据4月21日刊JAMA上的一则研究披露，在美国，因患2009年甲型流感（H1N1）而死亡的人中，孕妇有着不成比例的更高的风险，而对患者施行早期的抗病毒治疗与ICU入住率和死亡率的下降有关。
Centers for Disease Control and Prevention, Atlanta的Alicia M. Siston, Ph.D.及其同僚对呈报给CDC的孕妇流感病例的数据进行了分析，她们的症状起病时间在2009年的4月至12月之间。在研究人员所检验的结果中包括了70个罹患2009年甲型流感（H1N1）的病例（其中包括住院、入住加护病房 [ICU] 以及死亡的病例），她们按照抗病毒治疗的时间选择以及在症状起始的时候所处的妊娠期而进行分层。
在最初的数据收集阶段（2009年4-8月），共有总数为788例的孕妇甲型流感（H1N1）被呈报。在这些人中，有30人死亡（占了2009年所报告甲型流感死亡总数的5%）。在509名住院妇女中，有115人（占22.6%）被ICU收治。那些在症状起始4天或更长时间之后接受治疗的孕妇，其被ICU收治的可能性比那些症状起始2天之内接受治疗者要高出6倍以上（56.9% vs. 9.4%）。
“在美国人口中，孕妇所占比例大约为1%，但她们在2009年上报给CDC的甲型流感（H1N1）在美国的死亡率中占了5%。在此报告的数据与以往的研究结果是一致的，这些研究证明孕妇罹患该流感之后出现严重病例及死亡的风险会增加。另外，延迟施与抗病毒治疗与疾病变得更为严重及发生死亡具有关联性，这种情况过去在季节性流感和2009年甲型流感（H1N1）中都有显示。而对患者进行早期治疗与病人患病时间缩短、症状严重性和死亡率下降及继发性并发症、住院率及抗生素的使用减少都有关联。我们的分析支持目前的针对孕妇的公共卫生方面的建议，这些建议包括了给她们接种2009年甲型流感（H1N1）的单价疫苗以及对可能罹患2009年甲型流感（H1N1）的病人给予抗病毒药物的早期治疗。”
文章的作者补充说，尽管有这些建议，但孕妇可能不愿意接受这些治疗，而临床医生看来也不愿意为其接种季节性流感疫苗。 “为了使孕妇接受进一步的治疗，有义务对孕妇以及她们的医生宣讲妊娠期间罹患流感的风险，并使他们了解接种疫苗既可防止季节性流感又可预防2009年甲型流感（H1N1）。”
原文出处：
JAMA. 2010;303(15):1517-1525.
Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Alicia M. Siston, PhD; Sonja A. Rasmussen, MD; Margaret A. Honein, PhD; Alicia M. Fry, MD; Katherine Seib, BS; William M. Callaghan, MD; Janice Louie, MD; Timothy J. Doyle, MPH; Molly Crockett, MPH; Ruth Lynfield, MD; Zack Moore, MD; Caleb Wiedeman, MPH; Madhu Anand, MPH; Laura Tabony, MPH; Carrie F. Nielsen, PhD; Kirsten Waller, MD; Shannon Page, BS; Jeannie M. Thompson, MPH; Catherine Avery, CFNP; Chasisity Brown Springs, MSPH; Timothy Jones, MD; Jennifer L. Williams, MSN; Kim Newsome, MPH; Lyn Finelli, DrPH; Denise J. Jamieson, MD; for the Pandemic H1N1 Influenza in Pregnancy Working Group
Context Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.
Objective To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.
Design, Setting, and Patients Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.
Main Outcome Measures Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.
Results We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%);
Conclusions Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.
