Dengue is a high-grade viral fever which is caused by the Aedes Aegypti mosquito. The occurrence of dengue in women who are pregnant is on a rise due to the rampant increase in mosquitoes in densely populated areas. According to the World Health Organisation, there are 190 million cases of dengue reported worldwide, out of which 96 million cases require treatment. In India, there is 25 per cent increase each year, mainly attributed to ineffective preventive steps to check mosquito breeding.
Hence, it becomes extremely important to keep your surroundings clean and save oneself, pregnant women and newborn babies safe from mosquitoes to prevent dengue. Dr Nupur Gupta, Director, Obstetrics and Gynaecology, Fortis Gurugram shares a few important things about dengue that pregnant women and breastfeeding mothers need to keep in mind.
Effect on mother
For pregnant women who contract dengue fever, we immediately prescribe the need for adequate fluid intake, as hydration is essential for maintaining embryonic fluid level. Other than high grade fever, other symptoms of dengue can be intense headache, retro-orbital pain, abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement and increasing haematocrit with decreasing platelets. Severe dengue can be associated with severe plasma leakage, haemorrhage, or organ failure. Dengue fever during pregnancy requires proper hydration, antipyretics and careful monitoring by medical experts. There is a possibility of pre-term delivery, low birth weight babies and pre-eclampsia.
Effect on baby
Dengue fever may cause preterm premature rupture of membranes (PPROM) and premature delivery. Effects on the fetus or new-born seem to be variable, with apparently less fetal harm occurring earlier in pregnancy.
Treatment of dengue fever during pregnancy
Paracetamol after six hours – but only under doctor’s prescription – is to be taken and the dose should not exceed four grams in 24 hours. It is strictly prohibited to take NSAID like ibuprofen, aspirin and diclofenac sodium. Tepid sponging for fever is recommended. Oral intake of fluids is encouraged like ORS, coconut water, kanji, juice along with simple home cooked meals along with drinking fresh clean water, at least 2.5 litres a day.
Early detection and access to proper medical care reduces fatality from 20 per cent to below 1 per cent. Warning symptoms and signs for capillary leak are to be looked for carefully, especially when the fever starts subsiding. These patients are considered for IV fluid therapy. Symptoms to be scrutinised are abdominal pain and tenderness, persistent vomiting with lethargy and restlessness.
Newborns with mothers who had dengue just before or at delivery, should be closely monitored after birth in view of the risk of vertical transmission.
Breastfeeding during dengue
As per expert advice, breastfeeding is safe if the mother is infected with dengue. Research suggests that this risk of transmission of dengue virus from mother to the baby through breast milk is very low. The benefits of breastfeeding during maternal infection are much higher than the chances of infection to the baby. Evidence shows that the colostrum, the first breast milk, and breast milk have anti-dengue antibodies which protect the baby from the infection.
According to WHO guidelines, it is important to breastfeed the baby during maternal dengue infection as breast milk has lot of nutrients and antibodies which protect the baby, prevent dehydration and maintain emotional well-being in the baby. At the same time, it should be noted that there is no specific treatment for dengue infection, only symptomatic care and safe category drugs are used for its treatment. If you are moderate to severely ill, then the doctor can put your baby on formula or top feed.
Tips if you are a breastfeeding mother and have dengue:
*Discuss your situation with a doctor. Consult them if it is safe or not.
*Try not to feed your baby if you have high fever and are not feeling physically well.
*Discuss the options of formula feed with your doctor.
*Try and discuss breast milk storage and breast milk pumping options.
*Please be open to use the breast milk of other mothers if the situation worsens.
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