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- Title
Characteristics and Outcomes of Hospitalized Pregnant Women With Influenza, 2010 to 2019 : A Repeated Cross-Sectional Study.
- Authors
Holstein, Rachel; Dawood, Fatimah S.; O'Halloran, Alissa; Cummings, Charisse; Ujamaa, Dawud; Daily Kirley, Pam; Yousey-Hindes, Kimberly; Fawcett, Emily; Monroe, Maya L.; Kim, Sue; Lynfield, Ruth; McMullen, Chelsea; Muse, Alison; Bennett, Nancy M.; Billing, Laurie M.; Sutton, Melissa; Thomas, Ann; Talbot, H. Keipp; Schaffner, William; Risk, Ilene
- Abstract
<bold>Background: </bold>Pregnant women may be at increased risk for severe influenza-associated outcomes.<bold>Objective: </bold>To describe characteristics and outcomes of hospitalized pregnant women with influenza.<bold>Design: </bold>Repeated cross-sectional study.<bold>Setting: </bold>The population-based U.S. Influenza Hospitalization Surveillance Network during the 2010-2011 through 2018-2019 influenza seasons.<bold>Patients: </bold>Pregnant women (aged 15 to 44 years) hospitalized with laboratory-confirmed influenza identified through provider-initiated or facility-based testing practices.<bold>Measurements: </bold>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.<bold>Results: </bold>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% (n = 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.<bold>Limitation: </bold>Maternal and fetal outcomes that occurred after hospital discharge were not captured.<bold>Conclusion: </bold>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.<bold>Primary Funding Source: </bold>Centers for Disease Control and Prevention.
- Subjects
INFLUENZA; CENTERS for Disease Control &; Prevention (U.S.); PREGNANT women; H1N1 influenza; EXTRACORPOREAL membrane oxygenation; CROSS-sectional method; INTENSIVE care units; INFLUENZA prevention; COMMUNICABLE disease epidemiology; INFLUENZA epidemiology; RESEARCH; RESEARCH methodology; EVALUATION research; HOSPITAL mortality; COMPARATIVE studies; PREGNANCY complications; HOSPITAL care; QUESTIONNAIRES; INFLUENZA A virus, H1N1 subtype; INFLUENZA A virus, H3N2 subtype
- Publication
Annals of Internal Medicine, 2022, Vol 175, Issue 2, p149
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M21-3668