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Prompt treatment may be beneficial for pregnant and postpartum women with suspected influenza A (H1N1)
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Delayed treatment of suspected influenza A (H1N1) illness among pregnant women may result in a four-fold risk of intensive care admission or death, according to results of a recent study.
Regardless of rapid antigen test results, prompt evaluation and antiviral treatment should be considered for pregnant or postpartum women displaying influenza A (H1N1)-like symptoms, according to researchers from the California Department of Public Health.
The study was a review of records for women of reproductive age who had been hospitalized or died from influenza A (H1N1) between April 23 and August 11, 2009.
The study involved 94 pregnant women, 137 non-pregnant women and 8 postpartum women who had delivered <2 weeks prior. False negative results for rapid antigen tests were observed in 38% of patients.
Among 94 pregnant women, 95% were in the second or third trimester. Risk factors for complications from influenza other than pregnancy were observed in 32 of 93 (34%) of those pregnant women.
Early antiviral treatment was defined as treatment <2 days after the onset of symptoms. Pregnant women treated later than this had an RR of 4.3 for admission to an ICU or death.
Intensive care was required for 18 pregnant women and four postpartum women (total, 22 of 102 [22%]). There were eight deaths (8%).
Of six deliveries which took place in the ICU, four were emergency cesarean deliveries.
The specific mortality ratio associated with influenza A (H1N1), which the researchers defined as the number of maternal deaths per 100,000, was 4.3.
The researchers wrote that influenza A (H1N1) may increase the 2009 maternal mortality ratio in the United States.
Louie J. N Engl J Med. 2009;doi:10.1056.
This report validates the recommendations that pregnant women should receive influenza vaccine and that they should be given antiviral drugs if they are suspected of having influenza. It is important that oseltamivir be given promptly and that one not reject therapy because of a negative rapid test as these have been shown to be insensitive. Waiting for PCR results is not prudent. It also is important to recognize that the period of increased risk extends for at least a week after delivery. When pregnant women are seen with an ILI, especially if they are in an intensive care unit, one would do well to involve an obstetrician in her care as premature delivery is a risk. This being the case, at some time a pediatrician or, if possible, a neonatologist should be alerted. Finally, it would be a miscalculation to use these data for assessing the risk of all pregnant women with influenza. The population reported in this paper were already sick enough to be admitted to he hospital.
- Philip A. Brunell, MD
Infectious Disease News Editorial Board member