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Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States. JAMA. 2010;303(15):1517–1525. doi:10.1001/jama.2010.479
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Author Affiliations: Epidemic Intelligence Service (Drs Siston and Nielsen), National Center for Immunization and Respiratory Diseases, (Drs Siston, Fry, and Finelli), National Center on Birth Defects and Developmental Disabilities (Drs Rasmussen and Honein, and Mss Seib, Williams, and Newsome), National Center for Chronic Disease Prevention and Health Promotion (Drs Callaghan and Jamieson), Centers for Disease Control and Prevention, Atlanta, Georgia; California Department of Public Health, Richmond (Dr Louie); Florida Department of Health, Tallahassee (Mr Doyle); Massachusetts Department of Public Health, Boston (Ms Crockett); Minnesota Department of Health, St Paul (Dr Lynfield); North Carolina Department of Health and Human Services, Raleigh (Dr Moore); Arizona Department of Health Services, Phoenix (Mr Wiedeman); New York State Department of Health, Albany (Ms Anand); Texas Department of State Health Services, Austin (Ms Tabony); Wisconsin Department of Health Services, Madison (Dr Nielsen); Pennsylvania Department of Health, Harrisburg (Dr Waller); Ohio Department of Health, Columbus (Ms Page); Oklahoma State Department of Health, Oklahoma City (Ms Thompson); New Mexico Department of Health, Santa Fe (Ms Avery); South Carolina Department of Health and Environmental Control, Columbia (Ms Brown Springs); Tennessee Department of Health, Nashville (Dr Jones).
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.
On April 21, 2009, the Centers for Disease Control and Prevention (CDC) reported that 2 children from southern California were identified with a novel influenza A virus infection.1 Since that time, the 2009 influenza A(H1N1) has rapidly spread worldwide, and on June 11, 2009, the World Health Organization raised the pandemic alert level to the highest level of 6.2 Although 2009 influenza A(H1N1) has generally been characterized as a self-limited uncomplicated infection, severe illnesses and deaths have been reported among some patients.3-5 Recent studies have shown that health conditions typically associated with risk for seasonal influenza complications were also found among individuals with 2009 influenza A(H1N1) admitted to an intensive care unit (ICU), including chronic lung disease, neurological disorders, diabetes, and pregnancy.4-6
Changes in the immune, cardiac, and respiratory systems are likely reasons that pregnant women are at increased risk for severe illness with influenza.7,8 During previous pandemics, mortality rates among pregnant women appeared elevated,9-12 and data from seasonal influenza demonstrate that pregnant women are at higher risk for hospitalization than women a year before pregnancy13 or 6 months after delivery.14 A study of pregnant US women with confirmed or probable 2009 influenza A(H1N1) during the first month of the outbreak as reported to the CDC showed that 11 of the 34 cases (32.4%) were hospitalized and that hospital admission rates for pregnant women were 4 times higher than those for the general population.15
The objective of this project was to further describe the effects of 2009 influenza A(H1N1) on pregnant women. We present data on all influenza cases of pregnant women reported to the CDC with symptom onset from April through August 21, 2009, including data on maternal characteristics, underlying illness, severity of illness, and maternal outcomes related to timing of antiviral treatment. In addition, we provide an update of all pregnant women with influenza who were admitted to an intensive care unit (ICU) or who died, with symptom onset from August 21 through December 31, 2009, who were reported to the CDC Pregnancy Flu Line by January 31, 2010.
On August 24 and 26, 2009, the CDC requested that all state health departments and the local health departments for Chicago, New York City, and the District of Columbia (N = 53) provide additional information on all pregnant women reported with confirmed or probable 2009 influenza A(H1N1) from the beginning of the outbreak in April 2009 through August 21, 2009, using a standardized case report form. A confirmed case was defined as an individual reported with acute respiratory illness and laboratory-confirmed 2009 influenza A(H1N1) by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) or viral culture. A probable case was defined as an individual with an acute febrile respiratory illness, a positive test for influenza A, and a negative influenza rRT-PCR test result for H1 and H3.16 The case report form included data elements to assess demographics, gestational age, underlying conditions, treatment, illness onset, and severity including hospitalization and maternal and infant outcomes. Gestational weeks at illness onset were computed as 40 weeks −(estimated delivery date −illness onset date)/7. Some jurisdictions chose to provide gestational age as either month of pregnancy or gestational weeks. For those women who delivered, gestational age at delivery was computed as 40 weeks −(estimated delivery date −actual delivery date)/7. Delivery at gestational age less than 37 completed weeks was categorized as a preterm delivery. Underlying conditions were entered as open text and were classified into the following categories: asthma, chronic lung disease, pregestational and gestational diabetes, obesity, thyroid disease, immune suppression, autoimmune disease, neurological disease, cardiovascular disease, hypertension, anemia, and other. Hospitalization was defined as admission and discharge dates occurring 1 or more days apart; patients with admission and discharge dates occurring on the same day were included in the analyses but were designated as not being hospitalized. Hospital length of stay was computed as (discharge date) −(admission date). Several health departments chose to provide hospital length of stay directly. Among hospitalized women, a yes, no, or unknown response was requested for ICU admission and mechanical ventilation. Hospitalized patients who were reported to have mechanical ventilation were classified as having received ICU care, even if ICU status was not provided on the report form. Maternal outcome was recorded by reporting jurisdictions as survived, died, or unknown. Delivery method included precoded responses: spontaneous vaginal delivery, vacuum-assisted vaginal delivery, forceps-assisted vaginal delivery, cesarean delivery, spontaneous abortion, or therapeutic abortion; and the following imputed responses: delivered—type unknown or estimated delivery date occurring on or before November 6, 2009, and not yet delivered or estimated delivery date occurring after November 6, 2009. Race/ethnicity was recorded based on abstraction of medical records by state and local health departments.
Demographic and clinical characteristics of women with severe outcomes (hospitalization, ICU admission, and maternal deaths) were assessed. However, because these groups are not mutually exclusive and therefore not independent (maternal deaths are a subset of ICU admission, and ICU admission is a subset of all hospitalizations), statistical tests comparing these groups were not performed.
Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for severe outcomes (hospital and ICU admission, mechanical ventilation, and maternal death) by timing of antiviral treatment: none; late, more than 4 days after symptom onset; intermediate, 3 to 4 days after symptom onset; and early, within 2 days of symptom onset. Stratified analysis for ICU admission or death among hospitalized patients was used to compare intermediate and late treatment with early treatment by pregnancy trimester at illness symptom onset. We decided a priori to use the early-treatment group as the referent instead of the no-treatment group because the latter includes pregnant women who might have had mild illness and recovered without treatment.
A significant amount of data on some variables was missing. Among the 465 women hospitalized with known ICU status, 153 (32.9%) did not have information on antiviral treatment or timing of treatment. Pregnancy trimester at illness onset was missing for 100 women, 73 (15.7%) of whom had intermediate or late treatment, resulting in their exclusion from the analysis of treatment timing by trimester.
States and municipalities provided de-identified information to the CDC electronically. Data were imported, merged, and analyzed using Microsoft Office Access version 2003 (Microsoft Corp, Redmond, Washington) and SAS version 9.2 (SAS Institute Inc, Cary, North Carolina). The Mantel-Haenszel χ2 test, and for small sample size comparisons, the Fisher exact test were used to test for statistical significance.
