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Grand Rounds

Hospitalized Pregnant Women with Influenza: Outcomes over the Last 9 Flu Seasons

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BACKGROUND AND PURPOSE:

  • Holstein et al. (Annals of Internal Medicine, 2021) describe characteristics and outcomes of hospitalized pregnant women with influenza

METHODS:

  • Cross-sectional study
    • Data derived from FluSurv-NET
    • Large, multicenter, CDC–sponsored network
    • Represents about 9% of the U.S. population
  • Population
    • Women 15 to 44 years
    • Hospitalized with laboratory-confirmed influenza
  • Exposures
    • Pregnancy status
    • Influenza A subtype
  • Study design
    • Flu seasons assessed were 2010–2011 through 2018–2019 influenza seasons
    • 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 outcomes
  • Primary outcomes
    • Severe maternal influenza-associated outcomes including
      • ICU admission
      • Mechanical ventilation
      • Extracorporeal membrane oxygenation (ECMO)
      • In-hospital death

RESULTS:

  • 9652 women hospitalized with influenza
    • Pregnant: 27.9%
  • Characteristics of pregnant women hospitalized with influenza
    • Median age: 28 years
    • Third trimester: 62%
    • Had at least 1 underlying condition: 42%
    • Vaccinated against influenza: 32%
    • Received antivirals: 88%
  • Influenza outcomes
    • Required ICU admission: 5%
    • Required mechanical ventilation: 2%
    • ECMO: 0.3%
    • Deaths: 0.3%
  • 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 were still pregnant at discharge: 71%
  • Pregnancy outcomes of those who were no longer pregnant at discharge
    • Live birth: 96%
    • Fetal loss: 3%

CONCLUSION:

  • Over the last 9 influenza seasons (2010 through 2019) in the US, a third of reproductive-aged women hospitalized with influenza were pregnant and symptomatic at the time of admission
  • Severe maternal outcomes were more likely in women with influenza A H1N1
  • The authors state

Considering that approximately 5% of U.S. women of reproductive age are pregnant at any given time, our study contributes to the evidence showing that pregnant women are disproportionately burdened by influenza-associated hospitalization

Pregnant women remain a high-priority target group for vaccination

Learn More – Primary Sources:

Characteristics and Outcomes of Hospitalized Pregnant Women With Influenza, 2010 to 2019

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Can Different Dosing Regimens Increase Effectiveness of the Flu Vaccine for Women Living with HIV?
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More Evidence that Maternal Influenza Vaccination is Safe and Effective

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