Pregnancy Complicated by Epidemic Influenza

Titus, Paul

doi:10.1001/jama.1919.02610230019004

Cited by 8 publications

(11 citation statements)

References 2 publications

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“…Pregnancy markedly increased the risk of secondary infections: about half of the 1918 influenza pandemic pregnancies developed secondary pneumonias which, in this pre-antibiotic era, increased maternal mortality and still-births. 1,21,22 Assuming that the incidence of influenza infection (33% of the adult population) was not affected by pregnancy, about 33% of all births should have experienced maternal influenza. Of these, pneumonia developed in about 50%.…”

Section: Resultsmentioning

confidence: 99%

Lingering prenatal effects of the 1918 influenza pandemic on cardiovascular disease

Mazumder

Almond

Park

et al. 2009

J Dev Orig Health Dis

176

174

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Prenatal exposure to the 1918 influenza pandemic (Influenza A, H1N1 subtype) is associated with ≥20% excess cardiovascular disease at 60 to 82 years of age, relative to cohorts born without exposure to the influenza epidemic, either prenatally or postnatally (defined by the quarter of birth), in the 1982–1996 National Health Interview Surveys of the USA. Males showed stronger effects of influenza on increased later ischemic heart disease than females. Adult height at World War II enlistment was lower for the 1919 birth cohort than for those born in adjacent years, suggesting growth retardation. Calculations on the prevalence of maternal infections indicate that prenatal exposure to even uncomplicated maternal influenza may have lasting consequences later in life. These findings suggest novel roles for maternal infections in the fetal programming of cardiovascular risk factors that are independent of maternal malnutrition.

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Section: Resultsmentioning

confidence: 99%

Lingering prenatal effects of the 1918 influenza pandemic on cardiovascular disease

Mazumder

Almond

Park

et al. 2009

J Dev Orig Health Dis

176

174

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“…Following the 1918 and 2009 H1N1 pandemics, studies found pregnant hosts had a greater likelihood of hospitalization after influenza infection versus nonpregnant women (Woolston and Conley 1918;Titus and Jamison 1919;Siston et al 2010). Strikingly, pregnant women account for only 1% of the general population, yet experience an excessive rate of mortality of 5% on influenza virus infection (Centers for Disease Control and Prevention 2010).…”

Section: Pregnancymentioning

confidence: 99%

Influenza in High-Risk Hosts—Lessons Learned from Animal Models

Honce

Wohlgemuth

Meliopoulos

et al. 2019

Cold Spring Harb Perspect Med

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Factoring significantly into the global burden of influenza disease are high-risk populations that suffer the bulk of infections. Classically, the very young, very old, and pregnant women have been identified as high-risk populations; however, recent research has uncovered several other conditions that contribute to severe infection. By using varied animal models, researchers have identified molecular mechanisms underpinning the increased likelihood for infection due to obesity and malnourishment, as well as insight into the role sex hormones play in antiviral immunity in males, in females, and across the life span. Additionally, novel comorbidity models have helped elucidate the role of chronic infectious and genetic diseases in influenza virus pathogenesis. Animal models play a vital role in understanding the contribution of host factors to influenza severity and immunity. An in-depth understanding of these host factors represents an important step in reducing the burden of influenza among the growing number of people living with one or more chronic medical conditions.

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“…In terms of miscarriages and stillbirths, Harris (1919) and Bland (1919) documented pregnancy termination in more than 50% of infected pregnant patients. Given that pregnancy was such an important risk factor for influenza mortality, the scientific community discussed whether pregnant women should be advised to have an abortion (Titus and Jamison, 1919). More recently, Bloom-Feshbach et al (2011) show that birth rates in the US, Copenhagen, Norway, and Sweden declined substantially in the aftermath of the 1918 flu pandemic.…”

Section: Culling In the Fetal Origins Literaturementioning

confidence: 99%

“…. ] acted like a veritable plague, carrying off pregnant women as it did no other class of people" (Titus and Jamison, 1919). Mortality rates among infected women were documented at 27%, while pregnancy termination was observed in over 50% of infected pregnant patients (Harris, 1919;Bland, 1919).…”

Section: Introductionmentioning

confidence: 99%

“…Mortality rates among infected women were documented at 27%, while pregnancy termination was observed in over 50% of infected pregnant patients (Harris, 1919;Bland, 1919). Pregnant women were affected so severely, that the medical profession discussed whether abortions should be recommended (Titus and Jamison, 1919). More recent evidence shows substantial decreases in birth rates (Bloom-Feshbach et al, 2011) and increased risks of stillbirth (Nishiura, 2009) in the months after the 1918 flu pandemic.…”

Section: Introductionmentioning

confidence: 99%

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Survival of the Weakest? Culling Evidence from the 1918 Flu Pandemic

et al. 2019

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When a negative shock affects a cohort in utero, two things may happen: first, the population suffers detrimental consequences in later life; and second, some will die as a consequence of the shock, either in utero or early in life. The latter effect, often referred to as culling, may induce a bias in estimates of later life outcomes. When the health shock disproportionately affects a positively selected subpopulation, the longterm effects are overestimated. The 1918 flu pandemic was plausibly more harmful to mothers of high socioeconomic status, as a suppressed immune system in mothers of low socioeconomic status may have been protective against the most severe consequences of infection. Using historical birth records from the city of Bern, Switzerland, we assess this concern empirically and document that a careful consideration of culling is paramount for the evaluation of the 1918 flu pandemic and other fetal health shocks.

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Pregnancy Complicated by Epidemic Influenza

Cited by 8 publications

References 2 publications

Lingering prenatal effects of the 1918 influenza pandemic on cardiovascular disease

Lingering prenatal effects of the 1918 influenza pandemic on cardiovascular disease

Influenza in High-Risk Hosts—Lessons Learned from Animal Models

Survival of the Weakest? Culling Evidence from the 1918 Flu Pandemic

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