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Pandemic H1N1 caused severe disease in pregnant women
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Pregnant women with pandemic influenza A (H1N1) in New York City had severe illness and various complications such as hospitalization, acute respiratory distress syndrome and emergency cesarean delivery, according to a study published in the Morbidity and Mortality Weekly Report.
“For pregnant and postpartum women and for those women considering becoming pregnant, clinicians and health departments should emphasize the importance of vaccination against seasonal influenza and 2009 H1N1 to prevent life-threatening complications,” the researchers wrote.
Researchers at the New York City Department of Health and Mental Hygiene (DOHMH) began active surveillance on April 25, 2009, to monitor cases of H1N1 in pregnant and postpartum women during three separate periods: April to June, July to September and October to December.
The researchers defined cases of severe illness as pregnant or postpartum women with lab-confirmed or probable H1N1 infection that led to ICU admission or death.
The DOHMH reported 16 pregnant patients and one postpartum patient who met inclusion criteria. Nine were admitted to ICUs from April to June, and eight were admitted from October to December. The researchers also noted the following:
- Median length of hospital stay was 12 days.
- Median patient age was 23 years.
- Median gestational age at hospital admission was 34 weeks.
- 11 women were in their third trimester.
The researchers noted that five women had risk factors for influenza complications including cardiovascular disease, sickle cell disease, asthma, seizure disorder and diabetes.
The researchers said all women were treated with oseltamivir (Tamiflu, Roche), but only one patient initiated treatment within two days after symptom onset.
Four women did not start treatment until five days or more after the appearance of symptoms. Only one woman was vaccinated; she was administered the seasonal influenza vaccine more than eight weeks and the H1N1 vaccine more than four weeks before symptom onset.
Nine women had emergency cesarean deliveries. Eight infants were live-born, although one died soon after birth, and one infant was stillborn.
Fine A. MMWR. 2010; 59:321-326.