Flu in pregnant women: interview with a doctor

What are the dangers of colds and flu in pregnant women?

Respiratory infections pose two threats. Firstly, they may be accompanied by fever, which can lead to defects in fetal development. And secondly, influenza and ARVI during pregnancy can lead to the development of complications. During pregnancy, a number of changes occur in the immune response, as well as in the functioning of the heart and lungs, making the mother's body especially vulnerable. Therefore, colds and flu in expectant mothers are much more severe than in non-pregnant women and are often complicated by bacterial infections, including bronchitis and pneumonia.

The World Health Organization has included pregnant women at risk of developing severe and/or complicated influenza. It has been proven that pregnant women with the flu require hospitalization 4 times more often than non-pregnant women. Among patients in the third trimester, 8% require hospitalization in intensive care units [3].

Timely vaccination can prevent infection with the influenza virus during pregnancy. If infection has already occurred, the woman needs to begin treatment for ARVI or influenza during pregnancy as early as possible.

Decreased immunity during pregnancy

During pregnancy, a woman's immune system decreases its activity. This happens so that the fertilized egg can attach to the wall of the uterus, develop further and not be attacked by immune cells. This evolutionary “adaptation” is called physiological immunosuppression; it helps to continue the birth, but makes the pregnant woman’s body vulnerable to infections, including ARVI. Infectious diseases during pregnancy can be more complicated, with negative consequences for the mother and fetus.

Is it necessary to bring down a high temperature during pregnancy and what medications can be used?

It is important to manage fever in pregnant women in a timely manner, since high temperature can negatively affect pregnancy. It is especially dangerous in the first 12 weeks, when the formation of all organs and systems occurs. Hyperthermia in pregnant women during the first trimester doubles the risk of developing neural tube defects (future brain and spinal cord defects) and may also be associated with other birth defects and adverse outcomes in the baby [1].

It is not known for certain which temperature exceeding the greatest danger. Thus, data from a cohort study involving more than 77 thousand women showed that the incidence of malformations was approximately the same among those who reported a fever below 39 and above 39 degrees in the first trimester [1].

The drug of choice for reducing fever is paracetamol, which is approved for use throughout pregnancy [2]. In addition, ibuprofen is used as an antipyretic and analgesic in the first and second trimesters. Multivitamins containing folic acid can reduce the risk of developmental defects due to hyperthermia [1].

Of course, every prudent expectant mother tries to take care during pregnancy, but nevertheless, many catch a cold - after all, the immunity of pregnant women is very significantly reduced. Therefore, even those factors that we are accustomed to not noticing can have a negative impact.

What are acute respiratory infections and acute respiratory viral infections? There is no diagnosis of a cold. The doctor writes ARVI. What is it? ARVI is an acute respiratory viral infection. The familiar flu refers specifically to ARVI. The main symptoms of ARVI are general intoxication of the body and damage to the respiratory tract. Intoxication of the body is manifested by increased temperature, weakness, muscle pain, and aching joints. Damage to the respiratory tract - runny nose, pain and sore throat, cough, change in voice. The nature of the manifestation of these symptoms, for example, the color of sputum, the nature of the cough, etc., depend on the causative agent of the disease.

What are the dangers of acute respiratory infections during pregnancy? The greatest danger is caused by viral infections (ARVI). The degree of danger depends on the stage of pregnancy.

The most dangerous period is the first trimester . At this stage, the baby is not yet protected by anything and the virus can cause developmental defects, including those incompatible with life and cause miscarriage.

In the second and third trimester, during normal pregnancy, the baby is reliably protected by the placenta, which is an insurmountable barrier to most infections. But with accompanying complications of pregnancy leading to disruption of placental metabolism (for example, histosis, threat of miscarriage, exacerbation of various chronic diseases), serious consequences can occur in the second and third trimester.

So, until the middle of the second trimester , a viral infection can disrupt the formation of organs of the central nervous system - the brain and spinal cord, as well as other systems.

From the second trimester, intrauterine infection of the fetus is possible with the development of an infectious and inflammatory process in various organs, for example, meningitis, encephalitis, pneumonia, etc. Malnutrition of the fetus can also be observed and, as a result, a lag in its physical development.

