Pregnancy and H1N1 infection

Denise Jamieson and colleagues¹ highlight high morbidity and mortality rates in pregnant women infected with the H1N1 influenza virus. Admission rates were 41% and the median time from symptom onset to receipt of antiviral therapy was 9 days. Could earlier initiation of antiviral treatment have resulted in a better outcome?

In 2003, Singapore was notably affected by severe acute respiratory syndrome (SARS),² which led to the formation of a rapid response team, hospital quarantine, infectious disease control measures, temperature screening at borders and in public buildings and spaces, timely public education, and constant communication with the public.3, 4 In response to the Centers for Disease Control and Prevention's advice on poorer outcomes in H1N1-affected pregnant women on May 12, 2009, the above SARS strategies, coupled with rapid access to quantitative reverse-transcriptase PCR within 24 h of presentation and early institution of antiviral therapy, was started from June 30, 2009, in Singapore.

Between July 7 and Aug 9, 2009, 28 pregnant women were diagnosed with H1N1 at the National University Hospital in Singapore. The time from symptom onset to initiation of oseltamivir treatment was a median of 2 days. Three women were admitted for observation, and one developed pneumonia; initiation of treatment was 4 days after symptom onset in this woman. No deaths have been reported nationwide in pregnant women thus far.

Our experience suggests that timely medical attention with early recourse to antiviral therapy is associated with a better outcome in H1N1-affected pregnant women.