The 2009 H1N1 pandemic, only two months after its discovery, was an unprecedented event. Evidence suggests disproportionate disease with rapid deterioration in the young and pregnant, but is rapidly evolving and frequently limited by poor denominator data. The authors investigated the prevalence and severity in pregnant and non-pregnant reproductive-age women (15 - 44 years) at a North East London hospital serving a multi-ethnic population of 700 000.
Results Sixty-three admissions with confirmed positive H1N1 RT-PCR occurred between 27/04/09 and 12/01/10. Seventeen (27%) were pregnant and seven (11%) non-pregnant reproductive-age women. Most were either Caucasian (41%) or Asian (33%) despite a predominantly Caucasian population. Presentation was at a median 28+5 weeks gestation (range 5+1 - 38+0), eight (47%) in the third and six (35%) in the second trimester. ITU admission occurred in 17% - three pregnant and one non-pregnant woman who died. Two (29%) of the non-pregnant had co-morbidities and one (14%) of the pregnant did. Overall 18 (75%), including all ITU cases, received anti-viral treatment within 48 h. Twelve delivered at a median 39+1 weeks gestation (range 28+6 - 41+0), seven (58%) vaginally and in three ITU cases (25%) by emergency caesarean within a week of admission – two under 37+0 weeks, the only preterm deliveries and SCBU admissions. All 23 survivors were discharged fully recovered and five remain pregnant.
Conclusion The authors support evidence of higher H1N1-associated risk in young, highly gravid, Caucasian or Asian women and highlight them as top-priority for counselling, vaccination, monitoring and prompt treatment in response to this pandemic.
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