Dr. Bassam Rimawi, MD, FACOG, discusses how influenza can affect pregnant women, which symptoms women should be aware of, and how the flu is treated. He also provides information on how the flu may impact the fetus.
Transcription:
Michael Carrese: The flu is a dangerous virus that kills thousands of Americans each year, but it's even more dangerous if you're pregnant. We're going to find out why today from Dr. Bassam Rimawi, a Maternal Fetal Medicine Physician with Wake Med Maternal Fetal Medicine. This is Wake Med Voices, a podcast from Wake Med Health and Hospitals. I'm Michael Carrese, and Dr. Rimawi, I thought it would make sense to start by having you remind everybody of the basics about the flu. What is this virus and why should people be concerned about protecting themselves from it?
Dr. Rimawi: Yeah. So influenza has been known for several years, and when influenza was first discovered, many people were getting sick rapidly, and were being hospitalized with progressive breathing issues and respiratory failure. And lo and behold, later they found out that this was due to a virus known as influenza. Influenza divided into two subtypes, which is influenza A and influenza B. Both of them are pretty dangerous to have, influenza A has been more notoriously known to spread faster and can cause illness much quicker and lead to conditions. What we call pandemics or endemics, where they spread rapidly across areas in the globe.
Host: You know, I think people, because it comes around every year, maybe don't take it as seriously as they should, but there are tens and tens of thousands of Americans every year that die from the flu.
Dr. Rimawi: That's correct. Yes sir. So many people get the flu every single year and one of the most important things that people can do to help reduce their chances of getting the flu and to reduce the spread of the flu, is to get the flu vaccine. The flu vaccine is recommended across all major people such as the centers for disease control and prevention, what we call the CDC, that Medical College of OB GYN and the Society of Maternal Fetal Medicine. People must also be weary that even if they get the flu vaccine, they can still get infected with the flu because there's different strains of the flu. But getting the flu vaccine helps to eliminate some of the other strains that could cause influenza.
Host: So you're fellowship trained in reproductive infectious diseases. And so the perfect guy to talk to obviously about how this affects pregnant women. So why are pregnant women more vulnerable to the flu?
Dr. Rimawi: Yeah, so pregnancy is a very amazing and wonderful condition for many people to go through in life. But one of the things that happens in pregnancy is in order for a pregnant woman to keep the baby inside the uterus and prevent the body from rejecting the baby, is her immune system naturally has to be weakened. Because women that have fully charged immune systems will likely reject a pregnancy. Because the immune system is weekend during pregnancy, they are more vulnerable to infections such as influenza. And not only is it during pregnancy, but also during the postpartum period, which is immediately after delivery. And there's multiple complications that can happen during pregnancy and during the postpartum period. So the complications that can happen during pregnancy for both the mom and for the baby are starting with the mom first. Is that because influenza can affect her lungs, her throat, and her breathing, it can cause progressive respiratory failure and one of the most concern things that it can lead to something called pneumonia. Pneumonia can lead to her having to be in the hospital and being admitted into the intensive care unit, having to require a tube to assist her for breathing. And if not treated appropriately and rapidly, these women will continue to progress into respiratory failure and can unfortunately die from their disease. For the baby because moms need to breathe appropriately to oxygenate the baby. This can lead to oxygenation issues for the baby, this can lead to early delivery, what we call preterm delivery, and can lead to multiple sequelae that are a result of being born very early.
Host: What's a sequelae?
Dr. Rimawi: Yeah, sequelae are manifestations or issues that can happen from being born early. For example, babies that are born early can have problems with breathing, can have infections, can have bleeding in their brain, can have issues with their bowels, what we call necrotizing enter colitis as a condition where the bowels in the small intestines get swollen and infected. And they can also have neurological problems later in life from being born early. And this can all be a complication of having influenza in pregnancy.
Host: So breathing, you've already pointed out as being super important piece of this, but what are some other symptoms that pregnant women should be on the lookout for?
