicine to treat pregnant women who have 2009 H1N1 flu.

Fever should be treated right away. It can cause problems for the pregnant woman and her unborn child. Acetaminophen (Tylenol®) is best for a pregnant woman to use to lower a fever.

Is it safe for me to take antiviral medicines for flu while I am pregnant?

The flu can cause severe illness and even death in pregnant women. Taking antiviral medicines can help prevent these severe outcomes. At this time, there are no studies suggesting harm to a pregnant woman or her unborn baby if she takes antiviral medicines. Being pregnant should not stop women from using antiviral medicines if their doctor advises them to take the medicine. Antiviral medicines can be taken at any stage during pregnancy. Take the medicine your doctor prescribes.

• Questions and Answers for Pregnant Women on Antiviral Recommendations

Feeding Your New Baby

If you can, breastfeed. Breast milk is the perfect food for your baby. There are many ways that breastfeeding and breast milk protect your baby’s health. Babies who are breastfed get sick from infections like the flu less often and less severely than babies who are not breastfed. Flu can be very serious in young babies. You do not have to stop breastfeeding if you have the flu.
If you are sick with the flu, certain precautions can be taken to protect your baby.

• Learn more about feeding your baby while you are sick

Pregnant Women who work in Schools, Child Care or Health Care

Pregnant women who work in schools, child care and health care are at higher risk for being exposed to the flu. Certain precautions can be taken to reduce this risk.

• Information for pregnant women more likely to be exposed at work

Protect Yourself, Protect Your Baby

• Get your flu shots — pregnant women will need both the 2009 H1N1 flu shot and the seasonal flu shot.

• Take everyday precautions.

• If you have been exposed to someone who likely had the flu, call your doctor.

• If you start to feel sick, call your doctor right away. Take the medicines your doctor prescribes.

• Plan to breastfeed as soon as your baby is born.

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Pregnant

Preeclampsia May Lead to Reduced Thyroid Function

Women who experience preeclampsia, a serious complication of pregnancy, may have an increased risk for reduced thyroid functioning later in life, according to a new report.

Preeclampsia is a life-threatening complication that affects 3-5% of pregnancies. It results in high blood pressure and protein in the urine. Though it begins with mild symptoms, it can progress to severe preeclampsia and eclampsia—dangerously high blood pressure and convulsions that can lead to disability or death.

The causes of preeclampsia aren’t known. In earlier work, a team led by Dr. Richard J. Levine of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) found that high levels of 2 molecules in the blood may cause symptoms of preeclampsia. One of those molecules, soluble fms-like tyrosine kinase 1 (sFlt-1), acts by blocking a protein called vascular endothelial growth factor (VEGF).

Other studies have found that some cancer patients receiving treatments that block VEGF develop hypothyroidism, a condition in which the thyroid gland fails to produce enough hormones. The thyroid gland, located in the front of the throat, makes hormones that help regulate heart rate, blood pressure, body temperature and the conversion of food into energy. Reduced thyroid functioning, or hypothyroidism, results in overall weakness and fatigue, and increases the risk for cardiovascular disease.

Levine and his colleagues set out to see whether women with preeclampsia had problems with thyroid functioning as well. Funding for their work was provided in part by NICHD and NIH’s National Heart, Lung and Blood Institute (NHLBI).

The researchers first tested blood samples collected in an earlier NIH-led study on preeclampsia for levels of thyroid stimulating hormone (TSH), which stimulates the thyroid gland. Elevated TSH may signal a malfunction of the thyroid. The scientists also drew on findings from a study in Norway, in which researchers had collected data from over 7,000 women who gave birth to a first child in 1967 or later. The women’s blood samples had been tested for thyroid function in the mid-1990s.

The researchers found a link between preeclampsia and reduced thyroid functioning, as reported in the November 2009 edition of BMJ. In the first study, women who went on to develop preeclampsia had much higher levels of TSH toward the end of their pregnancies than women who never developed preeclampsia. The rise in TSH was strongly associated with levels of sFlt-1, one of the proteins linked to symptoms of preeclampsia.

In the Norway study, women who had preeclampsia in their first pregnancy were 1.7 times as likely to have high TSH an average of 20 years later as women who hadn’t had preeclampsia. Women with preeclampsia in both their first and second pregnancies were nearly 6 times as likely to have high TSH levels.

