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NEJM: Pregnancy and Postpartum Risks Of Novel H1N1 Infection

 

 

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Very early on in the pandemic outbreak of 2009 it became apparent the pregnant women faced higher risks for complications than did otherwise healthy members of the general public. 

 

Intensive care units in the US, and around the world, reported roughly 6% of their admissions of H1N1 patients were of pregnant women, and we’ve seen reports that pregnant women are between 5 and 6 times more likely to die from H1N1 influenza.

 

This is, quite sadly, something that has been observed during pandemic outbreaks of the past; including 1957 and 1918. 

 

Some blogs over the past six months dealing with issues of pregnancy and influenza include:

 

Australian Study: H1N1 Hospitalized Patients
UK: DOH Urges Doctors To Reassure Pregnant Women About Vaccine
Pregnancy & Flu: A Bad Combination
Lancet Study: Pregnancy And H1N1
Branswell On Swine Flu And Pregnancy Complications

 

 

While some of these complications may be caused by structural issues (increased abdominal pressure on internal organs and the diaphragm), some of it probably comes from the mother’s down-regulated immune system, something the pregnant woman’s body does to avoid rejecting the fetus.

 

Today, in the NEJM (New England Journal of Medicine) we get fresh analysis of severe H1N1 influenza infection in pregnant women . . . and postpartum women who had delivered in the previous two weeks.  

 

First however, from CIDRAP news, Maryn McKenna brings us an excellent summary of the NEJM article.

 

H1N1 poses grave risk to pregnant women, new moms

Maryn McKenna * Contributing Writer

Dec 23, 2009 (CIDRAP News) – Infection with H1N1 influenza poses a grave danger to pregnant women and those who have just delivered, and the risk increases when they do not receive antiviral treatment very rapidly, California and Atlanta researchers report today online ahead of print in the New England Journal of Medicine.

 

"This pandemic has the potential to notably increase overall maternal mortality in the United States in 2009," they write.

 

In surveillance data gathered by the California Department of Public Health between April and August 2009, early in the H1N1 pandemic, 22 of 102 pregnant and postpartum women who had been hospitalized for flu symptoms needed to be admitted to an intensive care unit (ICU), 16 were put on ventilators, and 8 died.

(Continue . . . )

 

 

Below you’ll find the link to the NEJM study. 

 

 

Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California


Janice K. Louie, M.D., M.P.H., Meileen Acosta, M.P.H., Denise J. Jamieson, M.D., M.P.H., Margaret A. Honein, Ph.D., M.P.H., for the California Pandemic (H1N1) Working Group


ABSTRACT


Background Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.

Methods Statewide surveillance for patients who were hospitalized with or died from 2009 H1N1 influenza was initiated by the California Department of Public Health. We reviewed demographic and clinical data reported from April 23 through August 11, 2009, for all H1N1-infected, reproductive-age women who were hospitalized or died — nonpregnant women, pregnant women, and postpartum women (those who had delivered 2 weeks previously).


<SNIP>

Conclusions 2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States.

 

(Continue . . . )

 

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H1N1
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