The postmortem on pregnancy and H1N1 flu

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As early as last July, federal health officials warned doctors and pregnant women that the H1N1 (swine) flu virus appeared especially hazardous for pregnant women. In the fall, officials urged pregnant women to be vaccinated against H1N1, although surveys showed that pregnant women often hesitated to get any vaccines. Health authorities also instructed doctors, by way of several bulletins to practitioners nationwide, that pregnant women who showed symptoms of the flu should be treated immediately with antiviral medications, even before H1N1 infection was confirmed.

A growing body of scientific evidence has crystallized regarding how important this advice is. A study published last week in the British Medical Journal found that pregnant women in Australia and New Zealand who had H1N1 were 13 times more likely to be admitted to the hospital with a critical illness compared with others who had H1N1. The study found that 11% of mothers and 12% of their babies who were admitted to an intensive care unit died.

Another study, from the U.S. Centers for Disease Control and Statistics, examined 2009 H1N1 cases among pregnant women in New York City last year and found the hospitalization rate was 55.3 per 100,000 people among pregnant women compared with 7.7 per 100,000 non-pregnant women.

Moreover, the study affirmed the importance of rapid treatment with antiviral medications. Among the pregnant women who received Tamiflu within two days of the onset of symptoms, only one of 30 women (3.3%) died. Among those who started Tamiflu on the third and fourth days, three of 14 women (21.4%) died. Among women who started treatment five or more days after the onset of symptoms, four of nine (44.4%) died. According to the study, published Monday in the journal Obstetrics & Gynecology, the infants died in five of the six cases of women with severe illness who delivered while hospitalized.

After the deaths that occurred in 2009, it will be hard to understand if pregnant women and their doctors don’t take the threat of H1N1 even more seriously in the coming year. Two safety nets exist: vaccination and rapid antiviral treatment. Click here for a story in February in The Times about a pregnant mother of six who died after contracting H1N1.

-- Shari Roan