If the mother caught a cold shortly before giving birth , then at birth the baby may show signs of hypoxia: the baby is lethargic, pale, the cry is weak, and there may be breathing problems. Then the child requires urgent treatment, and may even have to stay in the intensive care unit. In addition, after suffering from hypoxia, the child is more susceptible to birth trauma.

But there is no need to panic if you catch an acute respiratory infection or acute respiratory viral infection. According to statistics, 80% of women experience a cold in one form or another, most of them at the beginning of pregnancy, but for the majority, the pregnancy ends successfully, and, despite the illnesses they have suffered, they give birth to healthy babies.

How to treat acute respiratory infections? First, it’s worth listing what you should never do during pregnancy. No antibiotics, dietary supplements! Also forget about hot baths, steam rooms, foot baths. Never use aspirin or medications containing it (for example, Coldrex or Efferalgan). To reduce the temperature, do not use rubbing alcohol. Wool socks are also not a good idea.

If you have a runny nose, you should not self-prescribe or use medications containing vasoconstrictor components, such as SANORIN, DLYANOS, NAZIVIN, GALAZOLIN, OT-RIVIN, NAPHTHYZIN, etc. They can only be prescribed by a doctor and only if there are strict indications.

What can be used to treat acute respiratory infections during pregnancy?

To relieve fever, you can use paracetamol and drugs based on it. You can also wipe yourself with water at room temperature; in extreme cases, to quickly lower the temperature, you can add a little vinegar essence to the water, but just a little.

It is advisable to bring down the temperature with medications only if it has risen above 38 degrees. A temperature of up to 38 degrees indicates that the body is fighting infection - after all, this is a protective reaction of the body. It is at elevated temperatures that the production of interferon increases, a substance necessary to fight infectious agents, in particular viruses. In addition, an increase in body temperature causes the death of a number of pathogens.

But you should not expose the fetus to high temperatures for more than two days - elevated temperatures can lead to disruption of metabolic processes.

For a runny nose and sore throat, you should use folk remedies. Suitable rinses and inhalations based on eucalyptus tincture, sage decoction, soda, calendula tincture, malavita.

For inhalation, you need to bring the water to a boil, bend over at a distance of 25-30 cm from the surface of the water and breathe through your mouth or nose, depending on what you are treating - a cough or a runny nose. Inhalations are carried out every 2-3 hours.

If you have a runny nose, you can clear your nose with AQUA-MARISA - 1-2 sprays into each nostril 3-6 times a day. You can use homeopathic spray EUPHORBIUM COMPOSITES, EVA-MENOL ointment, oxalic ointment, PINOSOL ointment and drops.

For a sore throat, you can use aerosols STOPANGIN, GEXORAL. From the second trimester - KAMETON. You can also use medicinal lozenges for resorption with essential oils, for example, NEO-ANGIN and DOCTOR THEIS ANGI-SEPT, which have weak antiseptic and anti-inflammatory properties.

Nutrition during illness should be balanced - do not forget about vitamin complexes, fermented milk products, low-fat broths and soups. Appetite usually decreases when sick, but care must be taken to ensure that the baby receives a sufficient amount of nutrients.

You need to drink more water - at least 2 liters per day. Water very well removes toxic substances from the body that poison it. It is best to drink drinks such as weak tea with lemon, rosehip infusion, cranberry or lingonberry juice, dried fruit compote, and alkaline mineral water. At the same time, you need to ensure that approximately the same amount of water is removed from the body per day as you drank. But if you have severe edema or gestosis, then to remove toxins from the body you will have to go to the hospital - there, under the supervision of a doctor, you will undergo detoxification. You cannot prescribe diuretics yourself!

Prevention Of course, it is better not to get sick than to be treated. How to protect yourself from colds?

• watch your diet. Don't forget to take vitamin complexes.
• dress according to the season - you should not be cold or sweaty.
• avoid being in a confined space with a lot of people (transport, shops, etc.)
• Before visiting public places, lubricate your nose with oxaline ointment.
• Ventilate the room frequently and leave the room yourself.
• Carry out frequent wet cleaning, humidify the air in every possible way.
• You can place plates of chopped garlic and onions around the apartment.
• If one of your household members is sick, isolate him and wear a gauze bandage.

We hope that with our advice you will be able to avoid acute respiratory infections or acute respiratory viral infections! And if you do get sick, you will get over the disease as easily as possible! Prevention department

How to reduce a sore throat? What antiseptics can I take?

