Pandemic Influenza and Pregnant Women

Abstract

Planning for a future infl uenza pandemic should include considerations specifi c to pregnant women. First, pregnant women are at increased risk for infl uenza-associated illness and death. The effects on the fetus of maternal infl uenza infection, associated fever, and agents used for prophylaxis and treatment should be taken into account. Pregnant women might be reluctant to comply with public health recommendations during a pandemic because of concerns regarding effects of vaccines or medications on the fetus. Guidelines regarding nonpharmaceutical interventions (e.g., voluntary quarantine) also might present special challenges because of confl icting recommendations about routine prenatal care and delivery. Finally, healthcare facilities need to develop plans to minimize exposure of pregnant women to ill persons, while ensuring that women receive necessary care.

Increased Proinflammatory Responses of Monocytes and Plasmacytoid Dendritic Cells to Influenza A Virus Infection During Pregnancy

“…The enhanced morbidity and mortality are particularly prominent during pandemics, yet they also occur with annual seasonal influenza [2]. The degree to which alterations in the immune system during pregnancy contribute to this increased morbidity and mortality remains unclear.…”

Faut-il avoir peur de la grippe chez la femme enceinte ?

“…La virémie est très inconstante au cours de la grippe saisonnière, tout comme la transmission transplacentaire au foetus (revue dans [19]). À l'inverse, plusieurs cas de passage transplacentaire du virus H5N1 ont été documentés [20], par la présence d'ADN viral dans le cytotrophoblaste [21].…”

“…Certains modèles murins fondés sur l'inoculation intranasale de virus grippal à des souris BALB/c ont permis de mettre en évidence des modifications morphologiques cérébrales dans la descendance des animaux, avec notamment un amincissement du néocortex, de l'hippocampe, une atrophie des cellules pyramidales ainsi que des modifications comportementales [25]. Bien que l'association entre survenue d'une infection grippale maternelle et schizophrénie ou maladie de Parkinson dans la descendance ait été évoquée (revue dans [19]), aucune démonstration de cette association n'a été à ce jour apportée. [29].…”

Replication of influenza A virus in swine umbilical cord epithelial stem-like cells

“…Available data indicate that several influenza viruses including the highly pathogenic avian influenza H5N1 and 2009 H1N1 influenza virus infected pregnant women resulting in either their death, abortion or affected the fetal development. [12][13][14][15] Although not fully established, a few studies in humans and pigs speculated the vertical transmission of influenza virus from mother to fetus. [16][17][18] Pig's anatomy, physiology and immunology closely resemble to humans; therefore, pigs are useful large animal model for evaluating stem cell therapy in a preclinical model.…”