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Clinical Trial
. 2012;7(8):e41638.
doi: 10.1371/journal.pone.0041638. Epub 2012 Aug 3.

The comparative clinical course of pregnant and non-pregnant women hospitalised with influenza A(H1N1)pdm09 infection

Gayle P Dolan  1 , Puja R Myles, Stephen J Brett, Joanne E Enstone, Robert C Read, Peter J M Openshaw, Malcolm G Semple, Wei Shen Lim, Bruce L Taylor, James McMenamin, Karl G Nicholson, Barbara Bannister, Jonathan S Nguyen-Van-Tam; Influenza Clinical Information Network (FLU-CIN)
Affiliations
Clinical Trial

The comparative clinical course of pregnant and non-pregnant women hospitalised with influenza A(H1N1)pdm09 infection

Gayle P Dolan et al. PLoS One. 2012.

Abstract

Introduction: The Influenza Clinical Information Network (FLU-CIN) was established to gather detailed clinical and epidemiological information about patients with laboratory confirmed A(H1N1)pdm09 infection in UK hospitals. This report focuses on the clinical course and outcomes of infection in pregnancy.

Methods: A standardised data extraction form was used to obtain detailed clinical information from hospital case notes and electronic records, for patients with PCR-confirmed A(H1N1)pdm09 infection admitted to 13 sentinel hospitals in five clinical 'hubs' and a further 62 non-sentinel hospitals, between 11th May 2009 and 31st January 2010.Outcomes were compared for pregnant and non-pregnant women aged 15-44 years, using univariate and multivariable techniques.

Results: Of the 395 women aged 15-44 years, 82 (21%) were pregnant; 73 (89%) in the second or third trimester. Pregnant women were significantly less likely to exhibit severe respiratory distress at initial assessment (OR = 0.49 (95% CI: 0.30-0.82)), require supplemental oxygen on admission (OR = 0.40 (95% CI: 0.20-0.80)), or have underlying co-morbidities (p-trend <0.001). However, they were equally likely to be admitted to high dependency (Level 2) or intensive care (Level 3) and/or to die, after adjustment for potential confounders (adj. OR = 0.93 (95% CI: 0.46-1.92). Of 11 pregnant women needing Level 2/3 care, 10 required mechanical ventilation and three died.

Conclusions: Since the expected prevalence of pregnancy in the source population was 6%, our data suggest that pregnancy greatly increased the likelihood of hospital admission with A(H1N1)pdm09. Pregnant women were less likely than non-pregnant women to have respiratory distress on admission, but severe outcomes were equally likely in both groups.

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Conflict of interest statement

Competing Interests: JSN-V-T has received funding to attend influenza related meetings, lecture and consultancy fees and research funding from several influenza antiviral drug and vaccine manufacturers (F. Hoffmann-La Roche, GlaxoSmithKline, Baxter AG, Novartis, Sanofi-Pasteur MSD, Astra-Zeneca). All forms of personal remuneration ceased in September 2010, but influenza-related research funding from GlaxoSmithKline, F. Hoffmann-La Roche and Astra-Zeneca remains current. He is a former employee of SmithKline Beecham plc (now GlaxoSmithKline), Roche Products Ltd, and Aventis-Pasteur MSD (now Sanofi-Pasteur MSD), all prior to 2005, with no outstanding pecuniary interests by way of shareholdings, share options or accrued pension rights. PRM holds an unrestricted educational grant from F. Hoffman-La Roche Ltd for research in the area of pandemic influenza. RCR has received funding for vaccine-related research from Novartis and travel funding from GlaxoSmithKline. WSL has received unrestricted funding from Pfizer (previously Wyeth) for research in the area of pneumonia. SJB has received consultancy fees from GlaxoSmithKline and Baxter. JEE has received consultancy fees from GlaxoSmithKline, and holds an unrestricted educational grant from Astra-Zeneca for influenza-related research. KGN has received H5 avian influenza vaccines from Novartis and H1N1 pandemic influenza vaccines from GlaxoSmithKline and Baxter to facilitate MRC and National Institute for Health Research-funded trials. He has received consultancy fees from Novartis and GlaxoSmithKline and lecture fees from Baxter AG. A colleague of KGN at the University Hospitals of Leicester Natioanl Health Service Trust was Principal Investigator and recipient of research funding from Roche on antiviral resistance and from Novartis on pandemic H1N1 vaccines. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. No aspect of the work described in this report was supported or enabled by commercial funding.

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