The Effects of Influenza Vaccination during Pregnancy on Birth Outcomes: A Systematic Review and Meta-Analysis

Nunes, Marta C.; Aqil, Anushka; Omer, Saad B.; Madhi, Shabir А.

doi:10.1055/s-0036-1586101

Cited by 90 publications

(72 citation statements)

References 37 publications

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“…Our findings are consistent with a number of studies that found an association between receiving influenza vaccination and reduced likelihood of delivering a baby PTB or with LBW [16], [17], [18], [19], [20], [21], [22]. In addition, a recent meta-analysis found a strong association between receipt of influenza vaccination and reduced likelihood of PTB and LBW, and the magnitude of the association that Nunes et al reported was comparable to our findings [44].…”

Section: Discussionsupporting

confidence: 93%

Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua

Arriola

Vasconez²,

Thompson

et al. 2017

Vaccine

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Background: Studies have shown that influenza vaccination during pregnancy reduces the risk of influenza disease in pregnant women and their offspring. Some have proposed that maternal vaccination may also have beneficial effects on birth outcomes. In 2014, we conducted an observational study to test this hypothesis using data from two large hospitals in Managua, Nicaragua.Methods: We conducted a retrospective cohort study to evaluate associations between influenza vaccination and birth outcomes. We carried out interviews and reviewed medical records post-partum to collect data on demographics, influenza vaccination during pregnancy, birth outcomes and other risk factors associated with adverse neonatal outcomes. We used influenza surveillance data to adjust for timing of influenza circulation. We assessed self-reports of influenza vaccination status by further reviewing medical records of those who self-reported but did not have readily available evidence of vaccination status. We performed multiple logistic regression (MLR) and propensity score matching (PSM).Results: A total of 3268 women were included in the final analysis. Of these, 55% had received influenza vaccination in 2014. Overall, we did not observe statistically significant associations between influenza vaccination and birth outcomes after adjusting for risk factors, with either MLR or PSM. With PSM, after adjusting for risk factors, we observed protective associations between influenza vaccination in the second and third trimester and preterm birth (aOR: 0.87; 95% confidence interval (CI): 0.75–0.99 and aOR: 0.66; 95% CI: 0.45–0.96, respectively) and between influenza vaccination in the second trimester and low birth weight (aOR: 0.80; 95% CI: 0.64–0.97).Conclusions: We found evidence to support an association between influenza vaccination and birth outcomes by trimester of receipt with data from an urban population in Nicaragua. The study had significant selection and recall biases. Prospective studies are needed to minimize these biases.

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Section: Discussionsupporting

confidence: 93%

Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua

Arriola

Vasconez²,

Thompson

et al. 2017

Vaccine

View full text Add to dashboard Cite

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“…A study has shown the influenza vaccine also provided low‐to‐moderate protection against hospitalization with influenza virus infection . Reductions of 13% of preterm births and 26% of low birth weight were reported, but no effect on small for gestational age was reported . The safety of influenza vaccination during pregnancy was determined through post‐licensure vaccine safety monitoring platforms: pregnancy exposure registries; active and passive surveillance systems; and observational studies .…”

Section: Introductionmentioning

confidence: 99%

Predictors for influenza vaccination among Thai pregnant woman: The role of physicians in increasing vaccine uptake

Kaoiean

Kittikraisak

Suntarattiwong

et al. 2019

Influenza Resp Viruses

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Background Physician recommendation and attitudes and beliefs of pregnant women toward influenza and vaccination may influence vaccine uptake during pregnancy. We examined how physician recommendation and health beliefs of pregnant women may jointly affect influenza vaccination during pregnancy. Methods Thai pregnant women aged ≥18 years and >13 gestational weeks attending antenatal care (ANC) clinics, and ANC physicians were recruited during May‐August 2015. Women and physicians, linked using unique identifiers, provided data on demographic, health and work history, knowledge, attitudes, and beliefs toward influenza and vaccination, based on Health Belief Model constructs. Physicians also provided data on their practices in recommending influenza vaccination during pregnancy. Prevalence ratios for the association between knowledge, attitudes and beliefs of pregnant women, physician recommendation and documented receipt of vaccination within 30 days of the visit were calculated. Results Among 610 women, the median age was 27 years; 266 (44%) and 344 (56%) were in the second and third trimesters, respectively. Twenty‐one (3%) had pre‐existing conditions. Of 60 physicians with the median years of practice of 5; 17 (28%) reported frequently/usually/always recommending influenza vaccine to their pregnant patients, while 43 (72%) reported never/rarely/sometimes recommending the vaccine. Controlling for the pregnant women's knowledge and beliefs, pregnant women whose physician recommended influenza vaccination were 2.3 times (95% confidence interval 1.4‐3.8) more likely to get vaccinated. Conclusions In this study, physician recommendation was the only significant factor associated with influenza vaccine uptake among Thai pregnant women. Understanding physicians’ motivation/barrier to recommending influenza vaccination to pregnant women may increase coverage.

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“…It is now established that influenza immunization during pregnancy reduces risk of influenza infection in pregnant women [8, 9]. Studies show no adverse effects of vaccination in relation to outcomes including, but not limited to, risk of preterm labor, C-section, or fetal malformation [10–13]. …”

Section: Introductionmentioning

confidence: 99%

Effects of prior influenza virus vaccination on maternal antibody responses: Implications for achieving protection in the newborns

Christian

Beverly

Mitchell

et al. 2017

Vaccine

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Background In the US, influenza vaccination is recommended annually to everyone ≥ 6 months. Prior receipt of influenza vaccine can dampen antibody responses to subsequent vaccination. This may have implications for pregnant women and their newborns, groups at high risk for complications from influenza infection. Objective This study examined effects of prior vaccination on maternal and cord blood antibody levels in a cohort of pregnant women in the US. Study Design Influenza antibody titers were measured in 141 pregnant women via the hemagglutination inhibition (HAI) assay prior to receipt of quadrivalent influenza vaccine, 30 days post-vaccination, and at delivery (maternal and cord blood). Logistic regression analyses adjusting for age, BMI, parity, gestational age at vaccination, and year of vaccination compared HAI titers, seroprotection, and seroconversion in women with versus without vaccination in the prior year. Results Compared to those without vaccination in the previous year (n=50), women with prior vaccination (n=91) exhibited higher baseline antibody titers and/or seroprotection rates against all four strains after controlling for covariates. Prior vaccination also predicted lower antibody responses and seroconversion rates at one month post-vaccination. However, at delivery, there were no significant differences in antibody titers or seroprotection rates in women or newborns, and no meaningful differences in the efficiency of antibody transfer, as indicated by the ratio of cord blood to maternal antibody titers at the time of delivery. Conclusion In this cohort of pregnant women, receipt of influenza vaccine the previous year predicted higher baseline antibody titers and decreased antibody responses at one month post-vaccination against all influenza strains. However, prior maternal vaccination did not significantly affect either maternal antibody levels at delivery or antibody levels transferred to the neonate. This study is registered with the NIH as a clinical trial (NCT02148874).

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The Effects of Influenza Vaccination during Pregnancy on Birth Outcomes: A Systematic Review and Meta-Analysis

Cited by 90 publications

References 37 publications

Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua

Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua

Predictors for influenza vaccination among Thai pregnant woman: The role of physicians in increasing vaccine uptake

Effects of prior influenza virus vaccination on maternal antibody responses: Implications for achieving protection in the newborns

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