Dr. Rimawi: Sure. So the classic symptoms for patients to be aware of when they're talking about influenza is number one. They may or may not present with a fever and the fever does not have to be a very high fever. It can be as low as just having a fever of 100 degrees Fahrenheit. They can also have a cough, they can have runny nose, they can have headaches or body aches, sore throat. It can feel very tired and it can have difficulty breathing or shortness of breath. It's very important to know that you don't necessarily have to have a fever in order to have influenza, but one of the key things that help to differentiate this from the common cold is that most of the time common colds won't present with body aches at the same time, but it could. So that's why all patients that present with these symptoms should consult their medical providers immediately to assess what their illness severity is.
Host: You mentioned the vaccine before everybody should get it, are there any particular considerations with women who are pregnant getting the vaccine?
Dr. Rimawi: Yes, so there are two types of vaccines people can get. One is an inhalation, which is a breathable form of the vaccine and one is an injectable form which comes as an injection. In pregnancy, we avoid the inhalation form only because it can contain some live particles of the virus and we try to avoid giving live particles to pregnant women, but the injectable form does not have any live particles inside. It's all inactivated viral particles. And basically it's recommended at all times during pregnancy. So all pregnant woman can receive it in any trimester during pregnancy, and it is recommended to receive it, especially doing the influenza season.
Host: So if unfortunately the vaccine doesn't do its job and a woman who's pregnant does get influenza, how do you treat it? Is it differently than how you would treat somebody else?
Dr. Rimawi: Great question. So anytime we have a patient that comes in with influenza like symptoms, the very first thing that we have to do is conduct what we call an illness severity assessment. So the questions that we have to know is to make a conclusion whether or not we can admit her to the hospital or she can be treated at home is number one. Does she have any difficulty breathing or shortness of breath? Number two, does she have any new pain or pressure in her chest other than just coughing and pain? Number three is she unable to keep any liquid down? Is she vomiting everything that she's eating or drinking? Does she show any signs of dehydration? For example, if she's standing up and she suddenly become very dizzy, the room is spinning. She starts to see white spots in her eyes. These are all signs of dehydration. Is she less responsive than normal or does she get confused very easily when someone's talking to her?
If she starts to have any of these symptoms, these women need to be immediately admitted to the hospital and be evaluated for possible admission to the intensive care unit and to be started on treatment. It should does not have any of these symptoms. Then the next thing we need to worry about is whether or not she has any other medical problems that may worsen her influenza. For example, does she have something called HIV infection, which is a condition that can worsen her immune system or does she have asthma or any other breathing problems? Because influenza, as we already spoken about can worsen your breathing ability, and if you have asthma or any other breathing condition, that in itself can worsen their breathing availability. Does she have any signs of preterm labor? So we ask them, do you have any contractions? Any leakage of fluid? Any bleeding?
If she has any of these, then we go ahead and we admit them to the hospital. If she says no to all of these, then to best avoid her from contaminating other pregnant women or any other hospital individuals, we usually just have them stay at home and we call them a prescription to the pharmacy. Now in terms of medical, the medical treatment is not very different than that of a non-pregnant patient. The treatment of choice is a medication called Oseltamivir, also known as Tamiflu. If medication is given by tablets, it's 75 milligrams and they take it twice a day for five days and there's lots of literature to support that. By taking this, not only do you help to reduce the whole duration of your infection, but you can also help to prevent a lot of these complications that can result from untreated influenza.
Host: But it's important to hop on that pretty quickly, right?
Dr. Rimawi: Yes. This is something that should be treated and be managed immediately. When a person first gets in contact with influence, it typically takes about two days or so for the person to start to become very symptomatic and to get very sick. But for pregnant patients, these patients can become sicker much sooner because their immune systems are weakened so they can start to see symptoms in as little as just 24 hours, even less depending on whether or not they have any other medical problems that may worsen their immune system.
Host: So as always with pregnant women, they have to be vigilant and pay a lot of attention to what's going on with their body and pick up on any symptoms of the flu and get to see a doctor right away. We're going to have to leave it there, but I want to thank our guest, Dr. Bassam Rimawi. He is a Maternal Fetal Medicine Physician at Wake Med Maternal Fetal Medicine. He's also fellowship trained in reproductive infectious diseases. Thanks very much for being with us today.
Dr. Rimawi: Thank you so much. I appreciate it.
Host: To learn more about Wake Med services and locations. Visit Wakemed.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for other topics that may interest you. I'm Michael Carrese with Wake Med Voices brought to you by Wake Med Health and Hospitals in Raleigh, North Carolina. Thanks for listening.
