RESPIRATORY INFECTIONS WHILE PREGNANT

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

It’s winter in South Africa, and as we see the temperatures drop, we see the number of respiratory infections rise. It’s commonly referred to as “flu season” but refers to a range of respiratory illnesses from the common cold to potentially dangerous viruses like influenza (flu) and Covid-19. In South Africa, flu season usually lasts from May to September.

The burden of flu is particularly high in South Africa, where between 6 000 and 11 000 people die flu-related deaths every year. About half of these deaths are in the elderly, and about 30% are HIV positive.

The highest rates of hospitalisation are in the elderly (65 years and older), HIV positive people, and children younger than five. Pregnant women are also at increased risk of hospitalisation and death from flu infections.

People with chronic illnesses such as diabetes, lung disease, tuberculosis, and heart disease are also at increased risk of being hospitalised from the flu. During the flu season in South Africa, about 8–10% of patients are hospitalised for pneumonia and 25% of patients with flu-like illness (fever and cough) will test positive for influenza.

PROTECTING YOURSELF FROM RESPIRATORY INFECTIONS

You can take steps to prevent common respiratory infections. And if you get sick, you can take care of yourself to keep the infection from getting worse. Without proper care, a respiratory infection can get worse. It can lead to serious complications and even death. If you aren’t getting better or if your symptoms are getting worse, consult your healthcare provider.

Respiratory viruses are spread through droplets. When an infected person coughs or sneezes, droplets containing the viruses are released into the air. The viruses also get onto your hands or the tissue when you blow your nose. When people then come into direct contact with each other, for instance by shaking hands or hugging, the virus is more likely to spread.

These viruses can also be passed to objects. They are easily spread from person to person wherever a lot of people touch the same objects, like door handles or handrails on escalators or public transport. Take the following precautions to protect yourself and your family:

Eat a balanced diet

Eat a well-balanced and nutritious diet to provide your body with the essential vitamins and minerals you need to stay fit and well throughout your pregnancy:

- Eat a wide variety of fruit, vegetables, whole grains, lean proteins, and healthy fats
- Limit highly processed foods
- Don’t restrict any particular food group from your meal plans, so include carbs, dairy (if you’re not lactose-intolerant), and healthy fats

2. Stay well hydrated

Hydration is important for overall health, particularly throughout pregnancy. Supporting your growing baby requires upping your daily intake from the recommended 2-3 litres of fluids by around 300ml. This includes fluid from water, other drinks, and food, so choosing water-rich foods like fruit, vegetables and soups will also help you stay hydrated. Food accounts for around 20% of our daily fluid intake, so make sure to drink sufficient water and other healthy drinks throughout the day to stay properly hydrated.

3. Consider taking supplements

A well-balanced diet should be your main source of nutrients during pregnancy, but supplements are a safe and cost-effective way to help support immunity during pregnancy, especially if you avoid certain food groups due to dietary requirements.

Some key supplements to consider taking during pregnancy include folic acid, iron, calcium, magnesium, omega 3 for supporting the baby’s development, and vitamins D and C for overall immune function. Your healthcare provider can help you decide on what is best for you, as well as advise you on the correct dosage.

4. Exercise regularly

Unless otherwise advised by your healthcare provider, moderate aerobic and strength exercises are an excellent way to stay fit and healthy, and also boost your immune system.

5. Get plenty of quality sleep

Sleep, especially the deep phase known as slow wave sleep, plays a crucial role in regulating our immune system. For pregnant women in particular, low sleep quality has been linked with a lower health-related quality of life.

6. Try to manage stress levels

Studies have shown that stress, particularly prolonged stress over an extended period, can lead to immune dysregulation, which can increase disease risk and worsen existing conditions. Stress could even have a negative effect on the developing baby.

7. Keep germs at bay

While your immune system is working hard to keep you and your baby healthy throughout the course of your pregnancy, you can do your bit to help it along by washing your hands regularly and avoiding close contact with anyone who seems sick, whenever possible.

