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Infections with 2009 pandemic influenza A (H1N1) virus have had disproportionately deleterious consequences in pregnant women, more akin to those seen with previous pandemic influenza than with seasonal influenza. Now, investigators report clinical outcomes among women in California with H1N1 influenza who were hospitalized or died from April 23 to August 11, 2009.
Records for 94 pregnant women, 8 postpartum women, and 137 women of reproductive age were reviewed; 95% of pregnant women were in their second or third trimester, and one third had risk factors (most commonly asthma) for more-severe influenza illness. Rapid antigen tests yielded false-negative results in 38% of patients who were tested. Initiation of antiviral therapy >48 hours after onset of symptoms was associated with fourfold higher risk for intensive care unit admission or death than was earlier antiviral initiation. Six women died during pregnancy, and two died postpartum. Thirteen infants were delivered during their mothers' hospitalizations; none had evidence of influenza.
Louie JK et al. Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med 2010 Jan 7; 362:27. (http://dx.doi.org/10.1056/NEJMoa0910444)
Comment
These data bolster the existing recommendations for managing pregnant women during the H1N1 pandemic and show that risk for severe illness and death extends into the postpartum period. Optimally, all women who are pregnant or who have just delivered should receive the H1N1 vaccine. Pregnant women who present with influenza-like illness should receive prompt antiviral therapy. Rapid tests for H1N1 influenza are not reliable; thus, antiviral therapy should not be delayed or withheld if such tests are negative. The good news is that the infants in this study — even those who were born to critically ill women — had no evidence of H1N1 infection.