“This suggests that a history of preeclampsia may predispose women to the later development of reduced thyroid function,” Levine says. Doctors treating women with a history of preeclampsia should be aware of a higher potential risk for reduced thyroid functioning.

“Reduced thyroid functioning is easy to diagnose when suspected, and inexpensive to treat,” says Dr. Susan B. Shurin, acting director of NICHD. “Replacement therapy substantially improves quality of life of affected persons.”

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Pregnant

Holiday Food Safety During Pregnancy

Learn how to keep you and your unborn baby healthy this holiday season by being food safe.

The holiday season is a very exciting time of year filled with parties, family gatherings and lots of food. From turkey and dressing to every type of dessert imaginable, there is never a time of year when food is more of a focus. While it is important that everyone keep food safety in mind during this season, it is especially important for pregnant women to do so.

Pregnant women should keep the following food safety tips in mind as they celebrate the holidays:

• Wash your hands often with soap and water, especially when

  • Touching raw meat, raw eggs or unwashed vegetables
  • Preparing food
  • Before eating or drinking

• Try not to share forks, cups, or food with young children. Wash your hands often when around children. Their saliva and urine might contain a virus that could be harmful for you and your unborn baby.

• Cook your meat until it's well done. The best way to tell that food has been cooked is to use a food thermometer. For more information see Is It Done Yet? (USDA). Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot. These undercooked meats and processed meats might contain harmful bacteria.

• Avoid unpasteurized (raw) milk and foods made from it. Do not eat soft cheeses such as feta, brie, and queso fresco unless they have labels that say they are pasteurized. Unpasteurized products can contain harmful bacteria and can cause infections such as Listeriosis which can be very harmful for both you and your unborn baby.

• Be aware of holiday beverages. Watch out for alcohol-containing holiday punches and eggnogs. Avoid eggnog entirely unless you know it was made with pasteurized eggs and contains no alcohol.

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Pregnant? Don't Smoke! Learn How and Why to Quit for Good

Quitting smoking can be hard, but it is one of the best ways a woman can protect herself and her baby's health. For free help, call 1-800-QUIT-NOW (1-800-784-8669).

Most people know that smoking causes cancer, heart disease, and other major health problems. But women who smoke during pregnancy put themselves and their unborn babies at risk for other health problems. The dangers of smoking during pregnancy include premature birth, certain birth defects, and infant death. Even being around cigarette smoke puts a woman and her baby at risk for problems.

Did You Know?

• Smoking makes it harder for a woman to get pregnant.
• Women who smoke during pregnancy are more likely than other women to have a miscarriage.
• Smoking during pregnancy causes major health problems for mom and baby. For example, smoking is one of the causes of problems with the placenta —the source of the baby's nutrition and oxygen during pregnancy.
• Smoking during pregnancy can cause a baby to be born too early and have low birth weight—making it more likely the baby will become sick or die.
• Smoking during and after pregnancy is one of the risk factors of Sudden Infant Death Syndrome (SIDS).
• Babies born to women who smoke are more likely to have a cleft lip or cleft palate—types of birth defects.

The Good News

Quitting smoking before getting pregnant is best. But for women who are already pregnant, quitting as early as possible can still help protect against some health problems, such as low birth weight. It is never “too late” to quit smoking.

Quit for Good!

It is important to quit smoking for good. Some women might think it is safe to start smoking again after their baby is born. But these babies are not out of harm's way. Babies who are around cigarette smoke have weaker lungs than other babies. They are more likely to have other health problems such as infections and more frequent asthma attacks. Being around cigarette smoke is also one of the risk factors of Sudden Infant Death Syndrome (SIDS).

Though quitting for good can be hard, the benefits are worth it—a healthy baby and many more years of good health to enjoy with him or her.

Free help and support are available for pregnant women and others who want to quit for good.

• Learn more from CDC at Smoking and Tobacco Use and Tobacco Use and Pregnancy.
• Learn about the Great American Smokeout® Challenge.
• For free help, call the quitline in your state. Call 1-800-QUIT-NOW (1-800-784-8669)
  or visit 1-800-QUIT-NOW.
• Find tips on quitting smoking, visit www.Smokefree.gov.
• Get information from The National Partnership for Smoke-free Families.
• Learn quitting tips from The March of Dimes.
• Learn quitting tips from The American Lung Association.
• Make the Smoke-free Home Pledge. Call 1-866-SMOKE-FREE (1-866-766-5337)
  or visit Smoke-free Homes and Cars Program.

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