During pregnancy, it is allowed to use a number of antiseptics for sore throats, so it is not necessary to endure sore throat and other unpleasant symptoms during this period. Medications that expectant mothers can take include:

• ambazon, which has an antimicrobial effect against streptococci, daily dose 4–5 tablets 0.04–0.05 g;
• the combination of lysozyme + pyridoxine exhibits an antiseptic effect against gram-positive and gram-negative bacteria, fungi and viruses. Vitamin B6 in its composition has a protective effect on the oral mucosa. Prescribe 2 tablets 3-4 times a day.

In addition, warm drinks, which are indicated in unlimited but reasonable quantities, help reduce sore throat.

Colds during early pregnancy

How dangerous is a cold in early pregnancy? – Viruses most often attack the mucous membranes of the upper respiratory tract. Typically, ARVI is accompanied by symptoms of intoxication: headache, muscle pain, lethargy, weakness. Infection occurs by inhaling droplets of sputum containing viruses that are released into the air by sick people when they cough, sneeze or talk. In the body, viruses multiply quickly in the mucous membrane of the upper respiratory tract. As a result, swelling and inflammation of the mucous membranes of the respiratory tract affected by the infection develop. From there, viruses enter the blood and spread to various organs. Pregnant women are very susceptible to acute respiratory infections: their respiratory organs constantly work under high load, since adaptation of the body requires large energy costs. ARVI, especially influenza, are dangerous due to their complications. They aggravate chronic diseases, including smoldering foci of infection. Therefore, treatment should not be neglected, even if the cold is easily tolerated.

Why are colds dangerous during pregnancy?

While expecting a baby, any treatment should be recommended by a doctor. traditional methods and medications can have a negative impact on the woman’s condition during pregnancy and on the intrauterine condition of the child

1. Acetaminophen (paracetamol) is sometimes prescribed to bring down the temperature Due to many years of use of this drug, assumptions have been made about its relative safety. This is true only if you do not exceed the daily doses recommended by your doctor. An increase in temperature is an important signal for the body, which allows it to respond in a timely manner to the development of a bacterial complication.
2. Until the third trimester, some doctors do not exclude the prescription of drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) , such as acetylsalicylic acid and ibuprofen. However, by the third trimester it is better to stop taking non-steroidal anti-inflammatory drugs, as they can negatively affect the development of the fetus and the health of the newborn. During this period, any painkillers are generally prohibited.
3. To reduce cough, expectorants are prescribed to thin sputum. Drugs whose main active ingredient is bromhexine are contraindicated for nursing and pregnant women. Herbal preparations are prescribed with great caution, as they contain alkaloids that can be toxic to the fetus and have an abortifacient effect.
4. For a sore throat, it is possible to use local antiseptic (antimicrobial) drugs.
5. For nasal congestion, most doctors do not recommend vasoconstrictor sprays or drops. Moreover, this requirement is especially relevant in the first trimester and for those women who do not protect themselves in the second half of the menstrual cycle and may soon become pregnant. It is allowed to use pharmaceutical isotonic solutions based on purified sea water to rinse the nose and thin the mucus.
6. Symptomatic therapy includes prescribing plenty of warm drinks. This prevents drying of the mucous membranes of the nose and throat and helps to thin sputum, sweating and reduce the level of intoxication. Symptomatic therapy is aimed at reducing intoxication and supporting the body's defenses.
7. Most experts recommend using local forms of medications in the first trimester. There are drugs that can act directly at the gates of infection (on the mucous membrane of the nose). Thus, VIFERON ointment and gel can be used in pregnant women, starting from the first week. Interferon, which is part of these drugs, is a protein substance; it is synthesized naturally in the body in response to the penetration of a pathogen.

Can pregnant women take any expectorant medications?

Therapists and obstetricians-gynecologists recommend that pregnant women refrain from taking expectorant medications if possible. The vast majority of drugs in this group are prohibited for use during pregnancy, including herbal remedies, which are often considered “safe” by consumers. In fact, plantain syrup, preparations based on thyme and thyme extract, and other popular herbal remedies are contraindicated for pregnant women.