In mid-October 2009, the CDC Pregnancy Flu Line was launched, which requested reports from all state and metropolitan health departments of all severely ill pregnant women (ICU admissions and deaths) with confirmed influenza diagnosed by (1) a positive rapid test result, (2) rRT-PCR positive result for influenza, (3) direct or indirect fluorescent antibody assay, or (4) viral culture. Reports were requested for all cases with symptom onset after August 21, 2009. Case reports included maternal and infant diagnostic, treatment, and outcome data. Health departments sent reports via secure email, fax, or telephone. This includes all CDC Pregnancy Flu Line reports with symptom onset on or before December 31, 2009, and reported to the CDC by January 31, 2010. These cases were all assumed to be 2009 influenza A(H1N1) influenza, based on US virological surveillance suggesting that nearly all influenza activity during this time was 2009 H1N1.17
Data collection was conducted as part of public health response and was deemed exempt from review by an institutional review board.
During our initial period of data collection (April-August 2009), we received responses from 50 of the 53 state and local health departments contacted, which reported a total 788 cases. The number of total cases reported per health department ranged from 1 from 11 states to 135 from a single state. Two states reported no cases. The 48 health departments that reported at least 1 case covered service areas representing approximately 97% of all US births.18 Among the health departments reporting on pregnant women with 2009 influenza A(H1N1), 5 reported only on hospitalized pregnant women. The 3 health departments that reported the most cases—representing 37% of the total cases—reported that 92% of pregnant women with influenza in their jurisdictions had been hospitalized.
The most commonly reported racial-ethnic groups among 788 reported cases were Hispanic (32.8%), non-Hispanic white (22.7%), non-Hispanic black (19.1%), and Asian/Pacific Islander (5.7%; Table 1). Among the 30 deaths, 44.8% were non-Hispanic white, 27.6% were Hispanic, and 13.8% were Asian/Pacific Islander, and 6.9% were non-Hispanic black. Maternal median age was 25 (range, 14-43) years and was similar among patients who died (Table 1). Eleven states accounted for 76% of the pregnant women reported to the CDC, and 37% of the pregnant women with 2009 influenza A(H1N1) influenza reported from these states were of Hispanic ethnicity, the same proportion as observed among live births from these states.18
The earliest date of influenza illness onset was April 14, 2009, and the latest was August 21, 2009, the last day of the requested data collection. Of the 592 women with available information on trimester, 11.3% were in their first, 42.2% were in their second, and 46.5% were in their third trimester of pregnancy. Among the 30 women who died, 3 (10.0%) were in their first, 9 (30.0%) were in their second, and 18 (60.0%) were in their third trimester.
Health departments provided information on the presence or absence of underlying conditions for 432 pregnant women (54.8%), of whom 213 had 1 or more underlying condition (49.3%). The most frequently reported conditions were asthma (22.9%), obesity (13.0%), pregestational or gestational diabetes (6.7%), anemia (3.5%), and hypertension (3.0%; Table 1). Underlying conditions were more common among hospitalized women (55.3%), women admitted to the ICU (62.8%), and deaths (78.3%). Among pregnant women who died, asthma was the most common underlying condition reported in 10 (43.5%).
Among the 588 women for whom treatment information was provided, 509 (86.6%) received antiviral treatment; 492 (83.6%) of women received oseltamivir alone or in combinations with zanamivir, amantadine, or rimantadine. Thirteen women received zanamivir alone. The treatment among women admitted to the hospital or the ICU or who had died was distributed similarly. Information about the timing of treatment initiation was available for 384 patients (65.3%). Two hundred nineteen women (43.0%) received treatment early, including 2 women who received prophylaxis 1 and 2 days before illness onset; 84 (16.5%) received intermediate treatment; and 81 (15.9%) received late treatment (Table 1). Only 13 women (15.9%) in the ICU received treatment within 2 days and only 15 (18.3%) in 3 to 4 days. Among the women who died, only 1 received treatment within 2 days and 4 received treatment in 3 to 4 days. The median time to treatment initiation increased from 2 days among hospitalized patients to 5 days among patients in the ICU and to 6 days among patients who died.
Illness severity indicators included hospitalization, ICU admission, mechanical ventilation, and death (Table 2). Among those hospitalized, 115 (24.7%) were admitted to an ICU, and 77 (18.8%) received mechanical ventilation. Among 169 live-birth deliveries for which gestational age was known, 51 (30.2%) were preterm.
Sixty-eight percent of women receiving antiviral treatment early vs 79% of women receiving intermediate treatment were hospitalized (RR, 1.2; 95% CI, 1.0-1.3); 9% of hospitalized women receiving early antiviral treatment vs 23% receiving intermediate treatment were admitted to the ICU (RR, 2.4; 95% CI, 1.2-4.8); and 5% of hospitalized women receiving antiviral treatment early vs 17% of women receiving intermediate treatment required mechanical ventilation (RR, 3.8; 95% CI, 1.4-9.9; Table 3). Compared with 9% of hospitalized women receiving early treatment, 57% of hospitalized women receiving late treatment were admitted to the ICU, a 6-fold increased risk (RR, 6.0; 95% CI, 3.5-10.6), and they experienced 12-fold increased risk of mechanical ventilation (5% early vs 56% late treatment; RR, 12.3; 95% CI, 5.4-27.7). Compared with women receiving early treatment, those who received no treatment had no increased risk of being hospitalized (68% early vs 58% no treatment; RR, 0.8; 95% CI, 0.7-1.0), but they had an increased risk of ICU admission (9% early vs 35% no treatment; RR, 3.7; 95% CI, 1.9-7.2) and had an increased risk of mechanical ventilation (5% early vs 21% no treatment; RR, 4.7; 95% CI, 1.8-12.4), Women who received intermediate treatment were more likely to die than those who received early treatment (0.5% early vs 5.0% intermediate treatment; RR, 9.9; 95% CI, 1.1-87.2), whereas those who received late treatment were 54 times more likely to die than those who received early treatment (27% late vs 0.5% early; RR, 53.5; 95% CI, 7.3-391.7).
To further examine the association between antiviral treatment with illness severity and any interaction with pregnancy trimester, we stratified analyses for ICU admission among hospitalized women by trimester (Table 4). We combined all trimesters for an early-treatment group and used this as the referent. Women in the first and second trimester receiving intermediate treatment did not differ statistically from women who received early treatment; however, women in their third trimester who received intermediate treatment were 3.5 times more likely to be admitted to the ICU (95% CI, 1.7-7.4) than those treated early. Compared with women in any trimester treated early, women in the first trimester receiving late treatment had an increased risk of ICU admission in all 3 trimesters (RR, 8.0; 95% CI, 3.7-17.1) and those in the second and third trimester had a 6-fold increased risk of an ICU admission.
Among pregnant women with symptom onset from April 14 to August 21, 2009, 30 women died. During this same period, 593 deaths associated with 2009 influenza A(H1N1) were reported to the CDC (M. Jhung, MD, medical epidemiologist, Influenza Division, CDC, oral communication, February 25, 2010); thus, pregnant women represented 5% of these deaths.
Based on reports to the CDC Pregnancy Flu line (pregnant women with confirmed influenza with symptom onset after August 21 and on or before December 31, 2009), an additional 165 women were admitted to an ICU (including 26 deaths). Thus, in total from April through December 2009, 280 pregnant women (including 56 deaths) were admitted to the ICU due to 2009 influenza A(H1N1) reported to the CDC (eTable). Women with symptom onset in the third trimester accounted for a higher proportion of severe illness (49% of ICU admissions and 64% of deaths), but severe illness occurred in all 3 trimesters and 7% of deaths had symptom onset in the first trimester. In the first 4 months of the pandemic, 77 women admitted to the ICU (67%) received mechanical ventilation compared with 91 in the latter 4 months of the pandemic (55%; P = .09).
