Editorial: Pregnancy and Pandemic Flu

[tetano]

Clinical Infectious Diseases 2010;50:691?692
? 2010 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2010/5005-0006$15.00
DOI: 10.1086/650461
EDITORIAL COMMENTARY
Pregnancy and Pandemic Flu

Elizabeth J. Elliott

Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, and The Children?s Hospital at Westmead, Sydney, Australia

Received 23 November 2009; accepted 24 November 2009; electronically published 25 January 2010.

*

(See the article by Hewagama et al, on pages 686?690.)

Reprints or correspondence: Prof Elizabeth J. Elliott, The Children?s Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW Australia (elizabe2@chw.edu.au).

For most women, pregnancy is a time of joy, tinged with the excitement and expectation of a new family member. However, the pandemic of H1N1 influenza A 2009 (H1N1/09) (swine flu) changed all that. Fear gripped pregnant women the world over as it became apparent, early after the emergence of the novel H1N1 virus, that some infected women became ill very rapidly. Some developed severe complications and required intensive care. Some of the women and some of their newborns died [1, 2].

But should we have been surprised? Pregnancy causes immunologic and physiologic changes, and both are likely contributors to increased susceptibility to infection and its complications. It has previously been recognized that pregnant women are more likely to experience complications, especially severe pneumonia, when infected with seasonal influenza. Furthermore, historical data from previous pandemics (in 1918 and 1957) indicate an excess of deaths in pregnancy and an increased risk of premature delivery and stillbirth [1].
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full article

http://www.journals.uchicago.edu/doi/full/10.1086/650461?prevSearch=h1n1&searchHistoryKey=

 

[kiwibird]

Re: Editorial: Pregnancy and Pandemic Flu

Of the women admitted to hospital with H1N1 influenza, almost all were in their second or third trimesters of pregnancy, as has previously been described [3]. Most had typical flulike symptoms, and interestingly 50% had no underlying risk factor apart from pregnancy. However, more than one‐third delivered during the hospitalization (40% before term, or 4 times the background rate of preterm labor) and 19% required intensive care, with 4 requiring ventilation support and 2 requiring extracorporeal membrane oxygenation. There was 1 maternal death, 2 deaths in utero, and 1 neonatal death. In their hospital‐based population of >6000 pregnant women, the authors calculated a risk of 1 per 500 for hospitalization in the second trimester and 1 per 200 in the third trimester during the 3‐month study period. There is potential for selection bias toward more severe cases and overestimation of risk in this sample, which draws from all 3 of the state?s tertiary maternity hospitals, and additional data are required to accurately calculate risk.

Thank you tetano interesting article. There could have been much more information provided though. It would be interesting to see info on progesterone levels etc. and some discussion about the mechanism of the severity of these cases. Perhaps we could add any we find to this thread.