Maternal Influenza Immunization and Reduced Likelihood of Prematurity and Small for Gestational Age Births: A Retrospective Cohort Study

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Background:
Infections during pregnancy have the potential to adversely impact birth outcomes. We evaluated the association between receipt of inactivated influenza vaccine during pregnancy and prematurity and small for gestational age (SGA) births.

Methods and Findings:
We conducted a cohort analysis of surveillance data from the Georgia (United States) Pregnancy Risk Assessment Monitoring System. Among 4,326 live births between 1 June 2004 and 30 September 2006, maternal influenza vaccine information was available for 4,168 (96.3%). The primary intervention evaluated in this study was receipt of influenza vaccine during any trimester of pregnancy. The main outcome measures were prematurity (gestational age at birth <37 wk) and SGA (birth weight <10th percentile for gestational age). Infants who were born during the putative influenza season (1 October–31 May) and whose mothers were vaccinated against influenza during pregnancy were less likely to be premature compared to infants of unvaccinated mothers born in the same period (adjusted odds ratio [OR] = 0.60; 95% CI, 0.38–0.94). The magnitude of association between maternal influenza vaccine receipt and reduced likelihood of prematurity increased during the period of at least local influenza activity (adjusted OR = 0.44; 95% CI, 0.26–0.73) and was greatest during the widespread influenza activity period (adjusted OR = 0.28; 95% CI, 0.11–0.74). Compared with newborns of unvaccinated women, newborns of vaccinated mothers had 69% lower odds of being SGA (adjusted OR = 0.31; 95% CI, 0.13–0.75) during the period of widespread influenza activity. The adjusted and unadjusted ORs were not significant for the pre-influenza activity period.

Conclusions:
This study demonstrates an association between immunization with the inactivated influenza vaccine during pregnancy and reduced likelihood of prematurity during local, regional, and widespread influenza activity periods. However, no associations were found for the pre-influenza activity period. Moreover, during the period of widespread influenza activity there was an association between maternal receipt of influenza vaccine and reduced likelihood of SGA birth.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Maternal Influenza Immunization and Reduced Likelihood of Prematurity and Small for Gestational Age Births: A Retrospective Cohort Study. PLoS Med 8(5): e32767. doi:10.1371/journal.pmed.1000441
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000441

Souhrn

Zdroje

1. GoodnightWH

SoperDE

2005 Pneumonia in pregnancy. Crit Care Med 33 S390 S397

2. HardyJM

AzarowiczEN

ManniniA

MedearisDNJr

CookeRE

1961 The effect of Asian influenza on the outcome of pregnancy, Baltimore, 1957–1958. Am J Public Health Nations Health 51 1182 1188

3. MakTK

MangtaniP

LeeseJ

WatsonJM

PfeiferD

2008 Influenza vaccination in pregnancy: current evidence and selected national policies. Lancet Infect Dis 8 44 52

4. ZamanK

RoyE

ArifeenSE

RahmanM

RaqibR

2008 Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med 359 1555 1564

5. GoldenbergRL

CulhaneJF

IamsJD

RomeroR

2008 Epidemiology and causes of preterm birth. Lancet 371 75 84

6. RomeroR

EspinozaJ

GoncalvesLF

KusanovicJP

FrielL

2007 The role of inflammation and infection in preterm birth. Semin Reprod Med 25 21 39

7. Centers for Disease Control and Prevention 2009 Pregnancy Risk Assessment Monitoring System (PRAMS): home. Available: http://www.cdc.gov/prams/. Accessed 29 April 2011

8. Georgia Department of Community Health 2009 What is Georgia PRAMS? Available: http://health.state.ga.us/epi/prams/index.asp. Accessed 29 April 2011

9. OkenE

KleinmanKP

Rich-EdwardsJ

GillmanMW

2003 A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 3 6

10. Georgia Department of Community Health 2009 Influenza surveillance in Georgia. Available: http://health.state.ga.us/epi/flu/. Accessed 29 April 2011