This report, which summarizes data on 788 pregnant women with confirmed or probable 2009 influenza A(H1N1) illness reported to the CDC from 50 of 53 state and local health departments, represents the most complete national description of the experience of pregnant women in the United States during the H1N1 pandemic, from April to August 2009. In addition, this report includes the first data to become available from the CDC Pregnancy Flu Line, showing a total of 280 ICU admissions and 56 deaths among pregnant women in the first 8 months of the pandemic. Although several series of pregnant women with 2009 influenza A(H1N1) have been reported,15,19-23 including a large case series from California21 and 1 from New York City24 included herein, a nationwide summary of infected pregnant women has not been published since early in the pandemic when a series of 34 infected pregnant women in the first month of the outbreak was reported.15
Pregnant women represent approximately 1% of the US population,15 yet they accounted for 5% of US deaths from 2009 influenza A(H1N1) reported to the CDC. The data reported herein are consistent with previous studies15,215,6,25 that demonstrate that pregnant women with influenza are at increased risk of serious illness and death. In addition, delayed treatment of antiviral therapy was associated with more severe illness and death as previously shown for both seasonal influenza and 2009 influenza A(H1N1), whereas early treatment initiation has been associated with reduced illness duration, symptom severity, mortality, and incidence of secondary complications, hospitalizations, and need for antibiotics.21,26-31 Our analysis supports current public health recommendations for pregnant women that include vaccination with 2009 influenza A(H1N1) monovalent vaccine32 and early treatment of women who present with possible 2009 influenza A(H1N1) with antiviral medications.33
Data from previous pandemics and seasonal influenza suggest that risk of influenza complications might be higher in the second and third trimester of pregnancy than in the first trimester.10,11,13,14 Consistent with this, we observed a higher proportion of ICU admissions and deaths occurring in the second and especially third trimester; however, pregnant women in all 3 trimesters were at increased risk of influenza-associated complications, especially when early antiviral treatment was not instituted.
Among hospitalized women, treatment administered within 2 days and from 3 to 4 days was associated with less severe disease. These data suggest that some benefit might be achieved even if treatment is delayed as many as 4 days after symptom onset,33 similar to data on hospitalized patients with seasonal influenza in which benefit is observed when treatment is initiated more than 48 hours after symptom onset.30 The reasons for delayed treatment are unknown but could indicate reluctance of pregnant women or clinicians to use antiviral medication because of concern for risk to the fetus, despite available evidence suggesting that treatment benefit likely outweighs the potential risk.34,35 In addition, although we did not collect information on date of presentation to medical care, some women may have delayed seeking medical care. Other reasons for delayed treatment could include inappropriate reliance on influenza diagnostic testing, such as rapid influenza diagnostic tests that have been shown to have low sensitivity (10%-70%) for the 2009 influenza A(H1N1) influenza virus.36-41 During the current outbreak, pregnant women with suspected influenza should be given empirical treatment as early as possible. Decisions regarding treatment should not be based on diagnostic testing, given issues with performance and timeliness of currently available tests.42
The proportion of women reported to have a condition (in addition to pregnancy) that would place them at higher risk for influenza-associated complications43 increased from 55.3% among hospitalized patients to 78.3% among those who died. The most common underlying condition was asthma, seen in 23.0% of hospitalized patients, 25.6% of ICU admissions, and 43.5% of deaths. The prevalence of obesity in our cases was slightly higher than that reported among women of childbearing age.44 Although limited information on obesity was obtained from health department reports, documentation of prepregnancy body mass index was unavailable, so the definitions of obesity during pregnancy are nonstandardized. Other studies have also suggested a higher than expected prevalence of obesity among hospitalized and severely ill patients with 2009 influenza A(H1N1),5,6,45 although many obese patients had other underlying conditions that placed them at higher risk.
Among women in our series for whom data on pregnancy outcomes were available, the rate of preterm birth (30.2%) was higher than the rate of preterm births (13%) reported nationally for the year 2007,46 consistent with data suggesting a high rate of preterm delivery during previous pandemics.11,12,47 However, it should be noted that complete follow-up on all pregnancy outcomes, which would be needed to produce an unbiased estimate of preterm births, was not available. In addition, pregnant women in our series had a higher rate of underlying conditions, which may have predisposed them to preterm delivery.
These data support recommendations of the Advisory Committee on Immunization Practices, identifying pregnant women as 1 of 5 initial target groups for the 2009 influenza A(H1N1) monovalent vaccine.32 Despite recommendations from the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists43,48 and from studies that show no evidence of increased maternal or fetal risk from immunization,49 pregnant women appear to be reluctant to receive50 and clinicians appear to be reluctant to offer51 seasonal influenza vaccination. Preliminary data from a time of limited vaccine availability, based on a survey of only 150 women, suggest that the uptake of 2009 influenza A(H1N1) vaccine among pregnant women (38%; 95% CI, 24%-52%) may be higher than that observed in previous years for seasonal influenza vaccine.52 To increase uptake further, pregnant women and their clinicians should be educated about the risks associated with influenza during pregnancy and made aware of the recommendations that vaccine can prevent illness from both seasonal influenza and 2009 influenza A(H1N1). Other strategies that might increase vaccination include instituting standing orders and reminder systems, and designating certain health care workers as vaccine champions.53,54
This study includes data on the largest number of pregnant women with 2009 influenza A(H1N1) influenza reported thus far; however, several limitations need to be considered. Our findings likely represent an underestimate of the total number of pregnant women with 2009 influenza A(H1N1) during this time period and an overestimate of the proportion of pregnant women with severe illness. It is likely that some reported cases of illness may not include relevant pregnancy status information, particularly among women in the first trimester who may be unaware of their pregnancy. Later in the study time period, confirmatory testing for 2009 influenza A(H1N1) influenza was limited to individuals with severe disease, and case-based reporting was limited to severe or hospitalized cases as the outbreak progressed and resources became limited. Therefore, the cases presented herein are likely an overrepresentation of severe cases. In addition, given that data were collected by public health authorities in the midst of a national public health emergency, the data requested were limited to an abbreviated data-collection instrument; thus, not all information of interest (eg, details of medical care provided, preexisting conditions, insurance coverage, socioeconomic status) was available for review. Although information on race and ethnicity was abstracted, it was not formally analyzed because we believe its distribution was reflective of the population of reporting states rather than a meaningful risk factor.
Another limitation is that data were often not available for all variables, especially for those not hospitalized; we noted that the level of missing data decreased as severity of illness increased. Missing information was highest for presence or absence of high-risk conditions and lowest for maternal age and hospital admission status. Missing data were also an issue for pregnancy outcomes, either because delivery had not yet occurred or because this information had not been reported to the health department. Finally, the numbers of cases available for some analyses, especially those related to treatment timing by trimester, were small and have sometimes resulted in unstable estimates.
In conclusion, based on data from the first 4 months of the H1N1 pandemic and corroborated by data through December of 2009, pregnant women are disproportionately represented among deaths due to 2009 H1N1. Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appears to be associated with fewer admissions to an ICU and fewer deaths.
