H1N1 Risky for Pregnant, Postpartum Women

Dec. 28, 2009 -- H1N1 influenza poses a special
risk to pregnant women and new mothers,
but life-threatening treatment delays are common in this group, a new study
confirms.
Researchers from the CDC and the California Department of Public Health
examined all H1N1-related hospitalizations among California women who were
pregnant or had just given birth in the early months of the H1N1 pandemic.
The analysis revealed that only about half of the women received antiviral
treatment within 48 hours of becoming ill.
Compared to pregnant women who received early treatment(given within 48
hours after the onset of symptoms),women treated later were four times more
likely to die or require treatment in intensive care units (ICUs).
H1N1 Deaths: Treatment Delays Common
Of the 94 pregnant and eight postpartum California women hospitalized with
H1N1 flu between April 23 and Aug. 11 of this year, 22 were treated in ICUs, 16
were put on ventilators, and eight died.
The CDC recommends starting antiviral treatment in pregnant women with
suspected or confirmed H1N1 influenza within 48 hours of the onset of
symptoms.
Five of the eight deaths occurred in women whose antiviral treatment began
after this time.
In some cases, women did not seek treatment until after this time and in
others the delays by health care providers in initiating treatment were to
blame.
Eight of the 22 women who required ICU treatment were otherwise healthy, and
14 had medical conditions.
The analysis appears in the current issue of the New England Journal of
Medicine.
CDC: Rapid Tests Not Reliable
Although tests that identify H1N1 influenza within 15 minutes are available,
these rapid tests are not very reliable and could have contributed to treatment
delays in this group of patients, the researchers concluded.
About 38% of patients with the flu had tested negatively (false negative
results); less than 30% of patients with false negative results received
antiviral treatment within 48 hours of symptom onset.
The CDC recently issued a health advisory alerting doctors on concerns about
reliability of the rapid tests, making it clear that decisions about whether to
start antiviral treatment should not be made based on their findings.
Seasonal influenza is a rare cause of death in pregnant women and new
mothers, but this is not true of H1N1 influenza.
The researchers conclude that the 2009 H1N1 pandemic has the potential to
increase rates of childbirth-related deaths in
the U.S.
The report also highlighted the fact that new mothers are also at
significant risk.
All eight of the new moms hospitalized for H1N1-related illness in the
analysis became ill within two weeks of delivery. Half required ICU treatment
and two died.
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