Michael Carrese: The flu is a dangerous virus that kills thousands of Americans each year, but it's even more dangerous if you're pregnant. We're going to find out why today from Dr. Bassam Rimawi, a Maternal Fetal Medicine Physician with Wake Med Maternal Fetal Medicine. This is Wake Med Voices, a podcast from Wake Med Health and Hospitals. I'm Michael Carrese, and Dr. Rimawi, I thought it would make sense to start by having you remind everybody of the basics about the flu. What is this virus and why should people be concerned about protecting themselves from it?
Dr. Rimawi: Yeah. So influenza has been known for several years, and when influenza was first discovered, many people were getting sick rapidly, and were being hospitalized with progressive breathing issues and respiratory failure. And lo and behold, later they found out that this was due to a virus known as influenza. Influenza divided into two subtypes, which is influenza A and influenza B. Both of them are pretty dangerous to have, influenza A has been more notoriously known to spread faster and can cause illness much quicker and lead to conditions. What we call pandemics or endemics, where they spread rapidly across areas in the globe.
Host: You know, I think people, because it comes around every year, maybe don't take it as seriously as they should, but there are tens and tens of thousands of Americans every year that die from the flu.
Dr. Rimawi: That's correct. Yes sir. So many people get the flu every single year and one of the most important things that people can do to help reduce their chances of getting the flu and to reduce the spread of the flu, is to get the flu vaccine. The flu vaccine is recommended across all major people such as the centers for disease control and prevention, what we call the CDC, that Medical College of OB GYN and the Society of Maternal Fetal Medicine. People must also be weary that even if they get the flu vaccine, they can still get infected with the flu because there's different strains of the flu. But getting the flu vaccine helps to eliminate some of the other strains that could cause influenza.
Host: So you're fellowship trained in reproductive infectious diseases. And so the perfect guy to talk to obviously about how this affects pregnant women. So why are pregnant women more vulnerable to the flu?
Dr. Rimawi: Yeah, so pregnancy is a very amazing and wonderful condition for many people to go through in life. But one of the things that happens in pregnancy is in order for a pregnant woman to keep the baby inside the uterus and prevent the body from rejecting the baby, is her immune system naturally has to be weakened. Because women that have fully charged immune systems will likely reject a pregnancy. Because the immune system is weekend during pregnancy, they are more vulnerable to infections such as influenza. And not only is it during pregnancy, but also during the postpartum period, which is immediately after delivery. And there's multiple complications that can happen during pregnancy and during the postpartum period. So the complications that can happen during pregnancy for both the mom and for the baby are starting with the mom first. Is that because influenza can affect her lungs, her throat, and her breathing, it can cause progressive respiratory failure and one of the most concern things that it can lead to something called pneumonia. Pneumonia can lead to her having to be in the hospital and being admitted into the intensive care unit, having to require a tube to assist her for breathing. And if not treated appropriately and rapidly, these women will continue to progress into respiratory failure and can unfortunately die from their disease. For the baby because moms need to breathe appropriately to oxygenate the baby. This can lead to oxygenation issues for the baby, this can lead to early delivery, what we call preterm delivery, and can lead to multiple sequelae that are a result of being born very early.
Host: What's a sequelae?
Dr. Rimawi: Yeah, sequelae are manifestations or issues that can happen from being born early. For example, babies that are born early can have problems with breathing, can have infections, can have bleeding in their brain, can have issues with their bowels, what we call necrotizing enter colitis as a condition where the bowels in the small intestines get swollen and infected. And they can also have neurological problems later in life from being born early. And this can all be a complication of having influenza in pregnancy.
Host: So breathing, you've already pointed out as being super important piece of this, but what are some other symptoms that pregnant women should be on the lookout for?
Dr. Rimawi: Sure. So the classic symptoms for patients to be aware of when they're talking about influenza is number one. They may or may not present with a fever and the fever does not have to be a very high fever. It can be as low as just having a fever of 100 degrees Fahrenheit. They can also have a cough, they can have runny nose, they can have headaches or body aches, sore throat. It can feel very tired and it can have difficulty breathing or shortness of breath. It's very important to know that you don't necessarily have to have a fever in order to have influenza, but one of the key things that help to differentiate this from the common cold is that most of the time common colds won't present with body aches at the same time, but it could. So that's why all patients that present with these symptoms should consult their medical providers immediately to assess what their illness severity is.