Corresponding Author: Margaret A. Honein, PhD, 1600 Clifton Rd, MS E-86, Centers for Disease Control and Prevention, Atlanta, GA 30333 (firstname.lastname@example.com).
Author Contributions: Dr Siston had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Siston, Honein, Williams, Finelli, Jamieson.
Acquisition of data: Siston, Honein, Seib, Louie, Doyle, Crockett, Lynfield, Moore, Wiedman, Anand, Tabony, Nielsen, Waller, Page, Thompson, Avery, Springs, Jones, Williams, Newsome, Finelli, Jamieson.
Analysis and interpretation of data: Siston, Rasmussen, Honein, Fry, Callaghan, Doyle, Williams, Jamieson.
Drafting of the manuscript: Siston, Rasmussen, Finelli.
Critical revision of the manuscript for important intellectual content: Siston, Rasmussen, Honein, Fry, Seib, Callaghan, Louie, Doyle, Crockett, Lynfield, Moore, Wiedman, Anand, Tabony, Nielsen, Waller, Page, Thompson, Avery, Springs, Jones, Williams, Newsome, Jamieson.
Statistical analysis: Siston, Honein.
Obtained funding: Williams.
Administrative, technical, or material support: Rasmussen, Fry, Seib, Crockett, Nielsen, Williams, Newsome, Jamieson.
Study supervision: Honein, Williams, Finelli, Jamieson.
Financial Disclosures: None reported.
Members of the Pandemic H1N1 Influenza in Pregnancy Working Group: NYC 2009 Swine Flu Investigation Team (New York City Department of Health and Mental Hygiene); Utah Department of Health (Valoree Vernon, MPH); Rhode Island Department of Health (Robin Neale, CLS, CIC); Illinois Department of Public Health (Carol Gibson Finley); Washington State Department of Health (Mary Chadden); New Jersey Department of Health (Lisa McHugh, MPH); Chicago Department of Public Health (Kathleen Ritger, MD, MPH); Michigan Department of Community Health (Susan Bohm, MS); Virginia Department of Health (Keri Hall, MD, MS); State of Oregon, Public Health Division (Meredith Vandermeer, MPH); Nebraska Department of Health and Human Services (Robin M. Williams); Hawaii Department of Health (Sarah Park, MD, FAAP); Arkansas Department of Health (Haytham Safi, MD, MPH); Colorado Department of Public Health and Environment (Tracy Woodall, DVM); Nevada Department of Health and Human Services (Carmen P. Cruz, MD, MPH); Wyoming Department of Health (Reginald McClinton, MPH); Louisiana Department of Health and Hospitals (Julie Hand, MSPH); District of Columbia Department of Health (Garret R. Lum, MPH); Indiana State Department of Health (Matthew D. Ritchey, DPT, MPH); Kansas Department of Health and Environment (Daniel Neises, MPH); Vermont Department of Health (Influenza Working Group), Alaska Department of Health and Social Services (Donna Fearey, ANP, MS); Alabama Department of Public Health (Tina Pippin, RN, BSN); Georgia Division of Public Health (Ariane Reeves, RN, MPH, CIC); Iowa Department of Public Health (Meghan L. Harris, MPH, CPM); Idaho Department of Health and Welfare (James Colborn, PhD, MSPH); Kentucky Cabinet for Health and Family Services (Jayaram Srinivasan, MD); Maine Department of Health and Human Services (Sara Robinson, MPH); Mississippi State Department of Health (Theresa Kittle, MPH); North Dakota Department of Health (Jennifer Cope, MD, EISO); Centers for Disease Control and Prevention (Kitty MacFarlane, CNM, Shannon Hebert, MPH, Laura Hartman, MD, Kim Brinker, and Marianne Zotti, DrPH).
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Additional Contributions: We thank the following individuals and working groups for their extensive efforts in the surveillance of pregnant women with influenza, without which this investigation would not have been possible:
California Department of Public Health (Meileen Acosta, MPH, Kathleen Winter, MPH); Florida Department of Health (Leah Eisenstein, MPH, Kate Goodin, MPH, Janet Hamilton, MPH); Massachusetts Department of Public Health (Noelle Cocoros, MPH, Susan M Lett, MD, MPH); Utah Department of Health (Robert Rolfs, MD, Rachel Herlihy, MD, MPH); Minnesota Department of Health (Sara Lowther, PhD, MPH, Catherine Lexau, PhD, MPH, RN, Craig Morin, MPH); North Carolina Department of Health and Human Services (Nicole Standberry Lee, MPH); Arizona Department of Health Services (John Meyer, MPH, Cara Christ, MD, Laura Erhart, MPH); Rhode Island Department of Health (Influenza Working Group); Texas Department of State Health Services (Influenza Working Group of the City of El Paso Department of Public Health, Lesley Bullion); New York State Department of Health (Pregnancy and Influenza Working Group of Suffolk County Department of Health, Pregnancy and Influenza Working Group of Erie County Department of Health, Jamie Sommer, MPH); Illinois Department of Public Health (Craig Conover, MD, Debbie Richter, RN, BSN, Kymberly Haberman, BSW, MAED); Wisconsin Department of Health Services (Shaun Truelove, MPH, Jeannie Druckenmiller, CIC, Jeffrey P. Davis, MD); New Jersey Department of Health (New Jersey H1N1 Investigation Team); Chicago Department of Public Health (Fadila Serdarevic, MD, MPH, Omara Dogar, MBBS); Pennsylvania Department of Health (Maria Moll, MD, Ami Patel, PhD MPH); Michigan Department of Community Health (Susan Vagasky Peters, DVM); Virginia Department of Health (Office of Epidemiology); State of Oregon: Public Health Division (Melissa Powell, MPH); State of Connecticut, Department of Public Health (Maria T. Andrews, MPH, Randall S. Nelson, DVM, MPH, Alan J. Siniscalchi, MPH, MS); Oklahoma State Department of Health (Epidemiology Department of the Oklahoma City-County Health Department, Epidemiology Department of the Tulsa Health Department, Amy Rumsey, RN); , Nebraska Department of Health and Human Services (Douglas County Health Department Epidemiology Section, Sarpy/Cass Department of Health and Wellness Disease Investigation Unit, East Central District Health Department/Disease Surveillance and Investigation); South Carolina Department of Health and Environmental Control (Jennifer Assmann, RN, MS, Amy Roach, MPH); Hawaii Department of Health (Meera Sreenivasan, MD, MPH); New Mexico Department of Health (Influenza Surveillance Team, Mack Sewell, DrPH, MS, Joan Baumbach, MD, MPH, MS); Tennessee Department of Health (Robb Garman, MPH, Marion Kainer, MBBS, MPH); Arkansas Department of Health (Linda Gladden, RN, Margaret Holaway, RN); Colorado Department of Public Health and Environment, (Karen Gieseker, PhD,MS, Shaun Cosgrove, Jennifer Sadlowski, MSPH, Deborah Aragon, MSPH); Nevada Department of Health and Human Services (Denise Stokich, RN, BSN, Brian Labus, MPH); Wyoming Department of Health (Amber Erickson, MPH, Katie Bryan); District of Columbia Department of Health (A. Chevelle Glymph, MPH, Robin Diggs, MPH, Gabrielle Ray, MPH); Indiana State Department of Health (Shawn Richards); Alaska Department of Health and Social Services (Louisa Castrodale, DVM, MPH, Beth Funk, MD, MPH, Joe McLaughlin, MD, MPH); Alabama Department of Public Health (Sherri L Davidson, MPH); Iowa Department of Public Health (Patricia Quinlisk, MD, Diana L Von Stein, MPH); Idaho Department of Health and Welfare (Christine Hahn, MD, Leslie Tengelsen, DVM, PhD, Mike Taylor, MHE, CHES); Kentucky, Cabinet for Health and Family Services (Kraig E. Humbaugh, MD, MPH, Douglas A. Thoroughman, PhD, MS); Missouri Department of Health and Senior Services (Missouri Influenza Program) Mississippi State Department of Health (Peggy Oakes, RN, BSN, WHNP, Jannifer Anderson, RN, Mary Currier, MD, MPH); North Dakota Department of Health (Jill Hanson, Michelle Feist); and Centers for Disease Control and Prevention (Matthew Biggerstaff, MPH), none of whom received compensation beyond their normal pay.


