Mortalidad materna e Influenza A H1 N1

Cómo explicar la mortalidad materna en la epidemia de Influenza A H1 N1
La epidemia del virus H1N1 en la Argentina sorprendió afectando gravemente a mujeres embarazadas o puérperas. Entre ellas se contabilizaron los primeros casos fatales. Esta característica no se destacaba en las series de casos mejicanos y norteamericanos y recién ahora se lo cita en los informes epidemiológicos. En Argentina aparentemente hay 12 muertes maternas por neumonías sucedidas en las últimas cuatro semanas y habría dos casos más por confirmar, que las elevarían a 14 muertes maternas por neumonías ( 1 ).
En el hospital nacional de Antigua Guatemala, Sacatepéquez, Guatemala, el Jefe del Intensivo reporta verbalmente una muerte por Influenza A H1 N1 confirmada por laboratorio (2 ).

Cambios inmunitarios en el embarazo
The normal course of pregnancy is associated with a variety of changes in humoral and cellular immunity, such as a loss in CD4+ cells and other alterations in T-cell subsets. Reports on T-cell subsets during pregnancy have been conflicting. Some studies have found a progressive fall in the CD4+ count throughout pregnancy, from a mean of 950 cells/ml before 18 weeks to 720 cells/ml at term. Others have either reported a U-shaped CD4+ cell count profile during pregnancy, with a minimum at approximately 32 weeks of gestation (CD4 of 30% and a CD4+ count of 876 cells/ml), or have found stable CD4 levels and CD4:CD8 ratios during pregnancy with a rise (rebound) afterwards. Such differences may be attributable to different methodology (manual fluorescence microscopy versus automated flow cytometry), to differences in study populations or to the fact that blood was taken at different times during pregnancy. The altered immune status of pregnant women may also alter the response of the host to infectious agents.
Despite conflicting laboratory data, most studies agree that the humoral immune response in pregnancy is similar to that in nonpregnant women but that the cellular immune response is diminished. Mortality rates of, for example, pneumococcal pneumonia, malaria or influenza have been found to be higher in pregnant than in nonpregnant women ( 3 )
Bibliografia:
1.- Medardo Ávila Vázquez es Medico, Ex subsecretario de Salud de la ciudad de Córdoba. (especial para ARGENPRESS.info). Jueves 06/08/2009 14:11
2.- Comunicciòn verabal del Dr. Erick Yoc, Médico Internista y Neumólogo, Jefe del Intensivo del Hospital Pedro de Bethancourt de la Antigua Guatemala, Sacatepéquez, Guatemala.
3.- Cohen & Powderly: Infectious Diseases, 2nd ed. Copyright © 2004 Mosby, An Imprint of Elsevier Chapter 64 – Complications of Pregnancy: Maternal Perspectives. Marleen Temmerman