OBJECTIVE: To determine and analyze the demographic data, clinical, presentation and course, as well as maternal and neotal outcome of pregnant Filipino patients with influenza-like illness (ILI) versus confirmed cases of Influenza AH1N1 during the 2009-2010 pandemic who presented at the Influenza-like-illness (ILI) Clinic at a tertiary hospital in the Philippines from May 2009 until February 2010.
DESIGN: Cohort study
SETTING: The Medical City
PATIENTS: Pregnant patients who presented with influenzalike illness (ILI) and were seen at the Influenza-like-illness (ILI) Clinic from May 2009 until February 2010.
METHODOLOGY: This is a cohort study that reviewed the charts of pregnant patients who presented with influenza-like illness, diagnosed as Case under Observation (CUO) at the Influenza-like Illness (ILI) Clinic at The Medical City, from May 2009 until February 2010. The pregnant patients were classified into two groups: those who tested positive and those who tested negative to the H1N1-rRT-PCR (realtime reverse transcriptase polymerase chain reaction) throat swab test. Demographic characteristics, course and management of illness as well as prenatal and peripartum course were compared between the two groups. Followup was also done by phone calls. Any history of preterm labor, hospital admissions, respiratory illness, and complications were gathered. Maternal and neonatal outcome were documented including mode of delivery, birthweight, maturity and any neonatal complications.
MAIN OUTCOME: Pregnant women presenting with influenzalike illness (ILI) and confirmed Influenza A H1N1 infection have a higher rate of hospital admission (59.1% and 61.5%) compared to non-pregnant women of reproductive age (19.1% and 29.4%) with similar conditions (P = 0.05). Pregnant women who presented with influenza-like illness and with a positive throat swab result were significantly younger than those with negative results, with a 2.25 times higher risk for pregnant women aged 30 years old to have a positive throat swab test result (RR - 2.25; 95% CI = 1.08-4.67; P = 0.005). Difficulty of breathing was significantly more common among those with negative throat swab test result (44.4%) (P = 0.02). Association between the types of specimen collected with throat swab test results among pregnant patients with ILI showed a significantly higher proportion of subjects to have a positive result with nasooropharyngeal samples (P = 0.03).
CONCLUSION: Pregnant women with influenza-like illness (ILI) and confirmed cases of Influenza A H1N1 have a higher rate of hospitalization compared to non-pregnant women of reproductive age with similar conditions. Pregnant women who presented with influenza-like illness and with a positive throat swab result were significantly younger than those with negative results. Difficulty of breathing was significantly more common among those with negative throat swab test result. A significantly higher proportion of subjects have a positive result with naso-oropharyngeal samples. The issue of protecting the Filipino pregnant women from this vaccine-preventable disease remains a challenge to every healthcare worker in this country.