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Severe 2009 H1N1 influenza in pregnant and postpartum women in California.
N Engl J Med. 2010 Jan 07; 362(1):27-35.NEJM

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 < or = 2 weeks previously).

RESULTS

Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered < or = 2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza-specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3.

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.

Authors+Show Affiliations

California Department of Public Health, Richmond, CA 94804, USA. janice.louie@cdph.ca.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20032319

Citation

Louie, Janice K., et al. "Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California." The New England Journal of Medicine, vol. 362, no. 1, 2010, pp. 27-35.
Louie JK, Acosta M, Jamieson DJ, et al. Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med. 2010;362(1):27-35.
Louie, J. K., Acosta, M., Jamieson, D. J., & Honein, M. A. (2010). Severe 2009 H1N1 influenza in pregnant and postpartum women in California. The New England Journal of Medicine, 362(1), 27-35. https://doi.org/10.1056/NEJMoa0910444
Louie JK, et al. Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California. N Engl J Med. 2010 Jan 7;362(1):27-35. PubMed PMID: 20032319.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe 2009 H1N1 influenza in pregnant and postpartum women in California. AU - Louie,Janice K, AU - Acosta,Meileen, AU - Jamieson,Denise J, AU - Honein,Margaret A, AU - ,, Y1 - 2009/12/23/ PY - 2009/12/25/entrez PY - 2009/12/25/pubmed PY - 2010/1/15/medline SP - 27 EP - 35 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 362 IS - 1 N2 - 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 < or = 2 weeks previously). RESULTS: Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered < or = 2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza-specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3. 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. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/20032319/Severe_2009_H1N1_influenza_in_pregnant_and_postpartum_women_in_California_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa0910444?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -