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By Michael Smith, North American Correspondent, MedPage Today
Published: March 22, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. Earn CME/CE credit
for reading medical news
Expectant mothers were seven times more likely to be admitted to hospital if they contracted the flu than were nonpregnant women of reproductive age, according to CDC's Andreea Creanga, MD, PhD, and colleagues.
They were also seven times more likely to have severe disease -- defined by death or admission to intensive care -- Creanga and colleagues wrote in the April Obstetrics & Gynecology.
The report is the second in five days to demonstrate that pregnant women are at greater risk for severe H1N1 flu.
Australian and New Zealand researchers, reporting online in BMJ last week, found that pregnant women were seven times more likely to be admitted to the ICU if they had the pandemic flu. (See Pregnancy Linked to Critical H1N1 Illness)
Action Points
* Explain to interested patients that this study found that pregnant women were at increased risk of serious disease if they were infected with H1N1 flu during the first wave of the pandemic.
Although H1N1activity has fallen in the U.S., it's still circulating, Creanga told MedPage Today.
"This is why pregnant women should be counseled to recognize the symptoms of influenza and to seek medical care as soon as possible if they develop symptoms," she said.
In addition, she said, doctors should monitor their pregnant patients closely and be ready to administer antiviral drugs promptly.
The New York findings come from a review of medical records of 187 women -- 63 pregnant and 124 not pregnant but of reproductive age -- admitted to the hospital with confirmed H1N1 flu from May through June 2009.
Analysis showed:
* The rate of admission to hospital for pregnant women was 55.3 per 100,000, compared with 7.7 per 100,000 for nonpregnant women.
* The rate of severe disease was 7.0 per 100,000 pregnant women but 1.7 per 100,000 nonpregnant reproductive-aged women.
* Pregnant women represented 6.4% of people admitted to hospital for H1N1 flu (63 of 976) and 4.3% of all known deaths (two of 47).
The prompt use of oseltamivir (Tamiflu) appeared to have a beneficial effect, the researchers said. Among the 30 women who got the drug within two days of the onset of symptoms, only one (3.3%) had severe illness, they said.
On the other hand, three of the 14 (or 21.4%) who started treatment three or four days after symptoms appeared had severe disease, as did four of the nine (or 44.4%) who started treatment five or more days after symptom onset. The trend was significant at P=0.002.
Severe and moderate illness occurred in all trimesters, Creanga and colleagues found, but 54.8% of the patients were in the third trimester.
All told, 22 women delivered during their hospital stay and severe disease was significantly associated with death of the newborn or admission to neonatal ICU, they found.
Such outcomes occurred in the cases of five of six women (or 83.3%) with severe illness, compared with two of 16 women (or 12.5%) with moderate illness. The difference was significant at P=0.004.
The researchers cautioned that the study sample was small and yielded limited power to make demographic distinctions. In addition, they noted, data collection relied on hospital records, which might vary from institution to institution and might also be incomplete.
Also, the comparison group of nonpregnant women with the pandemic flu had a markedly higher proportion of patients with underlying chronic conditions, they said.
Published: March 22, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. Earn CME/CE credit
for reading medical news
Expectant mothers were seven times more likely to be admitted to hospital if they contracted the flu than were nonpregnant women of reproductive age, according to CDC's Andreea Creanga, MD, PhD, and colleagues.
They were also seven times more likely to have severe disease -- defined by death or admission to intensive care -- Creanga and colleagues wrote in the April Obstetrics & Gynecology.
The report is the second in five days to demonstrate that pregnant women are at greater risk for severe H1N1 flu.
Australian and New Zealand researchers, reporting online in BMJ last week, found that pregnant women were seven times more likely to be admitted to the ICU if they had the pandemic flu. (See Pregnancy Linked to Critical H1N1 Illness)
Action Points
* Explain to interested patients that this study found that pregnant women were at increased risk of serious disease if they were infected with H1N1 flu during the first wave of the pandemic.
Although H1N1activity has fallen in the U.S., it's still circulating, Creanga told MedPage Today.
"This is why pregnant women should be counseled to recognize the symptoms of influenza and to seek medical care as soon as possible if they develop symptoms," she said.
In addition, she said, doctors should monitor their pregnant patients closely and be ready to administer antiviral drugs promptly.
The New York findings come from a review of medical records of 187 women -- 63 pregnant and 124 not pregnant but of reproductive age -- admitted to the hospital with confirmed H1N1 flu from May through June 2009.
Analysis showed:
* The rate of admission to hospital for pregnant women was 55.3 per 100,000, compared with 7.7 per 100,000 for nonpregnant women.
* The rate of severe disease was 7.0 per 100,000 pregnant women but 1.7 per 100,000 nonpregnant reproductive-aged women.
* Pregnant women represented 6.4% of people admitted to hospital for H1N1 flu (63 of 976) and 4.3% of all known deaths (two of 47).
The prompt use of oseltamivir (Tamiflu) appeared to have a beneficial effect, the researchers said. Among the 30 women who got the drug within two days of the onset of symptoms, only one (3.3%) had severe illness, they said.
On the other hand, three of the 14 (or 21.4%) who started treatment three or four days after symptoms appeared had severe disease, as did four of the nine (or 44.4%) who started treatment five or more days after symptom onset. The trend was significant at P=0.002.
Severe and moderate illness occurred in all trimesters, Creanga and colleagues found, but 54.8% of the patients were in the third trimester.
All told, 22 women delivered during their hospital stay and severe disease was significantly associated with death of the newborn or admission to neonatal ICU, they found.
Such outcomes occurred in the cases of five of six women (or 83.3%) with severe illness, compared with two of 16 women (or 12.5%) with moderate illness. The difference was significant at P=0.004.
The researchers cautioned that the study sample was small and yielded limited power to make demographic distinctions. In addition, they noted, data collection relied on hospital records, which might vary from institution to institution and might also be incomplete.
Also, the comparison group of nonpregnant women with the pandemic flu had a markedly higher proportion of patients with underlying chronic conditions, they said.
