Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis

• Autores: Mertz, Dominik; Lo, Calvin Ka Fung; Lytvyn, Lyubov; Ortiz, Justin R.; Loeb, Mark; Ang, Li Wei; Anlikumar, Mehta Asmita; Bonmarin, Isabelle; Borja Aburto, Victor Hugo; Burgmann, Heinz; Carratalà, Jordi; Chowell, Gerardo; Cilloniz, Catia; Cohen, Jessica; Cutter, Jeffery; Filleul, Laurent; Garg, Shikha; Geis, Steffen; Helferty, Melissa; Huang, Wan Ting; Jain, Seema; Sevic, Biljana Joves; Kelly, Paul; Kusznierz, Gabriela; Lehners, Nicola; Lenzi, Luana; Ling, Ivan T.; Mitchell, Robyn; Mulrennan, Siobhain A.; Nishioka, Sergio A.; Norton, Robert; Oh, Won Sup; Orellano, Pablo Wenceslao
• Año de publicación: 2019
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: INFLUENZA; META-ANALYSIS; PREGNANCY; SEVERITY; VACCINE
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Background: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02–7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48–0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75–1.34). Conclusions: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.
Fil: Mertz, Dominik. Mc Master University; Canadá
Fil: Lo, Calvin Ka Fung. Mc Master University; Canadá
Fil: Lytvyn, Lyubov. Mc Master University; Canadá
Fil: Ortiz, Justin R.. Organizacion Mundial de la Salud; Argentina
Fil: Loeb, Mark. Mc Master University; Canadá
Fil: Ang, Li Wei. Ministry of Health; Singapur
Fil: Anlikumar, Mehta Asmita. Amrita Vishwa Vidyapeetham; India
Fil: Bonmarin, Isabelle. Santé publique; Francia
Fil: Borja Aburto, Victor Hugo. Instituto Mexicano del Seguro Social; México
Fil: Burgmann, Heinz. Medical University Vienna; Austria
Fil: Carratalà, Jordi. Universidad de Barcelona; España. Instituto de Investigación Biomédica de Bellvitge; España. Spanish Network for Research in Infectious Diseases; España
Fil: Chowell, Gerardo. Georgia State University; Estados Unidos. National Institutes of Health; Estados Unidos
Fil: Cilloniz, Catia. Universidad de Barcelona; España. Instituto de Investigaciones Biomédicas August Pi i Sunyer; España
Fil: Cohen, Jessica. Centers for Disease Control and Prevention; Estados Unidos
Fil: Cutter, Jeffery. Ministry of Health; Singapur
Fil: Filleul, Laurent. Santé publique; Francia. French National Public Health Agency; Francia
Fil: Garg, Shikha. Centers for Disease Control and Prevention; Estados Unidos
Fil: Geis, Steffen. London School of Hygiene and Tropical Medicine; Reino Unido
Fil: Helferty, Melissa. Public Health Agency; Canadá
Fil: Huang, Wan Ting. Taiwan Centers for Disease Control; China
Fil: Jain, Seema. Centers for Disease Control and Prevention; Estados Unidos
Fil: Sevic, Biljana Joves. Institute for Pulmonary Diseases of Vojvodina; Serbia
Fil: Kelly, Paul. Australian Capital Territory Health Directorate; Australia. Australian National University Medical School; Australia
Fil: Kusznierz, Gabriela. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorios e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Respiratorias; Argentina
Fil: Lehners, Nicola. Ruprecht Karls Universitat Heidelberg; Alemania
Fil: Lenzi, Luana. Universidade Federal do Paraná; Brasil
Fil: Ling, Ivan T.. Sir Charles Gairdner Hospital; Australia
Fil: Mitchell, Robyn. Public Health Agency; Canadá
Fil: Mulrennan, Siobhain A.. Sir Charles Gairdner Hospital; Canadá. University of Western Australia; Australia
Fil: Nishioka, Sergio A.. Ministerio de Salud de Brasil; Brasil
Fil: Norton, Robert. Townsville Hospital; Australia
Fil: Oh, Won Sup. Kangwon National University School of Medicine; Corea del Sur
Fil: Orellano, Pablo Wenceslao. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina