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Study: Pandemic H1N1 And Pregnancy

 

 


# 4593

 

 

Even before novel H1N1 emerged a little more than a year ago doctors and researchers were aware that novel influenza viruses often impacted pregnant women much harder than non-pregnant women.   

 

Although the concern at the time was a possible bird flu pandemic (and that concern has not diminished), back in December of 2008 I wrote a long essay on the subject entitled Pregnancy and Pandemic Influenza.

 

Much of what I wrote was based an a terrific study that appeared in the EID Journal in January of 2008 entitled Pandemic influenza and pregnant women by Rasmussen SA, Jamieson DJ, Bresee JS.

 

On May 1st of 2009, a little more than a week after the first cases of novel H1N1 began to make headlines, the CDC published new guidelines for pregnant women in the Health Care or Education field that might come in direct contact with the Swine flu virus (See CDC Guidelines On Pregnancy And Pandemic Flu).

 

Two weeks after that the MMWR published case studies of three pregnant women who had contracted novel H1N1. 

 

Throughout the summer, pregnancy and flu was a major topic by public health officials around the world. On October 1st, I summarized the impact of this new virus on pregnant women in Pregnancy & Flu: A Bad Combination. 


We are now in the process of getting many new studies and research articles based on what was learned over the past year.  Novel H1N1 will undoubtedly turn out to be the most studied influenza virus in human history.

 

Today, we get an investigation published in the Archives of Internal Medicine into 18 gravid (pregnant) admissions with H1N1, and their resultant complications.   

 

The authors report that pregnant patients admitted with H1N1 are “at risk for obstetrical complications including fetal distress, premature delivery, emergency cesarean delivery, and fetal death.”


The entire report is available online, and I’ve just reproduced excerpts from the abstract below.

 

Novel Influenza A(H1N1) Virus Among Gravid Admissions

Andrew C. Miller, MD; Farnaz Safi, MD; Sadia Hussain, BS; Ramanand A. Subramanian, PhD; Elamin M. Elamin, MD, MSc; Richard Sinert, DO

Arch Intern Med. 2010;170(10):868-873.

 
Background Pandemic novel influenza A(H1N1) is a substantial threat and cause of morbidity and mortality in the pregnant population.

 

Methods We conducted an observational analysis of 18 gravid patients with H1N1 in 2 academic medical centers. Cases were identified based on direct antigen testing (DAT) of nasopharyngeal swabs followed by real-time reverse-transcriptase polymerase chain reaction analysis (rRT-PCR) or viral culture.

<SNIP>

 

Results Eighteen pregnant patients were admitted with H1N1 during the study period. All patients were treated with oseltamivir phosphate beginning on the day of admission. Mean (SD) age was 27 (6.6) years (age range, 18-40 years); median length of hospital stay was 4 days.

 
Intensive care unit admission rate was 17% (n = 3).

<SNIP>

Seven patients delivered during hospitalization (39%), 6 prematurely and 4 via emergency cesarean delivery. There were 2 fetal deaths (11%). No maternal mortality was recorded.

 

Conclusions Admitted pregnant patients with H1N1 are at risk for obstetrical complications including fetal distress, premature delivery, emergency cesarean delivery, and fetal death. A high number of patients presented with gastrointestinal and abdominal complaints. Early antiviral treatment may improve maternal outcomes.

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