The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies

Wang, Ruitong; Yan, Wenxin; Du, Min; Tao, Liyuan; Liu, Jue

doi:10.1016/j.ijid.2021.02.095

Cited by 31 publications

(20 citation statements)

References 62 publications

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“…Based on the data discussed above, it is not surprising that several studies have reported increased risk of adverse pregnancy outcomes associated with influenza infection, but such findings were not confirmed by other studies (43). More specifically, it has been reported an increased occurrence of spontaneous miscarriage, preterm delivery, cesarean delivery, pneumonia, maternal hyperthermia, and post-partum hospital length of stay (43)(44)(45)(46). Similarly, the effects of maternal influenza infection on the fetus are also under investigation (43)(44)(45)(46), but evidence of the effects of inter-pandemic influenza on fetal outcomes has varied among different countries and the published studies have shown substantial biases (43).…”

Section: Influenza Virusmentioning

confidence: 90%

Section: Influenza Virusmentioning

confidence: 95%

“…Interestingly, this population was also at increased risk for developing chronic diseases both in early life and adult life ( 43 , 51 , 53 ). A multivariate analysis evaluating the long-term outcomes of offspring born from women exposed to influenza during pregnancy and followed up to 80 months after birth found that, while in utero exposure to the virus was associated with LBW, a higher proportion of the same population suffered from overweight and insulin-resistance.…”

Section: Influenza Virusmentioning

confidence: 99%

“…More specifically, it has been reported an increased occurrence of spontaneous miscarriage, preterm delivery, cesarean delivery, pneumonia, maternal hyperthermia, and post-partum hospital length of stay (43)(44)(45)(46). Similarly, the effects of maternal influenza infection on the fetus are also under investigation (43)(44)(45)(46), but evidence of the effects of inter-pandemic influenza on fetal outcomes has varied among different countries and the published studies have shown substantial biases (43). In general, when comparing non-infected to influenza-infected pregnant women, the general consensus is that the latter group has a higher risk for prematurity, small for gestational age (SGA) birth, low birth weight (LBW), stillbirth, hydrocephaly, cleft lip, neural tube and congenital heart defects in (43,(47)(48)(49)(50)(51).…”

Section: Influenza Virusmentioning

confidence: 99%

“…A multivariate analysis evaluating the long-term outcomes of offspring born from women exposed to influenza during pregnancy and followed up to 80 months after birth found that, while in utero exposure to the virus was associated with LBW, a higher proportion of the same population suffered from overweight and insulin-resistance. Moreover, hypertension, kidney disease, type 2 diabetes, cardiovascular disease, and other metabolic diseases occurred more frequently in the cohort of children born to influenza-infected mothers when compared to age-matched controls born to not-infected mothers (43,(53)(54)(55).…”

Section: Influenza Virusmentioning

confidence: 99%

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Effects of Vertical Transmission of Respiratory Viruses to the Offspring

et al. 2022

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Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.

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Section: Influenza Virusmentioning

confidence: 90%

Section: Influenza Virusmentioning

confidence: 95%

Section: Influenza Virusmentioning

confidence: 99%

Section: Influenza Virusmentioning

confidence: 99%

Section: Influenza Virusmentioning

confidence: 99%

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Effects of Vertical Transmission of Respiratory Viruses to the Offspring

et al. 2022

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Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases

Şahın

Tanaçan

Anuk

et al. 2022

Arch Gynecol Obstet

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Purpose To compare the clinical features and perinatal outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-variant and post-variant periods. Methods This prospective cohort study includes pregnant women with SARS-CoV-2 who were followed-up at Ankara City Hospital between 11, March 2020 and 15, September 2021. Demographic features, clinical characteristics and pregnancy outcomes were compared between the pre-variant ( n = 1416) and post-variant ( n = 519) groups. Results The rates of severe and critical cases significantly increased in the post-variant group (9.7% vs 2%, p < 0.001). The rates of respiratory support (26.8% vs 7.3%, p < 0.001), ICU admission (12.9% vs 1.8%, p < 0.001) and maternal mortality (2.9% vs 0.4%, p < 0.001) were significantly higher in the post-variant group. A significant increase was observed for pregnancy complications in the post-variant group (45.6% vs 18.8%, p = 0.007). The rates of preterm delivery (26.4% vs 4.4%, p < 0.001) and NICU admission (34% vs 18.8%, p < 0.001) were significantly higher in the post-variant group. Positive, weak, statistically significant correlations were observed between the post-variant period, disease severity and maternal mortality ( r = 0.19, r = 0.12 and p < 0.001). Conclusion Post-variant COVID-19 period was associated with a severe course of the disease and increased rates of adverse obstetric outcomes in pregnant patients.

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