TTC/Pregnancy & Swine Flu

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The latest scaremongering targets of the Swine Flu outbreak are those trying to conceive (TTC) or already pregnant ladies.

One of my dear friends, who is four months pregnant herself, sent me an article which had been published on the BBC on Sunday, and which was swiftly revised to make it sound less frantic than the first version, but it still strikes fear into the hearts of even the most unaffected of people;

"The Royal College of Midwives (RCM) says all expectant mothers should avoid crowded places and unnecessary travel.

Health experts say expectant mothers could suffer possible complications if they contract swine flu, such as pneumonia, breathing difficulties and dehydration, because they have suppressed immune systems. Young children are also vulnerable.

Most mothers-to-be with swine flu are being prescribed Relenza, an inhaled antiviral drug which treats the virus without reaching the foetus. However, where it is particularly severe, doctors can offer Tamiflu instead.

But the DoH says only the "particularly concerned" should consider the advice."

http://news.bbc.co.uk/1/hi/health/8157755.stm

What is 'unnecessary travel' we ask ourselves? Is it travel to and from work; to and from the supermarket; to and from public transport? What constitutes a crowded place? Should pregnant ladies wrap themselves in cotton wall and take cover in an iron lung for the next nine months just to avoid any sort of contact with other, possibly contagious, humans?

Before the colour drains from all fertile and pregnant women's faces please consider the following facts from the World Health Organisation's website - the people who actually issued the pandemic warning in the first place;

This pandemic has been characterized, to date, by the mildness of symptoms in the overwhelming majority of patients, who usually recover, even without medical treatment, within a week of the onset of symptoms.

http://www.who.int/csr/disease/swineflu/en/index.html

So in the vast majority of cases, if you are unlucky enough to actually contract swine flu they symptoms are no worse than a normal bad cold or seasonal flu and the recovery period is quick. The fear of the unknown is what is causing the debate to gather pace; no one knows of the effect that exposure to the virus may or may not have on a foetus. Then again how can you tell what effect any virus has on a foetus?

The debate seems to have been prompted by cherry-picked comments from Belinda Phipps, chief executive of the National Childbirth Trust;

The NCT, Britain's leading charity for parents, said delaying pregnancy could cut a woman's risk of catching the virus or reduce its severity. "Expectant mothers are thought to be at greater risk from the virus because the immune system is naturally suppressed during pregnancy to ensure it does not reject the baby,"

"Early figures also suggest it takes expectant mothers longer to fight off the disease. Most would still only develop a mild case, but in rare cases symptoms could lead to premature labour, a miscarriage or even cause birth defects."

However, since the weekend Phipps has backtracked on some of those comments by issuing the following statement which hopefully placates the concerns of those of you considering stopping TTC, or worrying about your unborn baby during the swine flu pandemic;

There seems to have been an outbreak of unwarranted panic this morning in some of the media.

What has appeared to happen is some journalists have come across some of the basic biological facts of pregnancy – already known to us who are NCT involved.

Namely that when you are pregnant your immune system is slightly suppressed so you are slightly more likely to catch any infection that's going – and because swine flu is prevalent you are slightly more likely to catch that.

The other aspect of your immune system being slightly depressed is that any illness you do catch may be slightly worse or more difficult to shake off. This is as true of swine flu as it is of any other infectious disease.

It has always been the case that those coming into contact with pregnant women should be aware of this and avoid them if they have an infection – this is part of normal considerate behaviour.

The measures being suggested about tissues and coughing and sneezing and hand washing are effective in reducing the transmission of many infective diseases so should be part of everyone's life swine flu or no swine flu.

Small children and babies do not have immune systems that function to the level of a healthy adult and children have not been exposed to many of the illnesses that adults are already immune to. They are therefore more likely to catch infections. As with pregnant women those with infections are, as part of normal considerate behaviour, expected to avoid close contact with young babies.

We also know that mother and baby being together and the baby or child being breastfed helps reduce the risk of infection and probably the severity of illness. This is because the mother will be exposed to the same infections as her child and her more sophisticated immune system will trigger antibodies etc which through her breast milk will help protect her child. We also know that breastmilk itself also contains factors which support and protect a child by providing optimal nutrition matched to the baby's age and stage and by supporting the immune system of the child. This is a biological fact which is true for swine flu as it is for other infections.

There are some infections which we know are very risky in pregnancy but swine flu does not seem to be one of these. For example Rubella (which is commonly known as German measles) is an infection which is very serious for the baby if a pregnant mother catches it but now vaccination is offered widely to reduce the prevalence of the disease and the risk of a woman catching it.

As far as conception is concerned, the Department of Health in its original guidance suggested that those planning an IVF pregnancy might want to delay. But now it is clear that swine flu looks to be a mild illness for all but the already seriously sick. Therefore they have revised their guidance. They are not suggesting delay.

In considering a pregnancy women will take many things into account. They may wait till after their holiday, their house move or their own age or the age of an older child might be the most important factor for them. Knowing that there will be a lot of swine flu about in the autumn is one factor that some women might consider in a small way among many other factors. This is no real change from the way people planning parenthood would go about deciding when to start a pregnancy.

It is important that those expecting a baby and those caring for a child have information so they can make up their own minds what to do.

The NCT does not advise people what decisions to take. It does however provide help once someone has made up their minds what they want to do and what to know how to do it.

Hope that helps

Belinda Phipps
CEO NCT