8. Stay up to date with vaccinations

As your immune system changes during pregnancy, you’re likely to be more susceptible to infections. Making sure you are up-to-date with all the recommended vaccinations means you’re less likely to get sick.

RESPIRATORY INFECTIONS COMMON IN SOUTH AFRICA AT THE MOMENT

The South African National Institute for Communicable Diseases (NICD) keeps a close eye in respiratory pathogens and issues a weekly surveillance report on the more dangerous viruses detected in the population. According to the NICD, at the moment we are experiencing an increase in influenza (flu), Covid-19 and RSV infections.

INFLUENZA

Flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. It can cause mild to severe illness and can be fatal. The best way to prevent flu is by getting a flu vaccine each year.

Symptoms

Symptoms begin 1–4 days after infection and usually last around a week. People with flu are most contagious during the first 3 days of their illness. Symptoms include sudden onset of fever, cough (usually dry), headache, sore throat, runny or stuffy nose, muscle and joint pain, fatigue, and generally feeling awful.

Treatment

There is no cure for flu. Treatment should aim to relieve symptoms. People with the flu should rest and drink plenty of liquids. Your healthcare provider can advise you on medications that can help with symptom relief. Most people will recover on their own within a week. In some cases, the cough can last two weeks or more. Medical care may be needed in severe cases and for people with risk factors.

Flu in Pregnancy

The flu can be dangerous during pregnancy because pregnancy affects your immune system, heart and lungs. A lowered immune system makes you more susceptible to infections. During pregnancy you need more oxygen. Your growing child puts pressure on your lungs, making them work harder in a smaller space. Your heart also has to work harder as it has to supply blood to both you and your baby.

If you’re pregnant or had a baby within the last two weeks, you’re more likely than other women to have serious health problems from the flu. Flu can cause pregnancy-specific complications for you and your baby, so if you experience any fly symptoms, it is important to seek medical advice.

The best way to prevent flu is with the vaccine, which is safe and effective in pregnancy. The flu vaccine can also benefit your baby as flu-fighting antibodies pass to your baby through the placenta. Breast milk delivers those same antibodies after birth, providing more protection from the flu.

If you fall ill with flu, the earlier you seek treatment for your symptoms, the better your chances of preventing them from getting worse. Speak with your healthcare provider about medications you can use and be sure to stay well hydrated and rested. It is especially important that you seek medical help if you have a fever.

When to go to the hospital

It is important to seek immediate medical assistance should you experience any of the following:

- No movement from your baby
- Seizures
- Breathing difficulties

COVID-19

Covid-19 is the disease caused by the SARS-CoV-2 coronavirus. It is most commonly spread through the air in tiny droplets of fluid between people in close contact. Many people with Covid-19 have no symptoms or mild illness. But for older adults and people with certain medical conditions, Covid-19 can be severe and lead to hospitalisation or death. The best way to prevent serious illness is staying up to date with the Covid vaccine.

Symptoms

Typical Covid-19 symptoms often show up 2 to 14 days after contact with the virus. You can have only a few of the symptoms, or even none at all, and still test positive for Covid-19. But you can still spread the virus.

Symptoms include a dry cough, shortness of breath, Loss of taste or smell, extreme fatigue, vomiting and/or diarrhoea, headaches, muscle aches, fever, and cold-like symptoms like congestion or sore throat.

If your symptoms end, you should stop being contagious after 14 days, but make sure by checking with your doctor before you start spending time in close proximity to others.

Treatment

There is no specific treatment for Covid-19. All treatment is supportive, like providing oxygen for patients who are short of breath or managing a fever. If your symptoms are mild, you can manage them at home with the help of your healthcare provider. Stay isolated, drink plenty of fluids and get lots of rest. Avoid alcohol and heavy exercise. Wear a mask if anyone is near you.

If you develop trouble breathing or become excessively fatigued or confused, seek emergency medical attention immediately. Inform emergency personnel that you are positive for Covid-19, and if possible, put on a face mask before they arrive.

Covid-19 in pregnancy

Avoiding Covid-19 is especially important while you’re pregnant, so make sure your vaccinations are up-to-date and avoid crowded places and spaces with poor airflow. You should also consider wearing a protective face mask when you’re in an area with a high number of sick people, like when you have your antenatal visits.

