Maternal and Fetal Outcomes in Pregnant Women Admitted to the Intensive Care Unit with A/H1N1pdm or SARS-CoV-2...

It is unclear if maternal and fetal outcomes of pregnant women admitted to the intensive care unit (ICU) with A/H1N1pdm and SARS-CoV-2 infection are different.

This retrospective study (2007-2022) included pregnant women admitted to the ICU with real-time reverse transcription polymerase chain reaction-confirmed A/H1N1pdm or SARS-CoV-2 pneumonia; non-viral pneumonia and incomplete records were excluded. The primary outcome was maternal mortality. Secondary outcomes included need for organ support, duration of ventilation, hospital stay, and fetal outcome. Predictors of maternal mortality were explored using multivariate logistic regression.

Fifty-six women (A/H1N1pdm = 42, SARS-CoV-2 = 14) were admitted to the ICU at a median (interquartile) gestational age of 32.3 (27.3-36) weeks. Gestational diabetes (p = 0.02), hypothyroidism (p = 0.04), hypertension (p = 0.09), and infertility treatment (p = 0.09) were more frequent among SARS-CoV-2 infected women. Time from symptom onset to ICU admission was 4 (3-5) days. Although APACHE-II scores were similar in both groups, a higher proportion of patients with A/H1N1pdm had tachycardia (87.8% vs 21.4%, p = 0.001), and their median oxygen saturation at admission was lower (89% vs 94%, p = 0.02). Ventilatory support (non-invasive and/or invasive support) was required in all A/H1N1pdm patients and 78.6% with SARS-CoV-2 (p = 0.013). Ventilation duration was 12 days (4-18) for SARS-CoV-2 and 4 days (2-7) for A/H1N1pdm (p < 0.001). The frequency of cardiac and renal dysfunction was similar in both groups. Maternal mortality was 21.4% in A/H1N1pdm and 28.6% in SARS-CoV-2; fetal loss was 16.7% and 26.3%, respectively. Four neonatal deaths occurred. Delayed hospital presentation independently predicted maternal mortality (OR: 1.8; 95% CI: 1.07-3.06).

Respiratory failure due to A/H1N1pdm and SARS-CoV-2 infections in pregnancy is associated with high maternal mortality and fetal loss. Delayed presentation is independently associated with maternal death.

Thomas VV, Nakkeeran G, Jacob KR, Chacko B, Moorthy M, Gowri M, et al. Maternal and Fetal Outcomes in Pregnant Women Admitted to the Intensive Care Unit with A/H1N1pdm or SARS-CoV-2 Infection: A Retrospective Study. Indian J Crit Care Med 2025;29(11):907-915.