Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States

Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Alicia M. Siston, PhD; Sonja A. Rasmussen, MD; Margaret A. Honein, PhD; Alicia M. Fry, MD; Katherine Seib, BS; William M. Callaghan, MD; Janice Louie, MD; Timothy J. Doyle, MPH; Molly Crockett, MPH; Ruth Lynfield, MD; Zack Moore, MD; Caleb Wiedeman, MPH; Madhu Anand, MPH; Laura Tabony, MPH; Carrie F. Nielsen, PhD; Kirsten Waller, MD; Shannon Page, BS; Jeannie M. Thompson, MPH; Catherine Avery, CFNP; Chasisity Brown Springs, MSPH; Timothy Jones, MD; Jennifer L. Williams, MSN; Kim Newsome, MPH; Lyn Finelli, DrPH; Denise J. Jamieson, MD; for the Pandemic H1N1 Influenza in Pregnancy Working Group
JAMA. 2010;303(15):1517-1525.

Context Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.

Objective To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.

Design, Setting, and Patients Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.

Main Outcome Measures Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.

Results We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%);

Conclusions Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.


Author Affiliations: Epidemic Intelligence Service (Drs Siston and Nielsen), National Center for Immunization and Respiratory Diseases, (Drs Siston, Fry, and Finelli), National Center on Birth Defects and Developmental Disabilities (Drs Rasmussen and Honein, and Mss Seib, Williams, and Newsome), National Center for Chronic Disease Prevention and Health Promotion (Drs Callaghan and Jamieson), Centers for Disease Control and Prevention, Atlanta, Georgia; California Department of Public Health, Richmond (Dr Louie); Florida Department of Health, Tallahassee (Mr Doyle); Massachusetts Department of Public Health, Boston (Ms Crockett); Minnesota Department of Health, St Paul (Dr Lynfield); North Carolina Department of Health and Human Services, Raleigh (Dr Moore); Arizona Department of Health Services, Phoenix (Mr Wiedeman); New York State Department of Health, Albany (Ms Anand); Texas Department of State Health Services, Austin (Ms Tabony); Wisconsin Department of Health Services, Madison (Dr Nielsen); Pennsylvania Department of Health, Harrisburg (Dr Waller); Ohio Department of Health, Columbus (Ms Page); Oklahoma State Department of Health, Oklahoma City (Ms Thompson); New Mexico Department of Health, Santa Fe (Ms Avery); South Carolina Department of Health and Environmental Control, Columbia (Ms Brown Springs); Tennessee Department of Health, Nashville (Dr Jones).
http://jama.ama-assn.org/cgi/content/abstract/303/15/1517