Annette K Regan1, Becca S Feldman2, Eduardo Azziz-Baumgartner3, Allison L Naleway4, Jennifer Williams5, Brandy E Wyant6, Kim Simmonds7, Paul V Effler8, Stephanie Booth9, Sarah W Ball6, Mark A Katz10, Rebecca V Fink6, Mark G Thompson3, Hannah Chung11, Jeffrey C Kwong11, Deshayne B Fell12. 1. Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, 1266 TAMU, College Station TX 77843-1266, United States; School of Public Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia. Electronic address: a_regan@tamu.edu. 2. Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel. 3. Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States. 4. Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States. 5. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States. 6. Abt Associates Inc, Cambridge, MA, United States. 7. Alberta Health, Edmonton, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada. 8. Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA, Australia. 9. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada. 10. Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel; Ben Gurion University of the Negev, Beersheba, Israel; University of Michigan School of Public Health, Ann Arbor, MI, United States. 11. ICES, Toronto, Ontario, Canada. 12. ICES, Toronto, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Abstract
OBJECTIVES: Findings during the 2009 pandemic suggest severe maternal infection with pandemic influenza had adverse perinatal health consequences. Limited data exist evaluating the perinatal health effects of severe seasonal influenza and non-influenza infections during pregnancy. METHODS: A retrospective cohort of pregnant women from Australia, Canada, Israel, and the United States was established using birth records to identify pregnancies and birth outcomes and hospital and laboratory testing records to identify influenza and non-influenza associated acute respiratory or febrile illness (ARFI) hospitalizations. ARFI hospitalized women were matched to non-hospitalized women (1:4) by country and season of conception. Log-binomial regression was used to estimate the relative risk (aRR) of preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW) birth, adjusting for pre-existing medical conditions, maternal age, and parity. RESULTS: 950 pregnant women hospitalized with an ARFI were matched with 3,800 non-hospitalized pregnant women. Compared to non-hospitalized women, risk of PTB was greater among women hospitalized with influenza-associated ARFI (aRR: 1.57; 95% CI: 1.15-2.15) and non-influenza ARFI (aRR: 2.78; 95% CI: 2.12-3.65). Similar results were observed for LBW; there were no associations with SGA birth. CONCLUSIONS: ARFI hospitalization during pregnancy was associated with increased risk of PTB and LBW.
OBJECTIVES: Findings during the 2009 pandemic suggest severe maternal infection with pandemic influenza had adverse perinatal health consequences. Limited data exist evaluating the perinatal health effects of severe seasonal influenza and non-influenza infections during pregnancy. METHODS: A retrospective cohort of pregnant women from Australia, Canada, Israel, and the United States was established using birth records to identify pregnancies and birth outcomes and hospital and laboratory testing records to identify influenza and non-influenza associated acute respiratory or febrile illness (ARFI) hospitalizations. ARFI hospitalized women were matched to non-hospitalized women (1:4) by country and season of conception. Log-binomial regression was used to estimate the relative risk (aRR) of preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW) birth, adjusting for pre-existing medical conditions, maternal age, and parity. RESULTS: 950 pregnant women hospitalized with an ARFI were matched with 3,800 non-hospitalized pregnant women. Compared to non-hospitalized women, risk of PTB was greater among women hospitalized with influenza-associated ARFI (aRR: 1.57; 95% CI: 1.15-2.15) and non-influenza ARFI (aRR: 2.78; 95% CI: 2.12-3.65). Similar results were observed for LBW; there were no associations with SGA birth. CONCLUSIONS: ARFI hospitalization during pregnancy was associated with increased risk of PTB and LBW.
Authors: Sarah J Stock; Helga Zoega; Meredith Brockway; Rachel H Mulholland; Jessica E Miller; Jasper V Been; Rachael Wood; Ishaya I Abok; Belal Alshaikh; Adejumoke I Ayede; Fabiana Bacchini; Zulfiqar A Bhutta; Bronwyn K Brew; Jeffrey Brook; Clara Calvert; Marsha Campbell-Yeo; Deborah Chan; James Chirombo; Kristin L Connor; Mandy Daly; Kristjana Einarsdóttir; Ilaria Fantasia; Meredith Franklin; Abigail Fraser; Siri Eldevik Håberg; Lisa Hui; Luis Huicho; Maria C Magnus; Andrew D Morris; Livia Nagy-Bonnard; Natasha Nassar; Sylvester Dodzi Nyadanu; Dedeke Iyabode Olabisi; Kirsten R Palmer; Lars Henning Pedersen; Gavin Pereira; Amy Racine-Poon; Manon Ranger; Tonia Rihs; Christoph Saner; Aziz Sheikh; Emma M Swift; Lloyd Tooke; Marcelo L Urquia; Clare Whitehead; Christopher Yilgwan; Natalie Rodriguez; David Burgner; Meghan B Azad Journal: Wellcome Open Res Date: 2021-02-02