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Swine flu hits pregnant women hard.

New research from Australia confirms that swine flu hits pregnant women particularly hard - especially if they have asthma, obesity or diabetes.

 While more than three-quarters of the women in the study had been treated with oseltamivir (Tamiflu), two-thirds had been sick for at least 48 hours before getting the drug.

Flu medication should be started as soon as possible after symptoms begin to give patients the most benefit, the researchers say.

Past studies have found that pregnant women with influenza may be at greater risk of complications like pneumonia, although the effects of the flu on the fetus are less well understood.

To investigate the effects of the H1N1 influenza A strain in pregnancy, the researchers looked at 43 pregnant women with lab-confirmed H1N1 admitted to six different hospitals during the 2009 outbreak.

Two women were admitted during their first trimester, 13 during their second and 28 in their third. Twenty-five had been hospitalized due to flu-like illness; all but one of these women spent less than a week in the hospital. But among the 11 patients admitted for pneumonia, seven were hospitalized for at least a week.

Half of the women had at least one other health problem, such as asthma, obesity, or diabetes mellitus, but these women did not seem to be at increased risk of pneumonia or pregnancy complications compared to women without other health problems.

Fifteen of the women delivered their babies during hospitalization, six before 37 weeks’ gestation and 9 at 37 weeks or later.

The researchers had outcome information on 24 babies at the end of July 2009. Twenty-one were alive, two had died in the womb (at 26 and 31 weeks’ gestation), and one died 26 days after delivery due to prematurity-related complications (this infant had been born at 26 weeks’ gestation). Seven of the babies, including the infant who died, were tested for H1N1, and none of them were infected.

The findings “underscored the importance of education regarding recommendations for vaccination in pregnancy and the need for rapid testing and earlier use of antivirals in suspected influenza,” Dr Michelle Giles of Monash Medical Center in Clayton, Victoria, and her colleagues wrote.

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