Impact on Pregnancies in South Brazil from the Influenza A (H1N1) Pandemic: Cohort Study

Silva, André Anjos da; Ranieri, Tani Schilling; Torres, Fernanda Duarte; Vianna, Fernanda Sales Luiz; Paniz, Graziella Rangel; Sanseverino, Paula Baptista; Picon, Paulo Dornelles; Azevedo, Pietro Baptista de; Costa, Marta Haas; Schüler‐Faccini, Lavínia; Sanseverino, Maria Teresa Vieira

doi:10.1371/journal.pone.0088624

Cited by 20 publications

(24 citation statements)

References 22 publications

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“…Hence, we gathered data from eight studies [19-21, 25-29]. There was no statistical significant association between influenza A virus infection and cesarean section ( P =0.28, RR=1.10, 95% CI: 0.93-1.30) and the heterogeneity existed (chi 2 =27.44, I 2 =74%).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Influenza A Virus Infection During Pregnancy Associated with an Increased Risk for Stillbirth and Low Birth Weight

Liu

et al. 2017

Kidney Blood Press Res

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Background/Aims: Impaired pregnancy outcomes, such as low birth weight are associated with increased disease risk in later life, however little is known about the impact of common infectious diseases during pregnancy on birth weight. The study had two aims: a) to investigate risk factors of influenza virus infection during pregnancy, and b) to analyze the impact of influenza virus infection on pregnancy outcome, especially birth weight. Methods: Prospective and retrospective observational studies found in PubMed, MEDLINE, Embase, Google Scholar, and WangFang database were included in this meta analysis. Data of included studies was extracted and analyzed by the RevMan software. Results: Pregnant women with anemia (P=0.004, RR=1.46, 95% CI: 1.13-1.88), obesity (P<0.00001, RR=1.35, 95% CI: 1.25-1.46) and asthma (P<0.00001, RR=1.99, 95% CI: 1.67-2.37) had higher rates of influenza virus infection. Regarding birth outcomes, influenza A virus infection did not affect the likelihood for cesarean section. Mothers with influenza had a higher rate of stillbirth (P=0.04, RR=2.36, 95% CI: 1.05-5.31), and their offspring had low 5-minute APGR Scores (P=0.009, RR=1.39, 95% CI: 1.08-1.79). Furthermore, the rate for birth weight < 2500g (P=0.04, RR=1.71, 95% CI: 1.03-2.84) was increased. Conclusion: Results of this study showed that anemia, asthma and obesity during pregnancy are risk factors influenza A virus infection during pregnancy. Moreover, gestational influenza A infection impairs pregnancy outcomes and increases the risk for low birth weight, a known risk factor for later life disease susceptibility.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Influenza A Virus Infection During Pregnancy Associated with an Increased Risk for Stillbirth and Low Birth Weight

Liu

et al. 2017

Kidney Blood Press Res

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“…The results are presented in Figure . In total, 100 studies were included in the review . Several studies provided data on maternal morbidity and mortality, pregnancy outcome and treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty‐two studies reported on maternal morbidity caused by influenza infection during pregnancy . The 2009 influenza A/H1N1 was the strain of influenza reported on in all these studies.…”

Section: Resultsmentioning

confidence: 99%

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Influenza virus infection in pregnancy: a review

Meijer

Noortwijk

Bruinse

et al. 2015

Acta Obstet Gynecol Scand

113

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“…It is now clear that mothers who have infections during pregnancy are at increased risk for maternal death [135–138]. This has been the case in the pandemics of influenza [139–149] and, more recently, Ebola [150–153] and has been attributed to a cytokine storm that occurs when pregnant women are exposed to microorganisms [154–156]. …”

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term V: umbilical cord plasma cytokine profile in the context of a systemic maternal inflammatory response

Romero

Chaemsaithong

Docheva

et al. 2015

Journal of Perinatal Medicine

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Objective Microbial invasion of the fetus due to intra-amniotic infection can lead to a systemic inflammatory response characterized by elevated concentrations of cytokines in the umbilical cord plasma/serum. Clinical chorioamnionitis represents the maternal syndrome often associated with intra-amniotic infection, although other causes of this syndrome have been recently described. The objective of this study was to characterize the umbilical cord plasma cytokine profile in neonates born to mothers with clinical chorioamnionitis at term, according to the presence or absence of bacteria and/or intra-amniotic inflammation. Materials and Methods A cross-sectional study was conducted, including patients with clinical chorioamnionitis at term (n=38; cases) and those with spontaneous term labor without clinical chorioamnionitis (n=77; controls). Women with clinical chorioamnionitis were classified according to the results of amniotic fluid culture, broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS), and amniotic fluid interleukin (IL)-6 concentrations into three groups: 1) no intra-amniotic inflammation; 2) intra-amniotic inflammation without detectable microorganisms; or 3) microbial-associated intra-amniotic inflammation. Fetal inflammatory response syndrome (FIRS) was defined as an umbilical cord plasma IL-6 concentration >11 pg/mL. The umbilical cord plasma concentrations of 29 cytokines were determined with sensitive and specific V-PLEX immunoassays. Nonparametric statistical methods were used for analysis, adjusting for a false discovery rate of 5%. Results 1) Neonates born to mothers with clinical chorioamnionitis at term (considered in toto) had significantly higher median umbilical cord plasma concentrations of IL-6, IL-12p70, IL-16, IL-13, IL-4, IL-10, and IL-8, but significantly lower interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α) concentrations than neonates born to mothers with spontaneous term labor without clinical chorioamnionitis; 2) neonates born to mothers with clinical chorioamnionitis at term but without intra-amniotic inflammation had higher concentrations of IL-6, IL-12p70, IL-13, IL-4, IL-5, and IL-8 but lower IFN-γ than neonates not exposed to clinical chorioamnionitis, suggesting that maternal fever in the absence of intra-amniotic inflammation leads to a change in the fetal cytokine network; 3) there were significant, positive correlations between maternal and umbilical cord plasma IL-6 and IL-8 concentrations (IL-6: Spearman’s correlation=0.53; p<0.001; IL-8: Spearman’s correlation=0.42; p<0.001), consistent with placental transfer of cytokines; 4) an elevated fetal plasma IL-6 (> 11pg/mL), the diagnostic criterion for FIRS, was present in 21% of cases (8/38), and all of these neonates were born to mothers with proven intra-amniotic infection; and 5) FIRS was associated with a high concentration of umbilical cord plasma IL-8, IL-10, and monocyte chemoattractant protein (MCP)-1. Conclusions Neonates born to mothe...

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Impact on Pregnancies in South Brazil from the Influenza A (H1N1) Pandemic: Cohort Study

Cited by 20 publications

References 22 publications

A Systematic Review and Meta-Analysis of Influenza A Virus Infection During Pregnancy Associated with an Increased Risk for Stillbirth and Low Birth Weight

A Systematic Review and Meta-Analysis of Influenza A Virus Infection During Pregnancy Associated with an Increased Risk for Stillbirth and Low Birth Weight

Influenza virus infection in pregnancy: a review

Clinical chorioamnionitis at term V: umbilical cord plasma cytokine profile in the context of a systemic maternal inflammatory response

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