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Master of Public Health

Characteristics and Outcomes of Hospitalized Pregnant Women With Influenza, 2010 to 2019 : A Repeated Cross-Sectional Study

AUTHORS

Holstein R , Dawood FS , O'Halloran A , Cummings C , Ujamaa D , Kirley PD , Yousey-Hindes K , Fawcett E , Monroe ML , Kim S , Lynfield R , McMullen C , Muse A , Bennett NM , Billing LM , Sutton M , Thomas A , Talbot HK , Schaffner W , Risk I , Reed C , Garg S , . Annals of internal medicine. 2021 12 28; ().

ABSTRACT

BACKGROUND: Pregnant women may be at increased risk for severe influenza-associated outcomes.

OBJECTIVE: To describe characteristics and outcomes of hospitalized pregnant women with influenza.

DESIGN: Repeated cross-sectional study.

SETTING: The population-based U.S. Influenza Hospitalization Surveillance Network during the 2010-2011 through 2018-2019 influenza seasons.

PATIENTS: Pregnant women (aged 15 to 44 years) hospitalized with laboratory-confirmed influenza identified through provider-initiated or facility-based testing practices.

MEASUREMENTS: Clinical characteristics, interventions, and in-hospital maternal and fetal outcomes were obtained through medical chart abstraction. Multivariable logistic regression was used to evaluate the association between influenza A subtype and severe maternal influenza-associated outcomes, including intensive care unit (ICU) admission, mechanical ventilation, extracorporeal membrane oxygenation, or in-hospital death.

RESULTS: Of 9652 women aged 15 to 44 years and hospitalized with influenza, 2690 (27.9%) were pregnant. Among the 2690 pregnant women, the median age was 28 years, 62% were in their third trimester, and 42% had at least 1 underlying condition. Overall, 32% were vaccinated against influenza and 88% received antiviral treatment. Five percent required ICU admission, 2% required mechanical ventilation, and 0.3% ( = 8) died. Pregnant women with influenza A H1N1 were more likely to have severe outcomes than those with influenza A H3N2 (adjusted risk ratio, 1.9 [95% CI, 1.3 to 2.8]). Most women (71%) were still pregnant at hospital discharge. Among 754 women who were no longer pregnant at discharge, 96% had a pregnancy resulting in live birth, and 3% experienced fetal loss.

LIMITATION: Maternal and fetal outcomes that occurred after hospital discharge were not captured.

CONCLUSION: Over 9 influenza seasons, one third of reproductive-aged women hospitalized with influenza were pregnant. Influenza A H1N1 was associated with more severe maternal outcomes. Pregnant women remain a high-priority target group for vaccination.

PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

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