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10 Budget Classics You Should Buy Now
There's a very serious debate going on in the muscle car world about the future of the hobby. Despite a recent, serious market correction in prices, most "headline" muscle cars–Hemi Mopars, Boss Mustangs, SS Chevys–are still valued beyond the reach of mere mortals who work for a living. That goes double for younger enthusiasts, who have watched helplessly as prices for those Detroit classics from the 1960s and early 1970s zoomed into the stratosphere.
It will likely be years before the Baby Boomers who drove up the prices age out of the hobby, and the market floods with countless big-block Camaros. That should drive down prices, but for those looking to enjoy a muscle car-era cruiser today, there are some left-of-center cars to consider. For the most part, their affordability lies in being an off-brand make or non-performance model–a regular Cutlass instead of a 442, for example.
We've compiled a list of what we believe are the best examples for affordable entries in the muscle car world. Besides being relatively cheap to buy into, the cars on our list also lend themselves to period modifications and more modern, pro touring-style upgrades. They'll drive like the more expensive top-line models, but at a substantially lower cost.
Of course, like everything in life, there's no upside without the corresponding downside. For these cars, their relative affordability means you're not likely to recoup your investment if you spend a great amount on restoration or modifications. A restored Cougar will never approach the value of a Mustang Boss 302, even if they've received similar investments in restoration.
Our advice is to find the best driver example you can, fix it up, modify it to your liking, and simply enjoy it. You'll spice up the local cruise night with something other than a red Chevelle SS, and you'll have just as much fun.
Listed prices were averaged from information at www.nadaguides.com. They are based on "good" condition examples–cars that are drivable and with no serious problems, but likely requiring attention commensurate with their age. The prices should be viewed as estimates, not hard-and-fast values.
1969-70 Mercury Cougar
With a slightly longer wheelbase than its Mustang cousin, the 1969-70 Cougar offers greater rear seat room, which is a strong consideration for an enthusiast with a family to share car events. But while their wheelbases differ, the rest of the drivetrain components are essentially identical between the Mustang and Cougar. That means you can use the plentiful and cheap Mustang resto parts for the engine, suspension, brakes, etc.–and all Cougars came with a V-8, so there's no worrying about swapping out a six. The Cougar also has a decidedly different body style, with features including hidden headlamps and sequential rear turn signals giving it distinction.
Like all Ford-produced cars of the era, the Cougar suffers from spotty build quality, so the interior trim must be carefully inspected for fit. Check the action of the heavy doors on their hinges, too. Rust is common in the lower body and the cowl area. Don't be surprised if headlamp doors are partially or fully up when you inspect the car, that's common. But they should close immediately when the engine is started. If they don't, there's a problem.
Convertibles are comparatively rare and therefore, more costly. XR7 models are more expensive and the top-end Eliminator model is among the top-shelf, expensive muscle car models.
1968-72 Pontiac T-37/Tempest/LeMans
The platform of a GTO, but without the price. That's the advantage of the lower-rung Pontiac A-bodies, and they make excellent automotive canvasses on which to express your automotive personality. No, not all of the GTO's engines were available in these cars, but they are easily swapped. But why even bother with that, when you can easily build a more powerful 400 or even 350 engine with readily available aftermarket parts. All of the other suspension/drivetrain parts are interchangeable.
Front-end styling is the biggest distinguishing difference between the GTO and its entry-level stablemates, but the Goat's nose is easily swapped if desired–just don't try to pass the car off as the real deal. As part of GM's A-body family, there are almost limitless options when it comes to modifying these cars, so the sky is the limit.
These cars were built in significant quantities, and many good, affordable examples are still out there. In fact, with the predominance of the GTO in the Pontiac world, the cars are largely overlooked in the market. Check for rust in the lower front and rear fenders, as well as around the rear window–especially if it has or had a vinyl top. Also, check for blue oil smoke at start-up. It's a common problem on Pontiac V-8s that indicates engine wear.
1968-70 Dodge Coronet and Plymouth Satellite/Belvedere
If you've watched any televised auctions or attended any in person in the last five years, you probably think that all Mopars are priced beyond reality. That's an understandable perception, but we're here to say there are still a few affordable options out there. The Dodge Coronet and Plymouth Satellite/Belvedere models share the same platforms as their more valuable cousins, but can still be had for comparatively reasonable prices.
The key to finding an affordable example is buying one with a Slant Six or 318 V-8 engine, as they were at the bottom end of the performance scale. The larger the engines, the more expensive Mopars get. Your biggest obstacle will be the well-heeled buyer who's looking for a cheap donor for a Hemi clone.
Keep your search to cars in or directly imported from the dryer climates of the western United States, because rust isn't merely a concern with these cars, it's a certainty. Also, if you buy a Slant Six-powered car and plan on a V-8 conversion, you'll need a V-8 K-member to mount it.
1979-81 Pontiac Trans Am
Once shunned by Trans Am aficionados, the 1979-81 Trans Ams are quickly gaining acceptance, thanks largely to affordability and styling that has come back into vogue. As part of the second-generation F-body platform, the body and interior are essentially the same as those introduced in 1970, but performance is what you'd expect for anything from the end of the decade.
No, the split headlamp design doesn't have the visual impact of the "Smokey and the Bandit" models circa 1977-78, and that's why the cars are so much more affordable–despite having essentially the same engine, suspension, and interior features. For the 1979 models, those with the Pontiac 400 engine (it was the engine's final production year) rather than the Oldsmobile-supplied 403 V-8 are worth substantially more to Pontiac purists, although performance between the engines is comparable. You can tell at a glance by the nomenclature on the shaker hood scoop: "T/A 6.6" means it's a Pontiac 400, while "6.6 Litre" means it's the Olds engine.
Second-gen cars weren't the best built, so find the lowest-mileage, most original example you can–and check to make sure nobody has screwed around with the original emissions equipment. T-top cars generally bring rattles and a general feeling of looseness. A low-mile, solid-roof 403-powered car is a great way to get the Trans Am experience for cheap.
1972-79 Ford Ranchero GT
This pick of ours is probably the most controversial, but it's also about the most affordable on the list. The Ranchero, of course, was Ford's car-based pickup that competed with the Chevy El Camino, but it was a lot less popular with enthusiasts. Make no mistake, these vehicles are large, heavy, and underpowered–but they accept any small-block or big-block Blue Oval engine you can think of with room to spare. They're also kind of good looking in that oddball, 1970s way.