At the same time, the drug ambroxol is still approved for use by pregnant women in the second and third trimesters with the label “with caution.” The same applies to bromhexine - it is prescribed, but only after a careful assessment of the benefit/risk ratio, and only the attending physician can carry it out. Therefore, primary care providers who advise pregnant women with requests for expectorant medications should limit themselves to insistent advice to consult a doctor. And the only recommendation that should be given in such situations is to drink warm drinks and sufficiently humidify the air in the room.

What can a pregnant woman take for a debilitating dry cough?

Antitussive drugs, like mucolytics, are prohibited from taking during pregnancy at all or are allowed under the supervision of a doctor after assessing the risks and benefits. Thus, the popular centrally acting antitussive drug butamirate can be taken only in the second and third trimesters and only after consultation with a doctor. The peripheral drug prenoxdiazine is also used with caution during pregnancy. Thus, when counseling a pregnant woman with a dry cough, she should be advised to immediately visit a doctor.

Flu in early and late pregnancy

Flu and pregnancy are a rather dangerous combination in many cases. According to doctors, severe, life-threatening complications develop more often in the second and third trimesters of pregnancy. However, in the first trimester there is a higher risk of fetal damage with the formation of gross malformations. Concomitant chronic diseases of the respiratory and cardiovascular systems, as well as the presence of endocrine diseases (for example, diabetes) and metabolic (excess weight) disorders significantly increase the risk of developing serious complications in a woman and unborn child. Smoking increases the likelihood of severe complications by 4.5 times, and sexually transmitted infections accompanied by decreased immunity (herpes simplex virus, syphilis, trichomoniasis, cytomegalovirus) increase the likelihood of severe ARVI in pregnant women by almost 7 times. Children born to mothers who had an influenza infection during pregnancy often show signs of immunodeficiency in the first months of life and are more likely to suffer from respiratory viral infections.vii

Dangerous complications of influenza during pregnancy

The most dangerous complication of influenza during pregnancy is pneumonia, systemic organ damage, and spontaneous miscarriages. Fetal loss syndrome can also manifest itself in the form of intrauterine fetal death and premature birth.

Consequences for the fetus, depending on the timing of pregnancy, include malformations, the likelihood of developing severe mental illness and many other types of neonatal pathology. Damage to the placenta by viruses can lead to the development of circulatory failure, which is fraught with various complications. Recently, it was found for the first time that, in addition to abnormalities in brain development, influenza infection can cause atrophy of the eyeball in a child.viii

Is it possible to be treated during pregnancy with infusions, decoctions of medicinal herbs or herbal teas?

Despite their natural origin, not all preparations based on medicinal plants, including herbal teas, are safe during pregnancy. Herbs may contain active substances that negatively affect the development of the fetus or increase the tone of the uterus. Herbs can cause miscarriage or stimulate premature labor. Medicinal plants that are unsafe during pregnancy include [4, 5]:

• chamomile - can promote uterine contractions;
• licorice root - may increase the risk of premature birth;
• laxative herbal teas based on senna and other plants - active intestinal peristalsis can stimulate the contractile activity of the uterus;
• common twig - stimulates the production of estrogen, may increase the risk of miscarriage;
• echinacea - activates the synthesis of oxytocin; aloe vera - stimulates the contractile activity of the uterus;
• calendula - has an abortifacient effect and many others.

However, there are also medicinal plants that have been proven safe during pregnancy. Among them [6]:

• raspberry leaves;
• peppermint leaves;
• plantain oval seed shell;
• garlic.

Since the list of medicinal plants that are unsafe during pregnancy is quite large, it is still better to take herbal medicines during this period after consulting with your doctor.

Can pregnant women get a flu shot?

Most experts, including representatives of the World Health Organization, recommend vaccination to all women whose pregnancy period coincides with the seasonal increase in the incidence of influenza infection and a possible epidemic. The appearance of this recommendation was dictated, among other things, by the need to protect newborns from infection during the most dangerous period for them - the first months of life.

However, despite WHO recommendations, there is still no unanimous opinion among doctors regarding regular vaccination of expectant mothers. Given the possible risks of vaccines, the US CDC and the American College of Obstetricians and Gynecologists (ACOG) advocate vaccination only in certain cases, namely:

• with a high risk of contact of a pregnant woman with sick people;
• in cases where the infection poses a proven danger to the mother or fetus.

