Severe 2009 A/H1N1v influenza in pregnant women in Spain.
OBJECTIVE
To describe the severity of the 2009 influenza A/H1N1v illness among pregnant women admitted to Spanish intensive care units.


METHODS
Prospective, observational, multicenter study conducted in 148 Spanish intensive care units. We reviewed demographic and clinical data from the Spanish Society of Intensive Care Medicine database reported from April 23, 2009, to February 15, 2010. We included women of reproductive age (15-44 yrs) with confirmed A/H1N1v infection admitted to intensive care units.


RESULTS
Two hundred thirty-four women of reproductive age were admitted to intensive care units, 50 (21.4%) of them pregnant. Seven deaths were recorded in pregnant and 22 in nonpregnant women. Among intensive care unit admissions, there were no statistically significant differences between pregnant women and nonpregnant in Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment scores, chest x-rays, inotrope requirement, or need for mechanical ventilation or steroid therapy. Mortality risk was significantly associated with Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and obesity. Viral pneumonia was more frequent in pregnant women than in nonpregnant women, with an odds ratio (adjusted for asthma, time from onset influenza symptoms to hospital admission and obesity) of 4.9 (95% confidence interval: 1.4-17.2). The development of primary viral pneumonia in women of reproductive age appeared to be related to the time of commencement of antiviral treatment, the lowest rates being reported with initiation of antiviral therapy within 48 hrs of symptom onset (63.6% vs. 82.6%, p = .03). However, antiviral therapy was started within this time span in only 14% of pregnant women.


CONCLUSIONS
More than 20% of women of reproductive age admitted to intensive care unit for pH1N1 infection were pregnant. Pregnancy was significantly associated with primary viral pneumonia. Pregnant women should receive prompt treatment with oseltamivir within 48 hrs of the onset of influenza symptoms.
Intensive Care Unit, Hospital Virgen del Camino, Pamplona, Spain. enrique.maravi.poma@navarra.es
Enrique
E
Maraví-Poma
Ignacio
I
Martin-Loeches
Eva
E
Regidor
Clara
C
Laplaza
Koldo
K
Cambra
Sara
S
Aldunate
Jose Eugenio
JE
Guerrero
Ana
A
Loza-Vazquez
Elena
E
Arnau
Jordi
J
Almirall
Leonardo
L
Lorente
Angel
A
Arenzana
Monica
M
Magret
Roberto
R
Reig Valero
Enrique
E
Marquez
Nagore
N
Gonzalez
Jesús Francisco
JF
Bermejo-Martin
Jordi
J
Rello
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000998:Antiviral Agents / Q000627:therapeutic use; D003140:Communicable Disease Control; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D007362:Intensive Care Units; D016014:Linear Models; D053139:Oseltamivir / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000821:virology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D015996:Survival Rate; D055815:Young Adult
D000998:Antiviral Agents; D053139:Oseltamivir