There were base, Squire, and GT models offered, but the only thing distinguishing the GT models was their tape-stripe graphics. But they tended to be the best-equipped models, too, with 351 or 400M engines, Magnum-style wheels, and plush cabins. The GTs were made in large quantities, too, so they're easy to find.
As with all cars of the era rust is a concern, but these vehicles weren't the biggest rust buckets of their day. Look closer for heavily used and beat-up pickup beds. Carpet, graphics, and other fix-up parts are surprisingly easy to find, making a budget restoration cheap and easy. For $5,000-$6,000, you can easily have a show winner–and probably the only Ranchero GT in the show.
1971-74 Buick Skylark
As the accompanying photos show, these are the ultimate clone canvasses, with their affordability enabling modifications and personalization without affecting collector value. The Gran Sport (GS) and GSX models draw all the attention in the admittedly limited boundaries of the Buick realm. That means the non-performance models are all but ignored–except for restorers looking for a donor vehicle to assist in a GS/GSX project.
Like the Tempest and LeMans models mentioned earlier, the 1971-72 Skylark models share the GM A-body platform and benefit from the plethora of aftermarket parts for it. We've included the 1973-74 models here too, even though they're built on the different "Colonnade" platform. That's because the same reasons to purchase the A-body versions apply to the mid-1970s examples, too.
The biggest obstacle to Skylark ownership is finding one. Compared to the other GM intermediates, few have survived; and as mentioned above, many have been cannibalized for GS/GSX restorations. Check the common rust areas in the quarter panels and around the rear window. Resto parts basically don't exist for the Colonnade cars, so make sure you find an example that doesn't need much.
1969-72 Pontiac Grand Prix
Among the cars on our list, the 1969-72 Pontiac Grand Prixs are those most primed for a solid collector value bump upward. Right now they're affordable and relatively plentiful, and they make excellent drivers. In our opinion, the 1969-70 models with quad headlamps look better than the 1971-72 models with only a pair of headlamps, but all share long, classic body lines and excellent proportions. They look particularly good in black.
Pontiac's trusty 400, 428, and 455 engines were available in these full-size cruisers, although you'll logically pay more for the big-cube examples. Garden-variety, 400-powered cars are plentiful, and a mildly built version of the engine won't severely affect the car's value. In fact, it may enhance it to someone who can't find a 455-powered car.
Unfortunately, there aren't many restoration parts for these cars, so it's important to find one without a lot of needs. Locate yourself a low-mileage original and you're likely to make a wise investment.
1968-74 AMC Javelin
AMC's weapon in the pony car wars was the Javelin. It had a long, narrow proportion that gave the car a light-on-its-feet appearance, and it could be had with a variety of the company's V-8 engines–from the 304 to 390.
There are two generations of the car: the 1968-70 models and the curvier, 1971-74 models. Arguably, the later cars with their blistered fenders are more visually appealing, and they even offered the nameplate's most powerful engine–a 335-hp, 401 V-8. The earlier cars tend to bring more money, too, and the price spread for Javelins is quite wide. With comparatively few on the road, you're bound to have the only one at the car show, and you'll draw plenty of questions about it.
You'll be surprised at the number of parts available for the car, and frustrated by the number that aren't. The AMC world is a tightly knit one and once you're in the inner circle, you'll be able to get the information on the parts you need–if they're available.
1968-71 Ford Torino
Ford's midsize Torino just didn't have the cache of GM's intermediates and those Mopar midsizers–and to be honest, it still doesn't. But if you're a Ford guy that's just fine, because there are plenty of plain-Jane Torinos out there just begging for a healthy 351 swap, a set of Magnum 500s, and a Competition Orange paint job.
There are pricey, collectable examples of the Torino, especially any equipped with a 429, Drag Pak equipment, etc. You'll be warned off them by the high asking price, but your everyday 302-powered, ex-commuter special is dirt cheap. The 1968-69 and 1970-71 look vastly different, but are largely the same underneath. Also, both body styles offered fastback and more formal sedan styling. Not surprisingly, the fastback examples are more popular and pricier.
Like our advice for checking out Cougars, take a close look at the wear-prone parts, like the door hinges, interior controls, etc. You'll also want to check for rust in hidden areas, like the lower portions of the trunk.
1968-72 Oldsmobile Cutlass
The addition of the Cutlass completes our inclusion of all non-Chevy GM A-bodies on the list. Like the Buick and Pontiac models, the base Cutlass had the style and basic drivetrain in common with the popular 442 and Hurst Olds models, but in a plain brown wrapper.
It very easy to build a great looking, personalized Cutlass cruiser that mixes elements of readily obtainable restoration parts, including the 442 grille, graphics, and rear wing. Build yourself a healthy Olds engine to go with it and you'll experience everything of the originals, but at a much lower investment. You can also go the whole-hog hot rod route, such as the car in our accompanying photo, without worrying about drawing the wrath of purists.
Like all A-bodies, lower-panel rust and rear-window rust is common. It can also be difficult to find some trim parts, which may mean injecting some 442 elements is all but mandatory. That's not a bad thing, however, as a nicely detailed Cutlass will always draw a crowd.
Here are a few more bargain muscle cars that were this close to making our list–you might consider one of 'em!
Mercury Cyclone/Montego and Comet–The Cyclone/Montego is Mercury's version of the Torino, while the Comet matched Ford's Falcon (and later, the Fairlane). Good-condition drivers can be difficult to find, and restoration parts can be an even tougher problem. As our photos show, there are excellent examples out there, and they make great alternatives to the other cookie-cutter muscle cars of the world.
AMC Rambler–The Rambler is somewhat of a cult car. It's a very pedestrian vehicle, with very basic styling, but those traits have made it ironically popular with hot rodders looking for a low-cost foundation for their projects. It's just about impossible to kill the value with modifications, so have at it with these compact canvasses of personalization.
Published Dec 7th, 2015
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Very organized & easy to find a product website! I have bought item here in the past & am very satisfied! Thank you!
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This is a very nicely-done website and shopping for my 'Ashtavakra Gita' (a Bangla one, no less) was easy. Thanks!
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Thank you for making these rare & important books available in States, and for your numerous discounts & sales.
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Goodbye Saturn, Thanks for the Ride (1985-2010)
Note: As General Motors gets ready to shut Saturn's doors at the end of this year, I'd like to take a moment to look back at why the brand was created and how it evolved over the years, what made the cars and company so special to me, and also address some concerns about how Saturn's closure will impact the future of SaturnFans.com.
Later tonight the giant ball in Times Square will be lowered when the clock strikes twelve and 2010 will come to an end. It's been a emotional year for Saturn employees, owners, and fans; October 31st marked the end of General Motors' grand Saturn experiment. Of all the news articles I've written for SaturnFans.com over the past 15 years, this one has been by far the hardest for me to write. Saying goodbye is never easy, and this time is no different. To me Saturn was more than just another car or company: it represented a fresh approach to running a business, and more significantly, it was a symbolic entry in America's ideological battle against the best vehicles the "import" car companies had to offer.
A Different Kind of Car Collector
From Hagerty: The most interesting car collection you've never heard of lives in a subdivision just outside Princeton, New Jersey. Nestled between patches of bucolic farmland and aging equestrian stables, in the cool shadow of a nature preserve, the neighborhood looks like any other. Drive past too quickly and you might miss the vast horde of Saturns, fanned out in the driveway of a single house like paint swatches in a catalogue. Before that rainbow array of plastic body panels stands its caretaker, a soft-spoken 26-year-old woman named Jessieleigh Freeman. She fiddles with a scrunchie on her wrist and purses her lips as I wander, speechless, among the coupes, sedans, and wagons.
