Maternal and Neonatal Outcomes of Pregnant Women With Seasonal Influenza, A Single-Center Study
-
Mohammadreza Salehi
,
Marjan Ghaemi
,
Fatemeh Asadi
,
Nafisseh Saedi
,
Mohammad Haddadi
,
Nasim Eshraghi
,
Maryam Rabiei
,
Parshang Nazeri
,
Maryam Forouzin
,
Sedigheh Hantoushzadeh
Abstract
Objective: Influenza causes significant mortality and morbidity in pregnant women and neonates especially in developing countries. This study aimed to investigate the maternal and neonatal outcomes in pregnant women with influenza and compare them with non-infected mothers.
Materials and methods: This case-control single-center cohort study was conducted during the influenza season in 2022 and included all pregnant women with influenza during pregnancy. Baseline characteristics including age, body mass index, job, vaccination, and ethnicity were documented and outcomes including premature rupture of membranes (PROM), preterm labor, cesarean section, neonatal distress, and neonatal hospitalization were evaluated and compared with the control group.
Results: In this study 39 pregnant women in each case and control group were evaluated. There was no significant difference in demographic data between the two groups. None of the participants in the case group received the influenza vaccine during pregnancy. The rate of cesarean section (63.2% vs 43.5%), neonatal distress (38.5% vs 12.8%), and neonatal hospitalization (43.5% vs 15.3%) was significantly higher in the case group than in healthy women (P-value=0.022, 0.010, 0.006 respectively). Although, the rate of PROM was not significantly different between the two groups (P=0.556). Preterm labor was higher in the case group than in the control group, but the difference was insignificant (P=0.135).
Conclusion: The study findings suggest that pregnant women infected with influenza are at higher risk of neonatal complications and vaccination is helpful in these mothers as preventive measures to reduce complications.
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23. Archer BN, Chiu CK, Jayasinghe SH, Richmond PC, McVernon J, Lahra MM, et al. Epidemiology of invasive meningococcal B disease in Australia, 1999-2015: priority populations for vaccination. Med J Aust. 2017;207(9):382–7.
24. ACOG Committee Opinion No. 753: Assessment and Treatment of Pregnant Women With Suspected or Confirmed Influenza: Correction. Obstet Gynecol. 2020;135(3):734. Erratum for: Obstet Gynecol. 2018;132(4):e169-e173.
25. Gouya MM, Nabavi M, Soroush M, Haghdoust AA, Ghalehee S, Hemmati P, et al. Mortality from Pandemic Influenza A (H1N1) in Iran. Iran Red Crescent Med J. 2011;13(10):698–701.
26. Mardani M, Yazdani A, Rezaei F, Gachkar L, Shokouhi S, Pourkaveh B, et al. Risk Factors Associated with Outcomes of Seasonal Influenza in Pregnant Women Referring to Healthcare Centers in Iran in 2015 - 2016. Arch Clin Infect Dis. 2019;14(3).
27. Song JY, Park KV, Han SW, Choi MJ, Noh JY, Cheong HJ, et al. Paradoxical long-term impact of maternal influenza infection on neonates and infants. BMC Infect Dis. 2020;20(1):502.
28. Wang R, Yan W, Du M, Tao L, Liu J. The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies. Int J Infect Dis. 2021;105:567–78.
29. He J, Liu ZW, Lu YP, Li TY, Liang XJ, Arck PC, et al. A Systematic Review and Meta-Analysis of Influenza A Virus Infection During Pregnancy Associated with an Increased Risk for Stillbirth and Low Birth Weight. Kidney Blood Press Res. 2017;42(2):232–43.
30. Doyle TJ, Goodin K, Hamilton JJ. Maternal and Neonatal Outcomes among Pregnant Women with
2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study. PLoS ONE. 2013;8(10).
2. Doyon-Plourde P, Fakih I, Tadount F, Fortin É, Quach C. Impact of influenza vaccination on healthcare utilization - A systematic review. Vaccine. 2019;37(24):3179-3189.
3. Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol. 1998;148(11):1094-102.
4. Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis. 2006;12(11):1638–43.
5. Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis. 2008;14(1):95-100.
6. Freeman DW, Barno A. Deaths from Asian influenza associated with pregnancy. Am J Obstet Gynecol. 1959; 78:1172–5.
7. World Health Organization. WHO global influenza preparedness plan: the role of WHO and recommendations for national measures before and during pandemics. https://apps.who.int/iris/handle/10665/68998, 2005 (accessed 27 May 2023).
8. Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, et al; Centers for Disease Control and Prevention (CDC). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010;59(RR-8):1-62. Erratum in: MMWR Recomm Rep. 2010;59(31):993. Erratum in: MMWR Recomm Rep. 2010;59(35):1147.
9. Munoz FM, Englund JA. Vaccines in pregnancy. Infect Dis Clin North Am. 2001;15(1):253–71.
10. Benowitz I, Esposito DB, Gracey KD, Shapiro ED, Vázquez M. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis. 2010;51(12):1355–61.