Pregnancy raises your risk of severe Covid-19. That risk stays higher for at least a month after giving birth. This risk also increases if you have other health issues, like obesity, diabetes or hypertension. Severe Covid-19 infection in pregnancy has also been linked to higher rates of premature births and preeclampsia. It is therefore essential that you inform your pregnancy healthcare team as soon as you find out you have Covid-19, no matter how mild your symptoms, so that they can monitor you and things like your oxygen levels.

After your infection, your healthcare provider may ask for imaging tests to make sure your unborn baby is growing as expected. In most cases, the Covid-19 infection doesn’t spread to the unborn baby, however high fevers in pregnancy, especially in the first trimester, can raise the risk of birth defects.

When to go to the hospital

You may need emergency medical attention if you have any of the following symptoms:

- Severe fever (higher than 39°C)
- Diarrhoea and vomiting
- Trouble breathing
- Chest pains
- Disorientation or confusion
- Blue-tinged lips
- Confusion, lethargy or having trouble staying awake

Inform emergency personnel that you are positive for Covid-19, and if possible, put on a face mask before they arrive.

RSV

Respiratory syncytial virus (RSV) causes infections of the lungs and respiratory tract. It’s so common that most children have been infected with the virus by age 2.

In adults and older, healthy children, RSV symptoms are mild and typically mimic the common cold. Self-care measures are usually all that’s needed to relieve any discomfort.

RSV can cause severe infection in some people, including babies 12 months and younger (infants), especially premature infants, older adults, people with heart and lung disease, or anyone with a weak immune system.

The best way to prevent RSV infection is hand washing and paying attention to hygiene. The RSV vaccine is not routinely provided in South Africa. It is very expensive and is used only for high-risk cases of chronic lung disease and premature babies.

Symptoms

RSV symptoms usually appear 4 – 6 days after exposure to the virus. In adults and older children, RSV usually causes mild cold-like signs and symptoms. These may include congested or runny nose, dry cough, low-grade fever, sore throat, sneezing, and headache.

In more severe cases, RSV can cause pneumonia or bronchiolitis — inflammation of the small airway passages entering the lungs. Symptoms may include fever, severe cough, wheezing, rapid or laboured breathing, and a bluish colour of the skin due to lack of oxygen.

Infants are most severely affected by RSV. You can learn more about this here.

Treatment

There is currently no cure or treatment for RSV, other than supportive symptom control. In milder cases, staying hydrated and getting enough rest will help your immune system to fight the infection.

Most children and adults recover in one to two weeks, although some might have repeated wheezing. In severe cases, people might need hospitalisation with supporting oxygen, hydration and medicine to control symptoms.

RSV in pregnancy

Although symptoms from RSV are often mild, pregnancy raises your risk of illness-related complications, such as preeclampsia or preterm labour. There is also a risk of the mother passing the virus to the foetus through the placenta. It is prudent to take all the precautions you can to avoid getting RSV while pregnant. These are the same preventative behaviours as with flu and Covid-19.

If you get RSV while pregnant, treatment typically involves rest and drinking plenty of fluids. If you develop severe symptoms, you must consult your healthcare provider. Life-threatening RSV-related complications include sepsis (the body’s extreme reaction to an infection), pneumonia and respiratory failure. If you develop any of these illnesses, you will require hospitalisation.

When to go to the hospital

Seek immediate medical attention if you or your child has difficulty breathing, a high fever, or a blue colour to the skin, particularly on the lips and nail beds.

RESPIRATORY INFECTIONS WHILE PREGNANT

RESPIRATORY INFECTIONS WHILE PREGNANT

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

PROTECTING YOURSELF FROM RESPIRATORY INFECTIONS

SUPPORTING YOUR IMMUNE SYSTEM DURING PREGNANCY

RESPIRATORY INFECTIONS COMMON IN SOUTH AFRICA AT THE MOMENT

INFLUENZA

COVID-19

RSV

FURTHER READING