Former Spring Hill Saturn Plant to Build RHD GMC Acadia SUVs for Export to Australia
General Motors today earlier this week that it will invest $47 million in its manufacturing facilities in Spring Hill, Tennessee and Bay City, Michigan to prepare for future product programs. The combined investments will result in 230 retained jobs in the US. This is part of a $1 billion investment in U.S. manufacturing operations announced by the company in January.
SaturnFans Webmail Provider to Charge Annual Fee for E-Mail Accounts Beginning November 15th
Attention SaturnFans.com Webmail users! Our longtime webmail provider, Everyone.net, will be ending access to free email accounts on Tuesday November 15th, 2016. Subscribers who upgrade to their Mail Plus Total Protection service will continue to have access to their "@mail.saturnfans.com" email addresses and will not be impacted. While on a personal level I am disappointed in the decision, Everyone.net says this change is part of ongoing efforts to reduce email abuse and improve security.
General Motors to Build V8 Engines at the Former Saturn Plant in Spring Hill, Tennessee
GM says it will invest $148 million to repurpose flexible machining and assembly equipment at its Spring Hill Manufacturing plant to build V8 engines to meet market demand, retaining approximately 200 jobs. The investment will enable Spring Hill to quickly add capacity to build the Small Block 6.2L V8 engine in the popular truck and SUV segment. This will be the first time Spring Hill will build V8 engines. The 6.2L truck engine is currently available in the Chevrolet Silverado Crew Cab, GMC Sierra Crew Cab, Yukon Denali, Yukon XL Denali and the Cadillac Escalade and Escalade ESV.
How Saturnalia Helped Us Save $900
My girlfriend and I have been using the info on this forum to help troubleshoot problems with her '98 SL2 for some time. Recently, it's been going through a phase of needing some new parts, which is not all that surprising given the age of the car. When we took it back to a local shop after they replaced the tensioner pulley and belt a new problem arose - choking and stalling out.
Service Outage Alert
SaturnFans.com will be offline for a few hours tonight for some emergency server maintenance. Work will be done to fix issues related to degrading hard drive performance and should be completed by morning. Thank you for you understanding and support!
Stay Up-to-Date on the Latest Saturn News
If you're interested in keeping up with the latest news surrounding Saturn and the expansive Ion, Outlook, and Sky recalls, I invite you to subscribe to GMBeat's Saturn newsletter either by e-mail or through your favorite news reader. If you choose to receive e-mails, you'll get Saturn news delivered right to your inbox whenever news happens.
Have You Experienced the Ignition Switch Issue?
We're interested in talking to owners of 2003-2007 Saturn Ions who have had their ignition replaced or have experienced the engine shutoff problems. In addition, according the NBC News, there were also about 500 people in the country who were given one of the plastic plugs (shown above) a few years ago to put into their key ring from GM. Did anyone get one of these?


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Kelly Rowland Shows Off Her Baby Bump At Beyonce & Jay-Z 'On The Run' Tour
Kelly Rowland is pregnant and she's loving it.
The R&B singer showed off her growing baby bump last night in Miami while attending the "On The Run" tour concert with besties and hair stylist Larry Sims. In a white crop top and tight pencil skirt, Kelly looked fierce and fabulous.
Fans at the show snapped the mom-to-be greeting fans and watching the electrifying show.
Check it out!
Aww, look @ Kelly #OnTheRunTour pic.twitter.com/Fggw0ej1uH— Beyoncé Lite (@BeyonceLite) June 26, 2014


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Saturday, January 16, 2010
Geek (Chic?)
My first stop this afternoon was a salon on the Lower East Side called Pimps & Pinups, which I found by Googling "retro hair salon." (Jeff insists on calling it Pimps & Ho's, but who can blame him really?) I was very pleased when I met my stylist Michelle and she was wearing a 50s frock and a big, lovely roll on top of her forehead. Whew! I'd found my people.
Michelle really had her work cut out for her (ha, ha) as I hadn't had so much as a trim in over six months. I have thick hair that works its way into a dry tangly mess when I neglect it, which I most certainly had. I told Michelle I wanted a versatile cut that could be worked into a variety of retro 'dos. She recommended a blunt cut with some layers throughout. She also took off a couple inches of length and thinned it out, which was a revelation! My heavy mess of hair was suddenly manageable. She blew it out very straight so she could see the layers, but I confess I hate my hair in that style (Jeff was relieved to see my "underbrush" had been hacked off, but he joked that the blowout made me look like a yuppie.) It was fun to get home and play with it - I set it briefly in some big rollers and then did a Victory Roll on my forehead and twisted both sides back. I don't know if this is actually an authentic look from the 40s or some sort of weird hybrid, but I like it.
Next I stopped at MAC in Soho and bought a new matte lipstick: Lady Danger. (Great name, eh?) One of you lovely readers recommended it, and I'm absolutely loving it. It's much more orange than my usual Russian Red, and it's a nice change I think. This pic (with major flash action) shows the color the best:
Next I got a call from my optometrist saying my new glasses were in. I picked these out a couple weeks ago and was super excited to get them. I was going to go with my usual cateye shape, but then I (half-jokingly) tried these on. Jeff was smitten, and I loved the way they looked with red lips and a 40s 'do.
So here I am, totally made over! What do you think?
56 comments:
- AnonymousJanuary 16, 2010 at 7:06 PM
Gertie! You're a doll!ReplyDelete
But Gertie- your hair in that "About Me" picture is luscious, thick, and beautiful. I am never for thinning hair.
But you do look lovely. You always do!
You look great, I wish I could pull off that look!ReplyDelete
You look great! I love your glasses!ReplyDelete
Anna, Italy
Wow, I am spectacularly jealous!! I tried frames like that but ooh, unfortunate. They look gorgeous on you though; good eye Jeff!ReplyDelete
HUGE fan of those glasses. You need to be carrying a stack of library books lashed together with a leather belt.ReplyDelete
Great look on you.ReplyDelete
You look great! Love the red lipstick.ReplyDelete
Absolutely gorgeous! I wish I had glasses like that! Love the hair.ReplyDelete
you look amazing! so pretty. what brand are the glasses?ReplyDelete
I'm with Imogen--what brand ARE your glasses? I'm in the market for the same style.ReplyDelete
Please tell us? Pretty please?
Lovely! By the way, how long are your bangs? I am growing out Bettie bangs and would love to have them long enough to do a front roll like yours.ReplyDelete
Love. It!!!ReplyDelete
My DH just ordered prescription Ray Bans that are similar to that shape, but in a deep blue. I can't wait to see him in them.
I love that red on your, too. And the hair!
wow, who knew you needed a makeover? I thought you looked great already. But yes, your new pampering paid off and you look posh!ReplyDelete
Thanks, ladies! You're so sweet. I'll tell you the brand of glasses, even though it's embarrassing: John Lennon brand glasses. Can you believe that? The model number is JLS Retro 03.ReplyDelete
Tart Deco, my bangs are about nose-level now. They're kind of tapered to the side rather than blunt, which I think helps incorporate them into the rest of the hair.