11. Fell DB, Johnson J, Mor Z, Katz MA, Skidmore B, Neuzil KM, et al. Incidence of laboratory-confirmed influenza disease among infants under 6 months of age: a systematic review. BMJ Open. 2017;7(9):e016526.
12. Jarvis JR, Dorey RB, Warricker FDM, Alwan NA, Jones CE. The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: Systematic review and meta-analysis. Vaccine. 2020;38(7):1601–13.
13. Wilcox CR, Holder B, Jones CE. Factors Affecting the FcRn-Mediated Transplacental Transfer of Antibodies and Implications for Vaccination in Pregnancy. Front Immunol. 2017;8:1294.
14. Poehling KA, Edwards KM, Griffin MR, Szilagyi PG, Staat MA, Iwane MK, et al. The burden of influenza in young children, 2004-2009. Pediatrics. 2013;131(2):207-16.
15. Neuzil KM, Mellen BG, Wright PF, Mitchel EF, Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med. 2000;342(4):225–31.
16. Sperling RS, Riley LE; Immunization and Emerging Infections Expert Work Group. Influenza Vaccination, Pregnancy Safety, and Risk of Early Pregnancy Loss. Obstet Gynecol. 2018;131(5):799-802.
17. Honarvar B, Odoomi N, Mahmoodi M, Kashkoli GS, Khavandegaran F, Bagheri Lankarani K, et al. Acceptance and rejection of influenza vaccination by pregnant women in southern Iran. Hum Vaccin Immunother. 2012;8(12):1860–6.
18. Nakhaeizadeh M, Bahar S, Khalooei A. The Prevalence of Seasonal Influenza Vaccination in Pregnant Women Referring to Tertiary Hospitals of Kerman, Iran. Shiraz E-Med J. 2021;22(2).
19. RCOG [Internet]. [cited 2024 Sep 14]. Perinatal Management of Pregnant Women at the Threshold of Infant Viability – the Obstetric Perspective (Scientific Impact Paper No. 41). Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/scientific-impact-papers/perinatal-management-of-pregnant-women-at-the-threshold-of-infant-viability-the-obstetric-perspective-scientific- impact-paper-no-41/
20. World Health Organization. Adolescent pregnancy [Internet]. [cited 2024 Sep 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy
21. World Health Organization, United Nations Children's Fund (UNICEF). Low birthweight: country, regional and global estimates. https://apps.who.int/iris/handle/10665/43184, 2004 (accessed 27 May 2023).
22. Yadav S, Lee B, Kamity R. Neonatal Respiratory Distress Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jul 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560779/
23. Archer BN, Chiu CK, Jayasinghe SH, Richmond PC, McVernon J, Lahra MM, et al. Epidemiology of invasive meningococcal B disease in Australia, 1999-2015: priority populations for vaccination. Med J Aust. 2017;207(9):382–7.
24. ACOG Committee Opinion No. 753: Assessment and Treatment of Pregnant Women With Suspected or Confirmed Influenza: Correction. Obstet Gynecol. 2020;135(3):734. Erratum for: Obstet Gynecol. 2018;132(4):e169-e173.
25. Gouya MM, Nabavi M, Soroush M, Haghdoust AA, Ghalehee S, Hemmati P, et al. Mortality from Pandemic Influenza A (H1N1) in Iran. Iran Red Crescent Med J. 2011;13(10):698–701.
26. Mardani M, Yazdani A, Rezaei F, Gachkar L, Shokouhi S, Pourkaveh B, et al. Risk Factors Associated with Outcomes of Seasonal Influenza in Pregnant Women Referring to Healthcare Centers in Iran in 2015 - 2016. Arch Clin Infect Dis. 2019;14(3).
27. Song JY, Park KV, Han SW, Choi MJ, Noh JY, Cheong HJ, et al. Paradoxical long-term impact of maternal influenza infection on neonates and infants. BMC Infect Dis. 2020;20(1):502.
28. Wang R, Yan W, Du M, Tao L, Liu J. The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies. Int J Infect Dis. 2021;105:567–78.
29. He J, Liu ZW, Lu YP, Li TY, Liang XJ, Arck PC, et al. A Systematic Review and Meta-Analysis of Influenza A Virus Infection During Pregnancy Associated with an Increased Risk for Stillbirth and Low Birth Weight. Kidney Blood Press Res. 2017;42(2):232–43.
30. Doyle TJ, Goodin K, Hamilton JJ. Maternal and Neonatal Outcomes among Pregnant Women with
2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study. PLoS ONE. 2013;8(10).
| Files | ||
| Issue | Vol 19, No 1 (March 2025) | |
| Section | Original Articles | |
| Keywords | ||
| Influenza Pregnancy Neonatal Outcomes Prenatal Care Flu Season | ||
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How to Cite
1.
Salehi M, Ghaemi M, Asadi F, Saedi N, Haddadi M, Eshraghi N, Rabiei M, Nazeri P, Forouzin M, Hantoushzadeh S. Maternal and Neonatal Outcomes of Pregnant Women With Seasonal Influenza, A Single-Center Study. J Family Reprod Health. 2025;19(1):8-13.