When deciding whether to vaccinate, American doctors recommend taking into account the balance between the risk posed by influenza infection to a pregnant woman and fetus and the risk associated with the use of the vaccine. Influenza vaccination is contraindicated for children under 6 months of age, although newborns and infants are also at increased risk for complications and deaths.

Are any antiviral drugs allowed during pregnancy?

The treatment regimen for influenza in pregnant women includes antiviral drugs from the group of neuraminidase inhibitors. They are active against influenza A and B viruses, and their effectiveness has been demonstrated in numerous clinical studies [7, 8]. Antiviral drugs of this group disrupt the ability of viral particles to penetrate into cells, which leads to localization of infection in the body, alleviation of the condition and reduction of the likelihood of complications during pregnancy [7]. According to international and Russian recommendations, neuraminidase inhibitors are the drugs of choice for influenza, including during pregnancy [8]. Their effectiveness is highest when taken within the first 48 hours after the onset of the disease, so when the first flu symptoms appear, it is very important to consult a doctor and begin treatment. Let us remember that neuraminidase inhibitors are prescription drugs ( also in this case it is necessary to make sure that the patient has the flu and not ARVI in pregnant women - editor's note.

).

When does a pregnant woman need intensive care for influenza?

Fortunately, an influenza infection in an expectant mother does not always lead to the development of severe complications that threaten the life and health of her and the unborn child. But the likelihood of developing complications when infected with this widespread infection must always be remembered. A woman and her relatives should know that hospitalization for influenza in an expectant mother is required in the following cases:

• high body temperature (> 38°C);
• severe shortness of breath (RR (respiratory rate) > 30/min);
• tachycardia - increased heart rate;
• suspicion of the development of pneumonia, when at the beginning of the disease a pregnant woman does not see a doctor, and then a complication develops in the form of pneumonia;
• disturbance of consciousness.

If you have any of these signs or suspect its development, you should immediately, without delay, seek help from a doctor.

How to boost immunity during pregnancy?

The following help increase the body's defense against respiratory infections during pregnancy:

• a balanced diet that compensates for a woman’s needs for nutrients, vitamins, and microelements;
• healthy sleep;
• laughter – helps to activate the immune response [9];
• taking probiotics, which normalize the composition of the intestinal flora, which helps reduce the risk of respiratory infections and reduce the severity of cold symptoms [10];
• taking multivitamin complexes containing vitamin D, which helps relieve cold symptoms and reduce the incidence of infection [11].

In addition, to increase the immune response, the doctor can prescribe interferon alpha-2b drugs - intranasal or rectal (there may be restrictions on the duration of pregnancy, for example, some of them are prescribed only after 14 weeks - editor's note).

Vaccination of pregnant women against influenza

During the entire period of pregnancy, influenza is very dangerous for expectant mothers. To date, WHO is continuing research aimed at assessing the risks and benefits of vaccination against pandemic influenza in pregnant womenii. The European Center for Disease Control and Prevention states: “Influenza vaccination is the main strategy for preventing severe and complicated illness, even if the vaccine is less effective than expected.” Some time after the vaccine is administered, the woman and newborn develop specific immunity that protects in case of contact with sick people.

In the Russian Federation, the issue of influenza vaccine prevention arose urgently in connection with the 2009-2010 pandemic. During this period, domestic and foreign split vaccines were used for the first time, which largely made it possible to avoid the severe consequences of the influenza epidemic. Since 2014, pregnant women have been officially immunized for epidemiological reasons.

Vaccination can reduce the risk of infection after birth and also reduces the likelihood of a baby contracting the flu during the first months of life. Antibodies are transferred to the child from the mother, which helps the formation of passive immunity. It is advisable for all family members to be vaccinated against influenza, including older childreniii.

Is it possible for a pregnant woman to apply mustard plasters and pepper plaster?

Despite the fact that both mustard plasters and pepper plaster act externally and do not affect the development of the fetus, they are potentially dangerous for pregnancy. Heat treatments can increase uterine contractility, which is associated with an increased risk of miscarriage or premature birth. In addition, increased microcirculation, which occurs under the influence of mustard plasters or pepper patches, can change uteroplacental blood flow, which is also undesirable. The greatest danger is posed by thermal procedures in the first and last trimester of pregnancy - in the first they increase the risk of miscarriage, in the last - premature birth.