Maternal and Neonatal Outcomes After Antepartum Treatment of Influenza With Antiviral Medications

Abstract

II.

Severe 2009 A/H1N1v influenza in pregnant women in Spain*

“…Mortality in pregnant women affected by an influenza A/H1N1v infection is unexpectedly high, from 20% (40,41) to 45% (34). However, in our study, mortality in pregnant women admitted to ICU (14%) for influenza A/H1N1v was lower than in previous reports and similar to the rates recorded by other authors (11)(12)(13).…”

“…Finally, the negative impact of the following factors in the severity and evolution of influenza A/H1N1v in pregnancy is clear: obesity, the delay in the diagnosis of viral infection (10,39,40) ICU admission and the onset of antiviral treatment (5,30). Our study also confirms the findings of other authors (5,9,12,33,41) regarding the severity of primary viral pneumonia in pregnant women with the highest need of mechanical ventilation and factors that are associated with risk of death, especially in women.…”

Prevention and Management of Influenza in Pregnancy

“…Current knowledge surrounding the safety of these medications (both currently category C) supports their use in pregnancy given the well-documented risks to pregnant women and the absence of any apparent risks from indicated use. 6,57,58 It is likely that with continued use of these medications, additional safety and treatment efficacy data will continue to support use and can also provide a more thorough risk/benefit ratio. The earlier the antiviral is started the better, as the current recommendation is to begin treatment within 48 hours of exposure to maximize potential benefits.…”

Influenza

“…Oseltamivir is preferred because there are more pharmacokinetic and outcome data available in pregnancy. 10 Zanamivir may also worsen pulmonary complications in certain pregnant women with respiratory issues. The CDC recommends the same dose of oseltamivir (75 mg twice daily for 5 days) for pregnant women as for nonpregnant patients, with pharmacokinetic studies demonstrating levels that remain constant across trimesters of pregnancy.…”

“…In a review of the 2009 H1N1 pandemic, antiviral treatment within 2 days of symptom onset decreased the likelihood of ICU admission and resulted in fewer maternal deaths. 10,11 Therefore, initiation of treatment as early as possible and preferably within 2 days of the onset of symptoms is recommended by the CDC. There is recent evidence, however, that initiation of antiviral therapy more than 2 days from the onset of symptoms may still improve the course of disease.…”