Perinatal outcomes after maternal 2009/H1N1 infection: national cohort study.
Perinatal outcomes after maternal 2009/H1N1 infection: national cohort study.
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DOI：
10.1136/bmj.d3214
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发表时间：
2011-06-14
期刊：
影响因子：
--
通讯作者：
UKOSS
中科院分区：
文献类型：
--
作者：
Pierce M;Kurinczuk JJ;Spark P;Brocklehurst P;Knight M;UKOSS
目的对确诊为2009/H1N1流感的妊娠期住院妇女进行跟踪调查，以获得妊娠结局的全貌，并估计胎儿和婴儿不良结局的风险。设计国家队列研究。在英国设立了221家设有产科医生主导产科病房的医院。参与者在2009年9月至2010年1月的第二波大流行感染期间，住院的256名确诊为2009/H1N1流感的孕妇；1220名孕妇作为对照。主要结果衡量死产、围产期死亡率和新生儿死亡率；感染妇女与对照妇女的优势比。结果感染孕妇所生婴儿围产儿死亡率(10/256‰，95%可信区间19~71)明显高于非感染者(9/1233，7/1000)(P<；0.001)。这主要是由于死胎率的增加(每1000名新生儿中有27名死胎，而每1000名总新生儿中有6名死胎；P=0.001)。感染妇女的婴儿也比对照妇女的婴儿更有可能早产(调整后的优势比为4.0，95%可信区间为2.7至5.9)。早产的感染妇女比足月分娩的妇女更有可能在妊娠晚期感染(P=0.046)，住进重症监护病房(P<；0.001)，以及继发性肺炎(P=0.001)。结论这项研究表明，感染2009/H1N1流感的妇女妊娠结局不良的风险增加，这强化了仅对母亲风险进行研究的信息。在未来一波又一波的流感大流行中，孕妇的健康是重要的公共卫生优先事项。
Objectives To follow up a UK national cohort of women admitted to hospital with confirmed 2009/H1N1 influenza in pregnancy in order to obtain a complete picture of pregnancy outcomes and estimate the risks of adverse fetal and infant outcomes. Design National cohort study. Setting 221 hospitals with obstetrician led maternity units in the UK. Participants 256 women admitted to hospital with confirmed 2009/H1N1 in pregnancy during the second wave of pandemic infection between September 2009 and January 2010; 1220 pregnant women for comparison. Main outcome measures Rates of stillbirth, perinatal mortality, and neonatal mortality; odds ratios for infected versus comparison women. Results Perinatal mortality was higher in infants born to infected women (10 deaths among 256 infants; rate 39 (95% confidence interval 19 to 71) per 1000 total births) than in infants of uninfected women (9 deaths among 1233 infants; rate 7 (3 to 13) per 1000 total births) (P<0.001). This was principally explained by an increase in the rate of stillbirth (27 per 1000 total births v 6 per 1000 total births; P=0.001). Infants of infected women were also more likely to be born prematurely than were infants of comparison women (adjusted odds ratio 4.0, 95% confidence interval 2.7 to 5.9). Infected women who delivered preterm were more likely to be infected in their third trimester (P=0.046), to have been admitted to an intensive care unit (P<0.001), and to have a secondary pneumonia (P=0.001) than were those who delivered at term. Conclusions This study suggests an increase in the risk of poor outcomes of pregnancy in women infected with 2009/H1N1, which reinforces the message from studies of maternal risk alone. The health of pregnant women is an important public health priority in future waves of this and other influenza pandemics.
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