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. 2011 Sep;118(3):593-600.
doi: 10.1097/AOG.0b013e318229e484.

Influenza-like illness in hospitalized pregnant and postpartum women during the 2009-2010 H1N1 pandemic

Michael W Varner  1 , Madeline Murguia Rice, Brenna Anderson, Jorge E Tolosa, Jeanne Sheffield, Catherine Y Spong, George Saade, Alan M Peaceman, Judette M Louis, Ronald J Wapner, Alan T N Tita, Yoram Sorokin, Sean C Blackwell, Mona Prasad, John M Thorp Jr, Amber Naresh, J Peter Van Dorsten; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU)*
Affiliations

Influenza-like illness in hospitalized pregnant and postpartum women during the 2009-2010 H1N1 pandemic

Michael W Varner et al. Obstet Gynecol. 2011 Sep.

Abstract

Objective: To estimate characteristics and outcomes of pregnant and immediately postpartum women hospitalized with influenza-like illness during the 2009-2010 influenza pandemic and the factors associated with more severe illness.

Methods: An observational cohort in 28 hospitals of pregnant and postpartum (within 2 weeks of delivery) women hospitalized with influenza-like illness. Influenza-like illness was defined as clinical suspicion of influenza and either meeting the Centers for Disease Control and Prevention definition of influenza-like illness (fever 100.0°F or higher, cough, sore throat) or a positive influenza test.

Results: Of 356 women meeting eligibility criteria, 35 (9.8%) were admitted to the intensive care unit (ICU) and four (1.1%) died. Two hundred eighteen women (61.2%) were in the third trimester and 10 (2.8%) were postpartum. More than half (55.3%) were admitted in October and 25.0% in November with rapidly decreasing numbers thereafter. Antiviral therapy was administered to 10.1% of the women before hospitalization and to 88.5% during hospitalization. Factors associated with an increased likelihood of ICU admission included cigarette smoking (29.4% compared with 13.4%; odds ratio [OR] 2.77, 95% confidence interval [CI] 1.19-6.45) and chronic hypertension (17.1% compared with 3.1%; OR 6.86, 95% CI 2.19-21.51). Antiviral treatment within 2 days of symptom onset decreased the likelihood of ICU admission (31.4% compared with 56.6%, OR 0.36, 95% CI 0.16-0.77).

Conclusion: Comorbidities, including chronic hypertension and smoking in pregnancy, increase the likelihood of ICU admission in influenza-like illness hospitalizations, whereas early antiviral treatment may reduce its frequency.

Level of evidence: II.

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Figures

Figure 1
Figure 1
Eligibility criteria.
Figure 2
Figure 2
Registry enrollment by month and by intensive care unit (ICU) and non-ICU admission.
See this image and copyright information in PMC

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References

    1. WHO Global Alert and Response. http://www.who.int/csr/don/2009_04_30_a/en/index.html.
    1. CDC Definition of Influenza-Like Illness. http://www.cdc.gov/h1n1flu/casedef.htm.
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