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Five things you need to know about flu and pregnancy

When Heather Lindsay was pregnant with her third child last year, the last thing she expected was to be struck down with a life-threatening illness – not once, but twice.

The former nurse, from Sydney’s Mount Colah, considered herself well informed, and was healthy. But at nine weeks into her pregnancy she became so severely incapacitated she required emergency help to care for her two older children and was bedbound for more than a week, with a temperature raging so high she faced the risk of miscarriage.

Then, at 32 weeks, she caught the flu again, this time suffering such serious respiratory problems she was on the brink of hospitalisation and gravely concerned about her ability to deliver safely.

Both times, the culprit was the flu, with effects devastating enough to alarm even this seasoned health professional.

“I was so horrifically sick, I felt like I was about to die,” she says. “I had temperatures of 40 degrees, terrible coughing and the shakes, and my body was so exhausted I couldn’t do anything. I was scared as well as sick because the first time the embryo was at such a crucial stage of development. The second time, my delivery date was approaching and I seriously didn’t know if I’d be well enough to be in the same room as my baby.”

Lindsay and baby Oliver fortunately both survived unscathed, but the experience has left her keen to spread the word about the dangers of the flu to pregnant women. The good news is that flu safeguarding for pregnant women is easy, safe and free. As the 2017 flu season begins in earnest, here’s what you need to know to protect yourself and baby.

 

1.  The flu is a serious danger for pregnant women

Dr Michael Nicholl, clinical Professor of Obstetrics and Gynaecology at University of Sydney, whose clinical practice is at Royal North Shore Hospital, has witnessed the flu’s most disastrous consequences for pregnant women. Almost every season, he sees a pregnant flu patient so ill she requires intensive care.

During the 2009 flu pandemic, he saw the number of pregnant flu patients hit double figures in ICUs across Sydney, with pregnant women hospitalised at five times the rate of non-pregnant women and seven times more likely to be admitted to intensive care than their non-pregnant counterparts. Tragically, four stillbirths and three infant deaths were recorded nationwide among women struck by that year’s deadly A/H1N1 influenza strain.

In any flu season, Dr Nicholl says, risks are greatly increased for pregnant women. “If someone has the flu in pregnancy they have five times the risk of losing that pregnancy through miscarriage, stillbirth or neonatal death.”

And yet, he says many women fail to fully comprehend those risks.

“When we have a conversation about the flu, women recall a non-pregnant previous experience that is usually mild, short lived and manageable,” he says. “There’s a lack of appreciation that the flu during pregnancy puts you into a much higher risk category.”

Heather Lindsay was one of those women. “If it hadn’t been so awful, I would have laughed at the irony of an ex-nurse getting flu twice, and so badly,” she says. “But if it can happen to me, it can happen to anyone.”

 

2.  Pregnancy makes you more susceptible to the flu

Pregnancy lowers your body’s natural defences against illness, says Dr Nicholl. “Your immune system has to change to accommodate the baby, which is half foreign material.”

Pregnancy’s changes to your body, says Dr Nicholl, also intensify flu symptoms, with the main risk coming from extra abdominal pressure from the growing baby that elevates and restricts your diaphragm, increasing your respiratory rate.

Risk of hospitalisation from the flu increases five-fold by the third trimester, when respiratory capacity is most reduced. If the flu strikes an expectant mum at this time, she could find herself in ICU, on a ventilator – which has dire implications for baby, too.

“When we have a very sick pregnant mum in intensive care, being ventilated to maintain her oxygenation, monitoring her baby becomes very difficult,” says Dr Nicholl. “These babies often end up in distress, leading to very difficult decisions about whether we deliver early by caesarean section. Families have to deal with the distress of a mother who’s in intensive care on a ventilator and an extremely preterm baby in neonatal intensive care.” Often he says, these families are shocked that it all began with ‘only the flu’.

 

3.  The flu shot is the best defence – for you both

When Heather Lindsay caught the flu, it was the first year she hadn’t had her flu shot. “It was April, so early in the season that I hadn’t got around to it,” she says.

“After I recovered from the first bout, my GP said I should still get the shot, because you can catch different strains and mutations of the virus. But like a typical busy mum, I put it off, and by the time I’d reached third trimester it was early spring and I thought I’d cleared winter and I’d be fine. But I wasn’t. And the second bout was even worse.”

She adds: “The inconvenience of having half a day off work would have saved me all that suffering and worry.”

Seasonal flu vaccination is the best way to protect you and your baby. After the vaccination your body makes antibodies that help protect against the flu. Even more importantly, your baby will continue to be protected during the critical first few months after birth – crucial, because babies under six months can’t be given the flu vaccination.

Each year, the Australian flu shot is adjusted to protect against the latest strains of flu virus – normally those most recently prevalent in the northern hemisphere – so your vaccination needs to be the most current available.

Says Dr Nicholl: “We recommend if you’re planning pregnancy and particularly giving birth through flu season, April to October, you should get vaccinated.”

In NSW, the flu shot is free for all pregnant women.

4.  The flu vaccination is safe

Dr Nicholls strongly emphasises that it’s safe to get the flu shot when you’re pregnant, and that any negative myths are entirely unfounded.

He says: “There is an international register purely related to adverse reactions following the vaccine, and there have been no recorded pregnancy-related adverse reactions.

“The side effects are very mild, very local; the injection site which might be a little sore and red for a day or two. That’s all.”

He’s also keen to point out that while the flu vaccine is harmless for your unborn baby, treatments for severe flu are quite the opposite.

“Women who aren’t vaccinated who end up hospitalised with severe flu during pregnancy require high-powered anti-viral medication,” he says. “For babies exposed to that, there can be profound adverse effects including respiratory distress.”

 

5.  Be germ aware

As well as the flu shot, there are simple actions which will help prevent catching and spreading the virus.

  • Wash your hands regularly, especially after coughing, sneezing or blowing your nose. Make sure everyone in your household does the same – especially those older kids who might encounter viruses at school.
  • “Don’t expose yourself to people who are unwell during pregnancy,” says Dr Nicholl. “We have a one-metre rule; you need to be at least a metre away from people who are coughing, spluttering or sneezing. Stay away from special situations when you know there are people who are unwell, particularly if they are in confined spaces.”
  • Practice good cough etiquette. Cover your mouth when coughing or sneezing, use disposable tissues, and dispose of tissues immediately after use.
  • Keep high-traffic household areas scrupulously clean. This is the time when everyone in the home needs to step in and help.

 

When you’re pregnant, catching the flu is far more serious. A flu shot is the best way to protect you and your baby during your pregnancy, and in the first critical months after birth. That’s important because babies under six months can’t be given the flu vaccination. Protection is only achieved by vaccinating the mum during pregnancy. Vaccination is free and safe at any stage of your pregnancy and available from your doctor, specialist or nurse. For more info, visit:  http://www.health.nsw.gov.au/flu/pregnancy