title: Presentation of seasonal influenza A in pregnancy: 2003-2004 influenza season.
abstract: OBJECTIVE
  To describe the clinical course of influenza in pregnant women followed at our institution during the 2003-2004 influenza season.
  
  
  METHODS
  This was a prospective evaluation of all pregnant women diagnosed with influenza A between October 22, 2003, and January 18, 2004. Pregnant women presenting with a flu-like illness were evaluated using a rapid diagnostic test, culture, or both. Patients were admitted in accordance with prospectively developed clinical protocols. Women with a laboratory-confirmed diagnosis were treated with Centers for Disease Control-recommended antivirals.
  
  
  RESULTS
  Influenza A was confirmed in 107 patients. All viral isolates obtained were of the H3N2 strain. Influenza was most commonly diagnosed in the third trimester (45%). Cough was the most commonly reported symptom (93%), followed by myalgias (61%), nausea or vomiting (60%), and rhinorrhea (56%). Eighty-four percent of the women had no comorbid conditions; however, 62% required admission. Twenty-one percent of patients had a maximum heart rate higher than 130 beats per minute. Complications of influenza A included pneumonia (12%), meningitis (1%), and myocarditis (1%). There were no maternal deaths. Eighty-one (76%) of the women delivered at our institution. When compared with our general obstetric population, there was no significant difference in obstetric or neonatal complications.
  
  
  CONCLUSIONS
  Influenza A in pregnancy is characterized by cough, myalgia, nausea or vomiting, and rhinorrhea. Profound tachycardia disproportionate to maternal fever uniquely affected the majority of the women in our cohort. Pneumonia complicated one in eight cases; however, the anticipated excess maternal morbidities and mortality did not occur.
authors.affiliation: From the University of Texas Southwestern Medical Center at Dallas, Departments of Obstetrics and Gynecology and Internal Medicine; and Parkland Memorial Hospital Department of Infection Control, Dallas, Texas.
authors.forename: Vanessa Laibl
authors.initials: VL
authors.lastname: Rogers
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Sheffield
authors.forename: Scott W
authors.initials: SW
authors.lastname: Roberts
authors.forename: Donald D
authors.initials: DD
authors.lastname: McIntire
authors.forename: James P
authors.initials: JP
authors.lastname: Luby
authors.forename: Sylvia
authors.initials: S
authors.lastname: Trevino
authors.forename: George D
authors.initials: GD
authors.lastname: Wendel
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009980:Influenza A virus; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013610:Tachycardia / Q000209:etiology; D055815:Young Adult
references.citation: Harris JW. Influenza occurring in pregnant women. JAMA 1919;72:978–80.
references.citation: Widelock D, Csizmas L, Klein S. Influenza, pregnancy, and fetal outcome. Public Health Rep 1963;78:1–11.
references.citation: Irving WL, James DK, Stephenson T, Laing P, Jameson C, Oxford JS, et al. Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG 2000;107:1282–9.
references.citation: Tuyishime JD, De Wals P, Moutquin JM, Frost E. Influenza-like illness during pregnancy: results from a study in the eastern townships, Province of Quebec. J Obstet Gynaecol Can 2003;25:1020–5.
references.citation: Centers for Disease Control and Prevention (CDC). Assessment of the effectiveness of the 2003–04 influenza vaccine among children and adults-Colorado, 2003. MMWR Morb Mortal Wkly Rep 2004;53:707–10.
references.citation: Centers for Disease Control and Prevention (CDC). Prevention and control of influenza. MMWR Morb Mortal Wkly Rep 2007;56:1–54.
references.citation: Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374:451–8.
references.citation: Centers for Disease Control and Prevention (CDC). Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2002;51:1–31.
references.citation: McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birthweight in relation to morbidity and mortality among newborn infants. N Engl J Med 1999;340:1234–8.
references.citation: Whitley RJ, Monto AS. Prevention and treatment of influenza in high risk groups: children, pregnant women, immunocompromised hosts, and nursing home residents. J Infect Dis 2006;194:S133–8.
references.citation: Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute hospital setting. Lancet Infect Dis 2002;2:145–55.
references.citation: Kilbourne ED. Influenza. New York (NY): Plenum Publishing Corporation; 1987. p. 157.
references.citation: Kasper DK, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's principles of internal medicine. 16th ed. New York (NY): McGraw-Hill; 2005. p. 1068.
references.citation: Peltola V, Ziegler T, Ruuskanen D. Influenza A and B infections in children. Clin Infect Dis 2003;36:299–305.
references.citation: Centers for Disease Control and Prevention (CDC). Prevention and control of influenza. MMWR Morb Mortal Wkly Rep 2004;53:1–40.
references.citation: Hindiyeh M, Goulding C, Morgan H, Kenyon B, Langer J, Fox L, et al. Evaluation of BioStar FLU OIA assay for rapid detection of influenza A and B viruses in respiratory specimens. J Clin Virology 2000;17:119–26.
references.citation: Money DM. Antiviral and antiretroviral use in pregnancy. Obstet Gynecol Clin North Am 2003;30:731–49.