- AnonymousJanuary 16, 2010 at 10:34 PM
The new lighter red will be perfect for spring/summer!ReplyDelete
I'm a chunky specs devotee, so I am wholly in favor of yours! I bought a pair of vintage frames from a dealer at the Brimfield antique fair - they are late 40's/50's Leonardo brand (Spanish). I love to wear them with a prim outfit at my rather conservative job. I think the juxtaposition between the tougher frame makes a ladylike outfit look even more chic - and much cooler. Have fun with yours! I recall you saying a long time ago that you didn't like to wear your glasses - I bet you won't be able to take these ones off!
My dear, you look perfect!!! I'm so happy for you - and a tad jealous.ReplyDelete
Those glasses are just too good on you! It's as if they were made for your face. And your hair and makeup look beautiful, too.
- AnonymousJanuary 16, 2010 at 10:46 PM
You look so of the 40's era. Your hair and glasses go well with your face. You are very beautiful.ReplyDelete
Fantastic look! I'm totally jealous of your new glasses, they really complete the look!ReplyDelete
Jeff is right to be smitten! I love those frames on you and both your hair and lipstick look terrific!!ReplyDelete
Gertie! You are so lovely! The glasses were a wonderful choice, and the hair looks great. I, like jm, miss your thicker hair, but I know how much of an annoyance that can be! Thinner looks fabulous too. Great makeover!ReplyDelete
You look lovely, and your hair really suits you that way. Your hair sounds similar to mine in thickness, and I'm trying to grow mine out at the moment from a short bob. I don't know how you managed not to get yours trimmed for 6 months, mine's driving me barmy!ReplyDelete
You look gorgeous. Of course, you always do.ReplyDelete
Lovely! And I adore those glasses!ReplyDelete
You have such beautiful skin! I love the new do, glasses, and lipstick!ReplyDelete
Seriously hot! And what a wonderful blog you have here...ReplyDelete
OMG. You've turned into Louis Lane. I always loved her in superman!ReplyDelete
cute! I love lady danger but its way too orange for my skin tone. I am forever a Ruby Woo girl. your glasses are so cute as well! I went looking for some vintage glasses at Old focal in Pasadena... no luck... My heart couldn't commit! Those look great on you though! I have some Ray bans turned into eye glasses and everyone loves them.ReplyDelete
You always look gorgeous, polished, and very cute. Today's photos are lovely. I have to admit though I had pangs of jealousy when I saw your hair in the tissue-fitting vlog because it was long, thick AND lustrous - and I'd just had mine cut above my shoulders!ReplyDelete
I'm getting more and more envious of that hair of yours... But I've haven't had long hair for over 15 years (oooh, that made me feel really old, but I cut my hair from bob to short when I was 14), and have been determined not to have long hair again... You're making me reconsider!!!ReplyDelete
Love the lipstick as well, and the glasses. Geeky chic is the best look!!
You look fantastic! I love your new glasses.ReplyDelete
Great look! I'm hoping to get a retro haircut soon. It's fantastic you found a retro salon in the city!ReplyDelete
I love the lipstick. Orangey reds are so pretty.ReplyDelete
- AnonymousJanuary 17, 2010 at 7:27 AM
You look lovely! It's just a different look from before. I did find your previous frames sassy, and to my uniniated eyes they provided more interest in interaction with your hair and dress style. These also suit you, of course :)ReplyDelete
Can I pimp the website that saved the condition of my own hair? forums.longhaircommunity.com. AND it's populated by lovely people. (The best of them hang out in the blogs and the friendship board.)
- melissaJanuary 17, 2010 at 9:08 AM
love the new glasses~very madmen and you pull it off so well! i am also a lady danger fan (in addition to ruby woo). for everyday wear, i've been in love with tarte's 24/7 lip sheer lip balm in monday. surprisingly pretty for a lip balm with lots of moisturizers in it. perfect for winter.ReplyDelete
- AnonymousJanuary 17, 2010 at 9:11 AM
I came back to clarify. Because I would feel soooo badly if I put the slightest crimp in your pleasure over your haircut. Because you do look beautiful.ReplyDelete
So let me 'splain:
Your hair is a wonder of nature. You don't pave the Grand Canyon to make it easier to cross, do you?
Think Rita Hayworth, Ava Gardner.
But I am so sorry, Gertie, if I took any fun away from your makeover.
Gertie, you look utterly adorable!ReplyDelete
Wow! I'm a fellow cat-eye lover/wearer, but those glasses sure caught my eyes! (pun unintended but appropriate!)ReplyDelete
I'm v. jealous about the glasses - I wear geeky thick rimmed rectangular tortoiseshell specs but feel inspired to try out a more retro style...
jm, I hear ya! I think the theory behind thinning is that it keeps heavy hair from looking weighted down, so when you curl it, it actually looks fuller. It is looking rather thin now, but that's because it was blown out bone straight yesterday. We'll see how it looks when it's curled. And hey - it's just hair. It will always grow back!ReplyDelete
You look AMAZING!!! I want that lipstick badly and the specs and hair are fantastic, really suits you.ReplyDelete
Oh! I just want to bop you on the head and steal your glasses! I've been in need of new glasses for so long...ReplyDelete
Cute Cute Cute! Definitely a great look for you - and I must sday you are channeling Kim Kardashian on photo #2ReplyDelete
Very chic! I love your style and the new glasses look great on you. I really like my short(ish) hair, but your beautiful pics make me want to grow it long again and try out pincurls and victory rolls!ReplyDelete
Love the new glasses. My husband has similar ones. I just bought new glasses yesterday and desperately tried to find black retro ones but alas, they are just too dark for my pale skin and light hair. Super cute on you though.ReplyDelete
Love the hair and the glasses!ReplyDelete
Have just found your blog through another blog. Why have I not been told about this before?! Glad to have found you now-it's wonderful.ReplyDelete
Liked the old glasses, like the new! I'm sure you're enjoying the change.ReplyDelete
And I think the very nice posters bemoaning your/your stylist's choice to thin don't have to deal with thick wavy hair...gotta hack out the underbrush to a) get more bounce for the ounce and b) enhance styling!
[One can thin without losing length, too.]
I LOVE your new glasses! Classic and stylish!ReplyDelete
- AnonymousJanuary 18, 2010 at 4:17 PM
Fab-u-lous! Geek chic ROCKS!ReplyDelete
Hey, this is the stylist that Cut Gertie! Thanks for the write up!ReplyDelete
I'll explain here the benefits to thinning. I understand many people can overly thin hair but in this case there are several reasons why I chose to. Because the cut is more blunt on the ends thinning a little can keep the hair from getting a triangular shape. (meaning heavy looking on the bottom.... very 80's.... ICK!) Also, Gertie has very thick hair and a little thinning will also make it a TON easier to style while also adding some longevity to the cut.
I don't thin every cut as it's not always necessary for everyone.
Great glasses Gertie and thanks again!
I thought I recognized Lady Danger. Looks fabulicious on you. You've inspired me to see if I can schedule a makeover at MAC when I am in Phoenix this week.ReplyDelete
By the way, you would look keen and sexy in my Schiap specs.
You look gorgeous with that new haircut and glasses!!! :D (Says she who needs both desperately... it's been 6 months since I got my hair cut too. Yikes!) I really love the look of the frames especially.ReplyDelete
Also: I'm excited to see how Lady Danger looks on you! I've been eying that shade for months (but haven't tried it because the MAC counter at Dillards is staffed by crappy sales people, and I haven't dragged myself downtown to the MAC store). Now I have to try it! ;)
♥ Casey
blog | elegantmusings.com
you are SUUUUUUUUPER pretty!ReplyDelete