title: Perinatal outcomes after maternal 2009/H1N1 infection: national cohort study.
abstract: OBJECTIVE
  To follow up a UK national cohort of women admitted to hospital with confirmed 2009/H1N1 influenza in pregnancy in order to obtain a complete picture of pregnancy outcomes and estimate the risks of adverse fetal and infant outcomes.
  
  
  METHODS
  National cohort study.
  
  
  METHODS
  221 hospitals with obstetrician led maternity units in the UK.
  
  
  METHODS
  256 women admitted to hospital with confirmed 2009/H1N1 in pregnancy during the second wave of pandemic infection between September 2009 and January 2010; 1220 pregnant women for comparison.
  
  
  METHODS
  Rates of stillbirth, perinatal mortality, and neonatal mortality; odds ratios for infected versus comparison women.
  
  
  RESULTS
  Perinatal mortality was higher in infants born to infected women (10 deaths among 256 infants; rate 39 (95% confidence interval 19 to 71) per 1000 total births) than in infants of uninfected women (9 deaths among 1233 infants; rate 7 (3 to 13) per 1000 total births) (P < 0.001). This was principally explained by an increase in the rate of stillbirth (27 per 1000 total births v 6 per 1000 total births; P = 0.001). Infants of infected women were also more likely to be born prematurely than were infants of comparison women (adjusted odds ratio 4.0, 95% confidence interval 2.7 to 5.9). Infected women who delivered preterm were more likely to be infected in their third trimester (P = 0.046), to have been admitted to an intensive care unit (P < 0.001), and to have a secondary pneumonia (P = 0.001) than were those who delivered at term.
  
  
  CONCLUSIONS
  This study suggests an increase in the risk of poor outcomes of pregnancy in women infected with 2009/H1N1, which reinforces the message from studies of maternal risk alone. The health of pregnant women is an important public health priority in future waves of this and other influenza pandemics.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pierce
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.forename: Patsy
authors.initials: P
authors.lastname: Spark
authors.forename: Peter
authors.initials: P
authors.lastname: Brocklehurst
authors.forename: Marian
authors.initials: M
authors.lastname: Knight
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000503:physiopathology*; D011256:Pregnancy Outcome; D006113:United Kingdom / Q000453:epidemiology