Swine Flu Drug for Pregnant Women

Pregnant women who get swine flu are at such high risk of complications like pneumonia, dehydration and premature labor that they should be treated at once with the antiviral drug Tamiflu — even though it is not normally recommended in pregnancy, the Centers for Disease Control and Prevention said Tuesday.

Because a positive test for the new H1N1 flu can take days, the agency said, Tamiflu should be given to any pregnant patient with flu symptoms and a history of likely contact with someone else with swine flu.

“If I’m thinking influenza — the classic symptoms, febrile, aching all over, came on all of a sudden — and this flu is in the community, and I’d otherwise give the patient Tamiflu if she wasn’t pregnant, we’re saying, ‘Don’t delay because she’s pregnant,’ ” said Dr. Denise Jamieson, a C.D.C. medical officer. “At that point, the benefit of giving Tamiflu outweighs the risk.”

Tamiflu is not normally recommended for use by pregnant women because the effects on the unborn child are unknown, according to its maker, Roche.

Dr. Jamieson, an obstetrician, said most medicines had insufficient safety data for pregnancy “because you don’t do clinical trials in pregnant women.” But she added, “Tamiflu and Relenza are fairly safe in pregnancy.”

Tamiflu and Relenza are in the same class of drugs. But Tamiflu is a pill and liquid, while Relenza is a powder that must be inhaled, so it is prescribed much less often.

The C.D.C. and the World Health Organization said case histories in Mexico and the United States suggested that pregnancy was emerging as a risk factor rivaling asthma, diabetes, immunosuppression and cardiovascular disease.

One of the three deaths in the United States involved a pregnant Texas woman who was on no medication other than prenatal vitamins, the disease centers said. The agency knows of 20 confirmed or probable swine flu infections in pregnant Americans, and “a few have had severe complications,” said Dr. Anne Schuchat, the interim deputy director for public health.

American doctors are often reluctant to prescribe flu drugs for pregnant women unless they develop severe symptoms like pneumonia. Pregnant women are often reluctant to take medication. A pregnant woman is at higher risk from flu because hormonal changes depress the immune system to protect the fetus.

Details about the death of the pregnant woman in Texas emerged Friday in the disease centers’ weekly morbidity and mortality report. Dr. Jamieson said the woman had mild asthma and psoriasis, but was relatively healthy. The woman has been widely identified as Judy Trunnell, 33.

Mrs. Trunnell was eight months pregnant when she entered the hospital with pneumonia on April 19, five days after flu symptoms began and she had been found flu-positive in a doctor’s office test. Her baby was delivered by Caesarean section and is healthy. She developed acute respiratory distress on April 21 and needed mechanical ventilation. She did not get Tamiflu until April 28. She died May 4.

It is becoming clear that the epidemic in the United States will mirror the epidemic in Mexico, and similar rates of severe illness should be expected. The outbreak across Europe is still spreading slowly because the Europeans aggressively treat every suspected mild case with Tamiflu, health officials said.

The United States now has more than 3,000 confirmed cases — two-thirds in people younger than 18 — but only 116 hospitalizations. But officials note that hospitalizations take slightly longer to appear in statistics and deaths take much longer.