11. JacksonML

NelsonJC

WeissNS

NeuzilKM

BarlowW

2008 Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study. Lancet 372 398 405

12. NelsonJC

JacksonML

WeissNS

JacksonLA

2009 New strategies are needed to improve the accuracy of influenza vaccine effectiveness estimates among seniors. J Clin Epidemiol 62 687 694

13. Centers for Disease Control and Prevention 2008 Pregnancy Risk Assessment Monitoring System (PRAMS): methodology. Available: http://www.cdc.gov/prams/methodology.htm. Accessed 29 April 2011

14. KleinbaumDG

KupperLL

MorgensternH

1982 Epidemiologic research: principles and quantitative methods New York John Wiley & Sons

15. RaoJNK

SottAJ

1984 On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Ann Stat 12 46 60

16. Centers for Disease Control and Prevention 2006 2005–06 U.S. influenza season summary. Available: http://www.cdc.gov/flu/weekly/weeklyarchives2005-2006/05-06summary.htm. Accessed 29 April 2011

17. IrvingWL

JamesDK

StephensonT

LaingP

JamesonC

2000 Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG 107 1282 1289

18. RasmussenSA

JamiesonDJ

MacfarlaneK

CraganJD

WilliamsJ

2009 Pandemic influenza and pregnant women: summary of a meeting of experts. Am J Public Health 99 Suppl 2 S248 S254

19. UchideN

OhyamaK

BesshoT

ToyodaH

2005 Induction of pro-inflammatory cytokine gene expression and apoptosis in human chorion cells of fetal membranes by influenza virus infection: possible implications for maintenance and interruption of pregnancy during infection. Med Sci Monit 11 RA7 16

20. RomeroR

DurumS

DinarelloCA

OyarzunE

HobbinsJC

1989 Interleukin-1 stimulates prostaglandin biosynthesis by human amnion. Prostaglandins 37 13 22

21. ChallisJR

SlobodaDM

AlfaidyN

LyeSJ

GibbW

2002 Prostaglandins and mechanisms of preterm birth. Reproduction 124 1 17

22. FidelPLJr

RomeroR

WolfN

CutrightJ

RamirezM

1994 Systemic and local cytokine profiles in endotoxin-induced preterm parturition in mice. Am J Obstet Gynecol 170 1467 1475

23. RebmannT

2005 Severe acute respiratory syndrome: implications for perinatal and neonatal nurses. J Perinat Neonatal Nurs 19 332 345

24. LiZ

RenA

LiuJ

PeiL

ZhangL

2007 Maternal flu or fever, medication use, and neural tube defects: a population-based case-control study in Northern China. Birth Defects Res A Clin Mol Teratol 79 295 300

25. AcsN

BanhidyF

PuhoE

CzeizelAE

2005 Maternal influenza during pregnancy and risk of congenital abnormalities in offspring. Birth Defects Res A Clin Mol Teratol 73 989 996

26. HartertTV

NeuzilKM

ShintaniAK

MitchelEFJr

SnowdenMS

2003 Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season. Am J Obstet Gynecol 189 1705 1712

27. FranceEK

Smith-RayR

McClureD

HambidgeS

XuS

2006 Impact of maternal influenza vaccination during pregnancy on the incidence of acute respiratory illness visits among infants. Arch Pediatr Adolesc Med 160 1277 1283

28. HamiltonBE

MininoAM

MartinJA

KochanekKD

StrobinoDM

2007 Annual summary of vital statistics: 2005. Pediatrics 119 345 360

29. MartinJA

KungHC

MathewsTJ

HoyertDL

StrobinoDM

2008 Annual summary of vital statistics: 2006. Pediatrics 121 788 801

30. FioreAE

ShayDK

BroderK

IskanderJK

UyekiTM

2009 Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 58 1 52

31. Centers for Disease Control and Prevention 2009 Receipt of influenza vaccine during pregnancy among women with live births—Georgia and Rhode Island, 2004–2007. MMWR Morb Mortal Wkly Rep 58 972 975