California Department of Public Health, Richmond, CA 94804, USA.
N Engl J Med. 2010 Jan 7;362(1):27-35. doi: 10.1056/NEJMoa0910444. Epub 2009 Dec 23.
Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.
Statewide surveillance for patients who were hospitalized with or died from 2009 H1N1 influenza was initiated by the California Department of Public Health. We reviewed demographic and clinical data reported from April 23 through August 11, 2009, for all H1N1-infected, reproductive-age women who were hospitalized or died--nonpregnant women, pregnant women, and postpartum women (those who had delivered < or = 2 weeks previously).
Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered < or = 2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza-specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3.
2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States.
与以往的传染病和大流行疾病一样，2009 年甲型 H1N1 流感可能会使孕妇罹患重症的风险增加。
加州公共卫生部启动了对因感染 2009 年 H1N1 流感住院或死亡的患者进行的全州范围监测。我们回顾了 2009 年 4 月 23 日至 8 月 11 日报告的所有感染 H1N1 的育龄期住院或死亡的孕妇（非孕妇、产妇和产后妇女[分娩后 <或=2 周]）的人口统计学和临床数据。
报告了 94 例孕妇、8 例产后妇女和 137 例非孕妇因感染 2009 年 H1N1 流感住院。接受检测的 153 例患者中有 38%（58 例）的快速抗原检测结果呈假阴性。大多数孕妇（94 例中的 89 例[95%]）处于妊娠第二或第三阶段，约三分之一（93 例中的 32 例[34%]）除妊娠外还存在流感并发症的既定危险因素。与孕妇早期（症状出现后 <或=2 天）接受抗病毒治疗相比，较晚治疗与入住重症监护病房（ICU）或死亡相关（相对风险，4.3）。共有 18 例孕妇和 4 例产后妇女（总共 102 例中的 22 例[22%]）需要重症监护，8 例（8%）死亡。6 例分娩发生在 ICU，包括 4 例紧急剖宫产。2009 年 H1N1 流感的特定孕产妇死亡率（每 10 万活产儿中的孕产妇死亡人数）为 4.3。
2009 年 H1N1 流感可导致孕妇和产后妇女罹患重症和死亡；无论快速抗原检测结果如何，均应考虑对有流感样症状的此类妇女进行及时评估和抗病毒治疗。高的特定病因孕产妇死亡率表明，2009 年 H1N1 流感可能会增加美国 2009 年孕产妇死亡率。
