What is flu advice in pregnancy?

As the Department of Health clarifies its guidelines to expectant mothers and parents with young children on how best to avoid swine flu, we try to make sense of the mixed messages that preceded it.

Public health minister Gillian Merron has been in the job just a few weeks, but she might have been expected to have been able to repeat the official guidance to pregnant women on swine flu and crowds.

You can find it on the NHS Choices website. In the section on pregnancy and travel it says: "If you are pregnant, you can reduce your risk of infection by avoiding crowds and unnecessary travel where possible.

"Pregnant women should also follow the general hygiene advice." The key word here is "unnecessary", but more on that in a moment.

First, to the minister. On the BBC News channel on Sunday she was asked whether pregnant women should avoid crowds.

She said: "Perhaps I can clarify. We are not advising pregnant women not to travel or not to go into crowds. Its advice if people have swine flu, because as all your viewers will know, the advice, the strong advice if you have swine flu, is to stay at home."

'Personal choice'

Clarity was perhaps not helped by the DoH's decision to "re-state" its advice to pregnant women - which meant moving it to a more prominent position on its website.

But this does not contain specific advice on travel and crowds. It never did. So what is the advice to pregnant women?

The answer is to follow the detailed advice on the NHS Choices website. Whatever women decide to do during pregnancy comes down to personal choice.

Let us look at two extremes. Keeping yourself in isolation for nine months - tricky with all those ante-natal checks - is a non-starter.

The other extreme would be to go to every rock concert in town and go to as many crowded places as possible. Also not sensible.

The advice on travel and crowds is to follow a common-sense approach.

If you have to get a train or bus every day to get to work, then carry on - you should not stop work because of swine flu.

Equally, it is sensible to avoid crowds where possible, but this is very difficult if you live in a city.

Pregnant women are at increased risk of complications from swine flu, but the vast majority who get infected will have a mild self-limiting illness.

I have dealt with the risks during pregnancy before. The Royal College of Obstetricians and the Royal College of Midwives have very sensible advice.

'Hand hygiene'

Recent news reports have suggested that pregnant women in Australia and New Zealand have been advised to wear masks in public and stay at home if possible to reduce the risk of swine flu infection.

The latest guidance issued by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends that "pregnant women should avoid unnecessary exposure to crowded areas, but complete isolation at home would be regarded as extreme for most women".

Experience with the current disease pattern shows that in most cases, swine flu tends to be a mild respiratory disease.

A few cases of severe illnesses among pregnant women and infants have been reported in the UK and other countries (Woman gave birth before flu death, 17 July). These have mostly affected women with pre-existing health problems.

Current guidance in the UK for pregnant and breastfeeding women remains unchanged.

Pregnant women are advised to practice good hand hygiene by washing hands frequently with soap and water.

Tissues should be used to cover the mouth and nose when sneezing and coughing, and used tissues should be disposed of promptly.

Pregnant women are advised to avoid crowded places when possible. Women who experience any symptoms of swine flu should contact the National Flu Service (Call the Swine Flu Information Line on 0800 1 513 513).

Women with symptoms of the influenza who have been advised by the National Flu Service to take antiviral medication should do so.

Once the antiviral treatment is authorised, women should arrange for a "flu friend" to collect the prescription on their behalf.

They should follow the advice to stay at home until they become symptom free.

There is currently no evidence to suggest that the use of antiviral medication might cause harm to the baby.

During pregnancy, it is also important to treat fever - a high temperature of about 38C (100F) or more. This can be controlled by taking paracetamol, which is known to be safe in pregnancy.