Host: You mentioned the vaccine before everybody should get it, are there any particular considerations with women who are pregnant getting the vaccine?
Dr. Rimawi: Yes, so there are two types of vaccines people can get. One is an inhalation, which is a breathable form of the vaccine and one is an injectable form which comes as an injection. In pregnancy, we avoid the inhalation form only because it can contain some live particles of the virus and we try to avoid giving live particles to pregnant women, but the injectable form does not have any live particles inside. It's all inactivated viral particles. And basically it's recommended at all times during pregnancy. So all pregnant woman can receive it in any trimester during pregnancy, and it is recommended to receive it, especially doing the influenza season.
Host: So if unfortunately the vaccine doesn't do its job and a woman who's pregnant does get influenza, how do you treat it? Is it differently than how you would treat somebody else?
Dr. Rimawi: Great question. So anytime we have a patient that comes in with influenza like symptoms, the very first thing that we have to do is conduct what we call an illness severity assessment. So the questions that we have to know is to make a conclusion whether or not we can admit her to the hospital or she can be treated at home is number one. Does she have any difficulty breathing or shortness of breath? Number two, does she have any new pain or pressure in her chest other than just coughing and pain? Number three is she unable to keep any liquid down? Is she vomiting everything that she's eating or drinking? Does she show any signs of dehydration? For example, if she's standing up and she suddenly become very dizzy, the room is spinning. She starts to see white spots in her eyes. These are all signs of dehydration. Is she less responsive than normal or does she get confused very easily when someone's talking to her?
If she starts to have any of these symptoms, these women need to be immediately admitted to the hospital and be evaluated for possible admission to the intensive care unit and to be started on treatment. It should does not have any of these symptoms. Then the next thing we need to worry about is whether or not she has any other medical problems that may worsen her influenza. For example, does she have something called HIV infection, which is a condition that can worsen her immune system or does she have asthma or any other breathing problems? Because influenza, as we already spoken about can worsen your breathing ability, and if you have asthma or any other breathing condition, that in itself can worsen their breathing availability. Does she have any signs of preterm labor? So we ask them, do you have any contractions? Any leakage of fluid? Any bleeding?
If she has any of these, then we go ahead and we admit them to the hospital. If she says no to all of these, then to best avoid her from contaminating other pregnant women or any other hospital individuals, we usually just have them stay at home and we call them a prescription to the pharmacy. Now in terms of medical, the medical treatment is not very different than that of a non-pregnant patient. The treatment of choice is a medication called Oseltamivir, also known as Tamiflu. If medication is given by tablets, it's 75 milligrams and they take it twice a day for five days and there's lots of literature to support that. By taking this, not only do you help to reduce the whole duration of your infection, but you can also help to prevent a lot of these complications that can result from untreated influenza.
Host: But it's important to hop on that pretty quickly, right?
Dr. Rimawi: Yes. This is something that should be treated and be managed immediately. When a person first gets in contact with influence, it typically takes about two days or so for the person to start to become very symptomatic and to get very sick. But for pregnant patients, these patients can become sicker much sooner because their immune systems are weakened so they can start to see symptoms in as little as just 24 hours, even less depending on whether or not they have any other medical problems that may worsen their immune system.
Host: So as always with pregnant women, they have to be vigilant and pay a lot of attention to what's going on with their body and pick up on any symptoms of the flu and get to see a doctor right away. We're going to have to leave it there, but I want to thank our guest, Dr. Bassam Rimawi. He is a Maternal Fetal Medicine Physician at Wake Med Maternal Fetal Medicine. He's also fellowship trained in reproductive infectious diseases. Thanks very much for being with us today.
Dr. Rimawi: Thank you so much. I appreciate it.
Host: To learn more about Wake Med services and locations. Visit Wakemed.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for other topics that may interest you. I'm Michael Carrese with Wake Med Voices brought to you by Wake Med Health and Hospitals in Raleigh, North Carolina. Thanks for listening.
