From the Epidemic Intelligence Service Program, Office of Workforce and Career Development; National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health; New York City Department of Health and Mental Hygiene; National Center for Immunization and Respiratory Diseases, Influenza Division; National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Developmental Disabilities; and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
Obstet Gynecol. 2010 Apr;115(4):717-726. doi: 10.1097/AOG.0b013e3181d57947.
To examine 2009 H1N1 influenza illness severity and the effect of antiviral treatment on the severity of illness among pregnant women.
We abstracted medical records from hospitalized pregnant (n=62) and nonpregnant (n=74) women with laboratory-confirmed 2009 H1N1 influenza in New York City, May through June 2009. We compared characteristics of pregnant and nonpregnant women and of severe and moderate influenza illness among pregnant women, with severe defined as illness resulting in intensive care admission or death.
The 2009 H1N1 hospitalization rate was significantly higher among pregnant than nonpregnant women (55.3 compared with 7.7 per 100,000 population). Eight pregnant (including two deaths) and 16 nonpregnant (including four deaths) cases were severe. Pregnant women represented 6.4% of hospitalized cases and 4.3% of deaths caused by 2009 H1N1 influenza. Only 1 in 30 (3.3%) pregnant women who received oseltamivir treatment within 2 days of symptom onset had severe illness compared with 3 of 14 (21.4%) and four of nine (44.4%) pregnant women who started treatment 3-4 days and 5 days or more after symptom onset, respectively (P=.002 for trend). Severe and moderate 2009 H1N1 influenza illness occurred in all pregnancy trimesters, but most women (54.8%) were in the third trimester. Twenty-two women delivered during their influenza hospitalization, and severe neonatal outcomes (neonatal intensive care unit admission or death) occurred among five of six (83.3%) women with severe illness compared with 2 of 16 (12.5%) women with moderate illness (P=.004).
Our findings highlight the potential for severe illness and adverse neonatal outcomes among pregnant 2009 H1N1 influenza-infected women and suggest the benefit of early oseltamivir treatment.
II.
研究 2009 年 H1N1 流感的严重程度以及抗病毒治疗对孕妇疾病严重程度的影响。
2009 年 5 月至 6 月，我们从纽约市因实验室确诊的 2009 年 H1N1 流感住院的孕妇（62 例）和非孕妇（74 例）的病历中提取资料。我们比较了孕妇和非孕妇、孕妇中重症和中度流感的特征，重症定义为需要重症监护治疗或死亡的疾病。
孕妇的 2009 年 H1N1 住院率明显高于非孕妇（每 10 万人口中分别为 55.3 例和 7.7 例）。8 例孕妇（包括 2 例死亡）和 16 例非孕妇（包括 4 例死亡）的病情严重。孕妇占 2009 年 H1N1 流感住院患者的 6.4%和死亡患者的 4.3%。仅 1/30（3.3%）在症状出现后 2 天内接受奥司他韦治疗的孕妇出现严重疾病，而在症状出现后 3-4 天和 5 天或以上开始治疗的孕妇中，分别有 3/14（21.4%）和 4/9（44.4%）出现严重疾病（趋势检验 P 值<.001）。所有妊娠期间都出现严重和中度 2009 年 H1N1 流感，但大多数孕妇（54.8%）处于孕晚期。22 名孕妇在流感住院期间分娩，严重新生儿结局（新生儿重症监护病房入住或死亡）发生在 6 例（83.3%）重症孕妇中，而在 16 例中度流感孕妇中仅有 2 例（12.5%）发生（P 值<.004）。
我们的研究结果强调了孕妇感染 2009 年 H1N1 流感后发生严重疾病和不良新生儿结局的可能性，并提示早期奥司他韦治疗可能有益。
II 级。
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