Pregnant and postpartum women are at high risk of serious complications of seasonal and pandemic influenza infection. Pregnancy itself is a high-risk condition, making the potential adverse effects of influenza particularly serious in pregnant women. If a pregnant woman has other underlying health conditions, the risk of adverse effects from influenza is even greater. Antiviral treatment is necessary for all pregnant women with suspected or confirmed influenza, regardless of vaccination status. Obstetrician–gynecologists and other obstetric care providers should promptly recognize the symptoms of influenza, adequately assess severity, and readily prescribe safe and effective antiviral therapy for pregnant women with suspected or confirmed influenza. Over-the-phone treatment for low-risk patients is preferred to help reduce the spread of disease among other pregnant patients in the office. Obstetrician–gynecologists and other obstetric care providers should treat pregnant women with suspected or confirmed influenza with antiviral medications presumptively based on clinical evaluation, regardless of vaccination status or laboratory test results. Pregnant women with suspected or confirmed influenza infection should receive antiviral treatment with oseltamivir or zanamivir based on the current resistance patterns. Treatment within 48 hours of the onset of symptoms is ideal but treatment should not be withheld if the ideal window is missed. Because of the high potential for morbidity and mortality for pregnant and postpartum patients, the Centers for Disease Control and Prevention advises that postexposure antiviral chemoprophylaxis can be considered for pregnant women and women who are up to 2 weeks postpartum (including after pregnancy loss) who have had close contact with infectious individuals.
This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.
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Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group
The Society for Maternal-Fetal Medicine endorses this document. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group, in collaboration with members Geeta K. Swamy, MD and Laura E. Riley, MD.
Published online on September 24, 2018.
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Assessment and treatment of pregnant women with suspected or confirmed influenza. ACOG Committee Opinion No. 753. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:e169–73.