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Andrew C. Miller, MD; Farnaz Safi, MD; Sadia Hussain, BS; Ramanand A. Subramanian, PhD; Elamin M. Elamin, MD, MSc; Richard Sinert, DO

Arch Intern Med. 2010;170(10):868-873.

Background  Pandemic novel influenza A(H1N1) is a substantial threat and cause of morbidity and mortality in the pregnant population.

Methods  We conducted an observational analysis of 18 gravid patients with H1N1 in 2 academic medical centers. Cases were identified based on direct antigen testing (DAT) of nasopharyngeal swabs followed by real-time reverse-transcriptase polymerase chain reaction analysis (rRT-PCR) or viral culture. Patient demographics, symptoms, hospital course, laboratory and radiographic results, pregnancy outcome, and placental pathologic information were recorded. Results were then compared with published reports of the H1N1 outbreak and reports of flu pandemics of 1918 and 1957.

Results  Eighteen pregnant patients were admitted with H1N1 during the study period. All patients were treated with oseltamivir phosphate beginning on the day of admission. Mean (SD) age was 27 (6.6) years (age range, 18-40 years); median length of hospital stay was 4 days. Intensive care unit admission rate was 17% (n = 3). Demographically, 2 patients were health care workers (11%); 15 were black (83%); 2, Hispanic (11%); and 1, white (6%). None reported recent travel. Half of the patients presented with gastrointestinal or abdominal complaints; 13 patients met sepsis criteria (72%). The most common comorbidities were asthma, sickle cell disease, and diabetes. Fourteen patients tested positive for H1N1 on DAT (initial or repeated) (78%); in the other 4 cases, H1N1 was identified by viral culture or rRT-PCR (22%). Seven patients delivered during hospitalization (39%), 6 prematurely and 4 via emergency cesarean delivery. There were 2 fetal deaths (11%). No maternal mortality was recorded.

Conclusions  Admitted pregnant patients with H1N1 are at risk for obstetrical complications including fetal distress, premature delivery, emergency cesarean delivery, and fetal death. A high number of patients presented with gastrointestinal and abdominal complaints. Early antiviral treatment may improve maternal outcomes.

Author Affiliations: Departments of Internal Medicine (Dr Miller), Emergency Medicine (Drs Miller, Subramanian, and Sinert), and Obstetrics and Gynecology (Dr Safi), State University of New York Downstate Medical Center and Kings County Hospital Center, Brooklyn; State University of New York Downstate College of Medicine, Brooklyn (Ms Hussain); and Pulmonary, Critical Care, and Sleep Medicine Section, James A. Haley Veterans Hospital, Tampa, Florida (Dr Elamin).

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