CLINICAL ARTICLE Pandemic (H1N1) 2009 virus infection during pregnancy in South India Angsumita Pramanick a, ⁎, Swati Rathore a , John V. Peter b , Mahesh Moorthy c , Jessie Lionel a a Department of Obstetrics and Gynecology Unit III, Christian Medical College Hospital, Vellore, India b Department of Medical Intensive Care, Christian Medical College Hospital, Vellore, India c Department of Clinical Virology, Christian Medical College Hospital, Vellore, India abstract article info Article history: Received 23 July 2010 Received in revised form 7 October 2010 Accepted 23 December 2010 Keywords: Fetal Maternal Mortality Pandemic influenza Pregnancy Objective: To assess the clinical profile of pregnant/puerperal women from a semi-urban Indian population who were infected with pandemic (H1N1) 2009 virus (P[H1N1]2009v) and to evaluate their outcome. Methods: In a cross-sectional study, 566 women (79 pregnant/puerperal, 487 nonpregnant) who presented to a tertiary care hospital with influenza-like illness were tested for P(H1N1)2009v by real-time reverse transcriptase polymerase chain reaction. Outcomes measures were the maternal mortality and the perinatal mortality rate (PMR). Results: Twenty (25%) pregnant/puerperal and 144 (30%) nonpregnant women tested positive for P(H1N1)2009v, with 5 pregnant and 3 postpartum women requiring admission to the intensive care unit (ICU). P(H1N1)2009v- related mortality was higher in pregnant than nonpregnant women (25% versus 8%; P =0.04). In the pregnant/ puerperal cohort, factors associated with death included delayed presentation (median 6 days versus 1.5 days in survivors; P =0.007), need for ICU admission (P =0.004), need for ventilation (P =0.001), and renal failure (P =0.001). The PMR was 55.5/1000 births compared with 33.5/1000 births in the hospital overall during the study period. Conclusion: In a low-income country, P(H1N1)2009v infection in pregnancy is associated with considerable mortality. Delayed presentation to a tertiary care center, lack of awareness, and restricted access to treatment might have contributed to the high mortality. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction Pandemic (H1N1) 2009 virus (P[H1N1]2009v) infection manifests as a mild influenza-like illness (ILI) in the majority of cases. In some people, infection results in pneumonitis and severe acute respiratory distress syndrome, which may be difficult to manage despite advanced ventilator techniques [1]. As with previous pandemics and seasonal influenza epidemics, pregnant women were identified as a group at risk of increased morbidity [1]. An analysis of New York City P(H1N1)2009v hospital admissions between May and June 2009 [2] found that pregnant women were 7.2 times more likely to be hospitalized and 4.3 times more likely to require admission to the intensive care unit (ICU) than nonpregnant women did. In low-income countries such as India, where 80% of the population live in rural areas with no structured healthcare system, there is often a delay in seeking health care. Compounding this problem is the fact that, within the nuclear family, women are often discriminated against receiving inadequate or delayed attention during illnesses in prefer- ence to male members and children in the family. These additional factors are likely to have an effect on outcomes in epidemics in low- income nations. The present study evaluated the clinical profile of pregnant women with P(H1N1)2009v infection and assessed maternal and fetal mortality as a consequence of P(H1N1)2009v infection in a semi-urban Indian population presenting to a tertiary care hospital during the first 6 months of the 2009 H1N1 pandemic. 2. Methods This retrospective cross-sectional study, conducted from August 5, 2009, to January 31, 2010, included pregnant and postpartum women who presented to the Christian Medical College Hospital in Vellore, India, with ILI or severe acute respiratory infection (SARI) and who tested positive on a real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay specific for P(H1N1)2009v (Centers for Disease Control and Prevention protocol [3]). Postpartum women were included if they had given birth up to 2 weeks before study entry, consistent with the inclusion criteria in another report [4] on P (H1N1)2009v infection in pregnant/postpartum women. The patients were identified by review of an electronic laboratory database of patients tested for P(H1N1)2009v. A case was defined as a pregnant/ postpartum woman who had ILI/SARI and a positive RT-PCR test for P (H1N1)2009v. A fatal case was defined as one with ILI/SARI symptoms and a positive RT-PCR test in whom P(H1N1)2009v infection was the attributed cause of death. Demographic and clinical data were collected by review of medical records. Data on the nature and duration of symptoms were obtained by International Journal of Gynecology and Obstetrics 113 (2011) 32–35 ⁎ Corresponding author. Department of Obstetrics and Gynecology Unit III, Christian Medical College, Vellore 632004, India. Tel.: +91 4162283399; fax: +91 4162232035. E-mail address: angsumita@gmail.com (A. Pramanick). 0020-7292/$ – see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2010.10.025 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo