GYN Q&A: H1N1 and Pregnancy's women's health expert answers your most pressing concerns

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GYN Q&A: H1N1 and Pregnancy’s women’s health expert answers your most pressing concerns

-Lissa Rankin

concerned motherA friend of mine who is pregnant just called me and told me she was worried because she has the sniffles. She doesn’t know what to do. She normally has allergies this time of year, but she’s afraid it might be the swine flu. She’s not sure if she should go to an ER or whether she can wait until morning to call her doctor.

Symptoms of swine flu should be very different than the seasonal allergies that are so pervasive this time of year. Swine flu usually presents with fever, body aches, fatigue, cough, occasional runny nose, and sometimes nausea, vomiting, and diarrhea. Allergies usually result in a drippy, runny, sneeze nose, watery, itchy, bloodshot eyes, hives on the skin, and, for those with a tendency towards asthma, wheezing and/or cough. A fever is the best way to differentiate, although a low grade fever and the sniffles could be a simple common cold.

If your friend has a fever as well as other symptoms of swine flu, I would recommend she call her doctor. If not, she might try taking an allergy medicine like Benadryl or Claritin, which are available over-the-counter and are safe in pregnancy. If the symptoms improve, it’s probably not swine flu.


I am 26 weeks pregnant, with twins :) and planning a trip to Spain. I was so worried, and your advice has helped me relax, thanks very much for that! There is just one thing still on my mind: If a pregnant woman gets a virus, swine flu included, does this pass to the baby? I mean, can they get ill, or can they suffer as a cause of it (does it pass the placenta)? And, if not (would be a great relief), could the antiviral medication do that? (Could the medication be more harmful than the illness?) Sorry if I’m making your head spin…

No, no head spinning, sweetie. That’s a very good question, and the reason I didn’t address it specifically is because we just don’t know yet. When new flu strains emerge, they have mutated from other flu strains, so their capacity to do things like cross the placenta can change. We know that some viruses–like the herpes virus and CMV–can cross the placenta during pregnancy and affect the fetus.

There is evidence that other strains of flu, such as the avian flu, have crossed the placenta as well. Perhaps swine flu can also. But this is not necessarily cause for alarm. Unlike herpes and CMV, which can cause severe birth defects, the flu virus does not usually affect how the organs develop in a fetus. And because you and your placenta are nurturing your twins while you gestate, your baby doesn’t have to worry about things like coughing, breathing problems, or even vomiting and diarrhea.

So yes, if you get a fever, your baby will get a fever. If you get dehydrated, your baby gets dehydrated, but for the most part, your baby is protected, even if you get swine flu. You are your babies’ incubator. You’re the ICU. So you don’t need to worry about your babies, just you. If you were to get swine flu, you would likely be hospitalized because of the twins, because getting the flu in pregnancy can increase your risk of preterm birth, which you are already at risk of because of your twins. So do be careful and make every effort to avoid being infected. But don’t be alarmed. If you were to get it, the decision of whether to treat you with anti-virals would depend on the severity of your illness. Since anti-virals are Category C, meaning we don’t have good data, you would likely only be treated if you were quite ill. As for Tamiflu and Relenza, the anti-virals, we do not know if they cross the placenta.

Until we know more, we are cautious about how we use any medication in pregnancy. Stay tuned, and feel free to ask more questions if they arise. I’m sure your questions mirror what many women are thinking.


I am 27 weeks pregnant and am supposed to be traveling to London in two days…I am really panicking about being on an airplane or in an airport at this time with the swine flu. If I catch it, can I be treated without harming the baby? Do you recommend that with what is happening, or should I cancel the trip?

I imagine this is a frightening time for anyone to travel, particularly someone who is 27 weeks pregnant. So far, travel recommendations from CDC and WHO do not call for us to change our travel plans (except the CDC, which recommends against non-essential travel to Mexico). But I can understand why being in crowded places would be scary at the time of an international pandemic.

And yes, pregnancy is a time to be more concerned about the flu. While most people who get swine flu will be watching chick flicks at home and merely feeling crappy, pregnant women must also worry about preterm labor, and at 27 weeks, you don’t want to go there.
But the likelihood is that if you fly to London, you and your baby will be just fine. What does your intuition tell you? I know when I have tough decisions to make, taking a moment to listen to my inner guide helps. (I know–sounds floofy, but you’d be surprised). If your intuition fails to help you, ask your doctor. Most likely, your doctor will turn the decision back around to you.

I hate to ever say this–because I’m not, and will never be–you. But if it were me and it was non-essential travel, I might reconsider at 27 weeks pregnant. If I was not pregnant and planning a trip to London (even if I was pregnant but not at the critical 24-32 week time of pregnancy), I would probably go. But that’s just me–I chose not to travel in my third trimester at all, so take my advice with a grain of salt.

Here are some Travel Guidelines:

Only you can decide. Talk to your family and your doctor, seek your inner answers, go with your gut, and let it go after that.

As for whether you can be treated if you do get swine flu, the answer is that it all depends. Because the medications we use for swine flu are Category C, meaning we don’t have data about whether they are safe or not during pregnancy, anti-viral treatment would be reserved for pregnant women who are very ill, when the benefits are determined to outweigh any potential risk. But other supportive treatments, such as IV fluids, Tylenol, and most cough medicine, are safe in pregnancy. Remember that the likelihood that you will get it is exceedingly low. More people were in car crashes today than caught swine flu. It’s important to keep things in perspective.

Lissa RankinRead more Q & A’s from Dr. Rankin: Dealing with PMS and Swine Flu and Pregnancy

Lissa Rankin is a gynecologist and author. She blogs at, and you can follow her on Twitter at @lissarankin


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