An international cohort study of birth outcomes associated with hospitalized acute respiratory infection during pregnancy

Annette K Regan; Becca S Feldman; Eduardo Azziz-Baumgartner; Allison L Naleway; Jennifer Williams; Brandy E Wyant; Kim Simmonds; Paul V Effler; Stephanie Booth; Sarah W Ball; Mark A Katz; Rebecca V Fink; Mark G Thompson; Hannah Chung; Jeffrey C Kwong; Deshayne B Fell

doi:10.1016/j.jinf.2020.03.057

An international cohort study of birth outcomes associated with hospitalized acute respiratory infection during pregnancy

J Infect. 2020 Jul;81(1):48-56. doi: 10.1016/j.jinf.2020.03.057. Epub 2020 Apr 20.

Authors

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

Affiliations

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.

PMID: 32325131
DOI: 10.1016/j.jinf.2020.03.057

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.

Keywords: Influenza virus; Pregnancy outcome; Pregnant women; Premature birth; Respiratory tract infections.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Australia / epidemiology
Cohort Studies
Female
Humans
Infant, Newborn
Israel / epidemiology
Pregnancy
Pregnancy Outcome / epidemiology
Premature Birth* / epidemiology
Retrospective Studies