Maternal and Neonatal Outcomes among Pregnant Women with 2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study

Abstract

IntroductionPregnant women have been identified as a high risk group for severe illness with 2009 pandemic influenza A(H1N1) virus infection (pH1N1). Obesity has also been identified as a risk factor for severe illness, though this has not been thoroughly assessed among pregnant women. The objectives of this study were to provide risk estimates for adverse maternal and neonatal outcomes associated with pH1N1 illness during pregnancy and to assess the role of obesity in these outcomes.MethodsWe established a retrospective population-based cohort of all live births occurring in Florida during the first 15 months of the pandemic. Illness with pH1N1 during pregnancy was ascertained through record linkage with the Florida state notifiable disease surveillance database. Data from the birth record, including pre-pregnancy body mass index, were analyzed to assess risk of adverse outcomes associated with pH1N1 illness.ResultsA total of 194 women were identified through surveillance with pH1N1 illness during pregnancy. Children born to women with pH1N1 illness during pregnancy were at increased risk for low birth weight [OR (95%CI): 1.78 (1.11-2.860)], premature birth [2.21 (1.47-3.330)], and infant death [4.46 (1.80-11.00)], after adjusting for other factors. Women with pH1N1 illness during pregnancy were at increased risk for severe outcomes including admission to an intensive care unit. Obesity was an observed risk factor, both for the more severe pH1N1 illness detected through surveillance, and for severe maternal outcomes.ConclusionsCase-patients in this analysis likely represent the most severely ill subset of all women infected with pH1N1 during pregnancy, limiting the generalizability of these findings to more severely ill patients rather than influenza infection in general. Nevertheless, these results suggest that more severe pH1N1 illness during pregnancy is associated with adverse neonatal outcomes and that pregnant women should continue to be targeted for appropriate prophylaxis and early treatment.

A Systematic Review and Meta-Analysis of Influenza A Virus Infection During Pregnancy Associated with an Increased Risk for Stillbirth and Low Birth Weight

“…Offspring born to pregnant women with influenza A had a higher risk of low birth weight ( P =0.04, RR=1.71, 95% CI: 1.03-2.84, I 2 =89%). The cases included only during influenza pandemic period, but the control included from pre-pandemic period in Doyle’s study [19] and Pierce’s study [25]. So the heterogeneity (89%) in this meta-analysis came from time inconsistency between case and control group (Figure 5).…”

“…Most studies were calculated the number of mothers who accepted cesarean delivery, but Doyle’s study [19] had the number of babies born from cesarean delivery. For the delivery mode, the exposed cohort numbers were 191 cases in cesarean section, and the control were 300,398 cases in Doyle’s study [19].…”

“…For the delivery mode, the exposed cohort numbers were 191 cases in cesarean section, and the control were 300,398 cases in Doyle’s study [19]. In Gerardin’s [20] study, as well as Doyle’s study [19], for the control cohort there were 445 cases in cesarean section. In addition, some information about mothers or babies was lost in other studies, so the total numbers of the samples may be different from the real situation.…”

“…Hence, we gathered data from eight studies [19-21, 25-29]. There was no statistical significant association between influenza A virus infection and cesarean section ( P =0.28, RR=1.10, 95% CI: 0.93-1.30) and the heterogeneity existed (chi 2 =27.44, I 2 =74%).…”

“…There was no statistical significant association between influenza A virus infection and cesarean section ( P =0.28, RR=1.10, 95% CI: 0.93-1.30) and the heterogeneity existed (chi 2 =27.44, I 2 =74%). The non-contemporary comparison bias appeared in studies of Doyle’s and Pierce’s [19, 25] for they enrolled the control groups in different periods.…”