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Pregnancy is considered to be a significant risk factor during an influenza pandemic.
Researchers know that during the 1918 pandemic an abnormally high number of pregnant women died from the influenza, and those that survived endured a very high miscarriage rate.
Even during the much milder 1957 Asian Flu, pregnant women reportedly suffered disproportionately higher mortality rates than non-pregnant women of the same age.
The following anecdotal reports come from:
Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis [serial on the Internet]. 2008 Jan [date cited].
Among 1,350 reported cases of influenza among pregnant women during the pandemic of 1918, the proportion of deaths was reported to be 27% (5).
Similarly, among a small case series of 86 pregnant women hospitalized in Chicago for influenza in 1918, 45% died (6).
Among pregnancy-associated deaths in Minnesota during the 1957 pandemic, influenza was the leading cause of death, accounting for nearly 20% of deaths associated with pregnancy during the pandemic period; half of women of reproductive age who died were pregnant (7).
Pregnant women also appear to be more susceptible to influenza than non-pregnant women, although the exact reasons for this aren't understood.
It is believed, however, that the normal protections of a woman's immune system are temporarily altered to allow her to carry what is essentially a foreign body- a fetus - without rejection.
And that alteration can place the mother (and child) at greater risk of infection during a pandemic.
In keeping with these concerns, the CDC released new guidelines yesterday for pregnant women in the Health Care or Education field who may, in the course of their work, come in direct contact with people carrying the A/H1N1 Swine Flu virus.
Considerations for Pregnant Women Who are More Likely to be Exposed to Novel H1N1 Flu (Swine Flu) at Work: Information for Women in Education, Child Care, and Health Care
May 1, 2009, 9:30 PM ET
This information is for pregnant women who work in jobs where they are more likely to be exposed to people with confirmed, probable, or suspected novel H1N1 virus infection.
Schools and Child Care Workers
Pregnant women working in school settings (e.g. teachers, day care workers) should follow the same guidance as nonpregnant school workers and the general public.
H1N1 Flu (Swine Flu) and You
Guidance for Schools K-12
Alert for institutions of higher learningHealth Care Workers
All health care workers in direct patient care, including pregnant women, should follow standard precautions with all patients, regardless of infection status (OSHA_pandemic_health.pdf, page 15).
Health care workers treating patients with suspected or known illness easily transmitted by contact, droplet, or airborne transmission (e.g. influenza viruses) should do a risk assessment to determine the type of transmission-based precautions needed. Contact, droplet, or airborne precautions may be indicated (OSHA_pandemic_health.pdf, pages 16-17).
Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.
If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures:
• Endotracheal intubation
• Aerosolized or nebulized medication administration
• Diagnostic sputum induction
• Bronchoscopy
• Airway suctioning
• Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)
• High-frequency oscillatory ventilation
For additional guidance for health care providers please see guidelines on infection control.
