Journal Article

French Experience of 2009 A/H1N1v Influenza in Pregnant Women

Matheron, Sophie, Richard, Jean-Christophe, Launay, Odile, Tsatsaris, Vassilis, Baugnon, Thomas, Dubar, Grégory, Mignon, Alexandre, Azria, Elie, Goffinet, François, Dupont, Hervé, Tesnière, Antoine, Luton, Dominique, Le Ray, Camille

2010

Overview

The first reports on the pandemic influenza 2009 A/H1N1v from the USA, Mexico, and Australia indicated that this disease was associated with a high mortality in pregnant women. The aim of this study was to describe and compare the characteristics of severe critically ill and non-severe pregnant women with 2009 A/H1N1v-related illness in France. A national registry was created to screen pregnant women with laboratory-confirmed 2009 A/H1N1v influenza. Three hundred and fifteen patients from 46 French hospitals were included: 40 patients were admitted to intensive care units (severe outcomes), 111 were hospitalized in obstetric or medical wards (moderate outcomes), and 164 were outpatients (mild outcomes). The 2009 A/H1N1v influenza illness occurred during all pregnancy trimesters, but most women (54%), notably the severe patients (70%), were in the third trimester. Among the severe patients, twenty (50%) underwent mechanical ventilation, and eleven (28%) were treated with extracorporeal membrane oxygenation. Three women died from A/H1N1v influenza. We found a strong association between the development of a severe outcome and both co-existing illnesses (adjusted odds ratio [OR], 5.1; 95% confidence interval [CI], 2.2-11.8) and a delay in oseltamivir treatment after the onset of symptoms (>3 or 5 days) (adjusted OR, 4.8; 95% CI, 1.9-12.1 and 61.2, 95% CI; 14.4-261.3, respectively). Among the 140 deliveries after 22 weeks of gestation known to date, 19 neonates (14%) were admitted to a neonatal intensive care unit, mainly for preterm delivery, and two neonates died. None of these neonates developed 2009 A/H1N1v infection. This series confirms the high incidence of complications in pregnant women infected with pandemic A/H1N1v observed in other countries but depicts a lower overall maternal and neonatal mortality and morbidity than indicated in the USA or Australia. Moreover, our data demonstrate the benefit of early oseltamivir treatment in this specific population.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Anesthesiology and Pain Management/Obstetric Anesthesiology / Anesthesiology and Pain Management/Perioperative Critical Care / Complications / Confidence intervals / Critical Care and Emergency Medicine/Perioperative Critical Care / Critical Care and Emergency Medicine/Respiratory Failure / Development and progression / Disease control / Female / France - epidemiology / Gestation / Health care / Hospital patients / Hospitals / Humans / Illnesses / Infant mortality / Infections / Infectious Diseases/Epidemiology and Control of Infectious Diseases / Infectious Diseases/Respiratory Infections / Infectious Diseases/Viral Infections / Influenza / Influenza A Virus, H1N1 Subtype - isolation & purification / Influenza, Human - complications / Influenza, Human - epidemiology / Influenza, Human - virology / Intensive care / Intensive care units / Maternal mortality / Mechanical ventilation / Medical research / Morbidity / Mortality / Neonates / Newborn babies / Newborn infants / Obstetrics / Obstetrics/Labor and Delivery / Obstetrics/Management of High-Risk Pregnancies / Obstetrics/Obstetrical Anesthesiology / Obstetrics/Postpartum Care / Obstetrics/Pregnancy / Oseltamivir / Oxygenation / Pandemics / Patients / Population / Pregnancy / Pregnancy complications / Pregnancy Complications, Infectious - epidemiology / Pregnancy Complications, Infectious - virology / Pregnant women / Registries / Respiratory Medicine/Respiratory Failure / Respiratory Medicine/Respiratory Infections / Surveillance / Swine flu / Ventilation / Virology/Emerging Viral Diseases / Womens health