Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis

Background: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes...

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Autores: Mertz, Dominik, Ka-Fung Lo, Calvin, Lytvyn, Lyubov, Ortiz, Justin R., Loeb, Mark, Carratalà, Jordi, Cillóniz, Catia, Torres Martí, Antoni, FLURISK-INVESTIGATORS
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/145341
Acceso en línea:https://hdl.handle.net/2445/145341
Access Level:acceso abierto
Palabra clave:Embarassades
Influenzavirus
Pregnant women
Influenza viruses
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spelling Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysisMertz, DominikKa-Fung Lo, CalvinLytvyn, LyubovOrtiz, Justin R.Loeb, MarkCarratalà, JordiCillóniz, CatiaTorres Martí, AntoniFLURISK-INVESTIGATORSEmbarassadesInfluenzavirusPregnant womenInfluenza virusesBackground: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02–7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48–0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75–1.34). Conclusions: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.BioMed Central2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/145341Articles publicats en revistes (Ciències Clíniques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1186/s12879-019-4318-3BMC Infectious Diseases, 2019, num. 19https://doi.org/10.1186/s12879-019-4318-3cc by (c) Mertz et al., 2019http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1453412026-05-27T06:46:51Z
dc.title.none.fl_str_mv Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
title Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
spellingShingle Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
Mertz, Dominik
Embarassades
Influenzavirus
Pregnant women
Influenza viruses
title_short Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
title_full Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
title_fullStr Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
title_full_unstemmed Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
title_sort Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
dc.creator.none.fl_str_mv Mertz, Dominik
Ka-Fung Lo, Calvin
Lytvyn, Lyubov
Ortiz, Justin R.
Loeb, Mark
Carratalà, Jordi
Cillóniz, Catia
Torres Martí, Antoni
FLURISK-INVESTIGATORS
author Mertz, Dominik
author_facet Mertz, Dominik
Ka-Fung Lo, Calvin
Lytvyn, Lyubov
Ortiz, Justin R.
Loeb, Mark
Carratalà, Jordi
Cillóniz, Catia
Torres Martí, Antoni
FLURISK-INVESTIGATORS
author_role author
author2 Ka-Fung Lo, Calvin
Lytvyn, Lyubov
Ortiz, Justin R.
Loeb, Mark
Carratalà, Jordi
Cillóniz, Catia
Torres Martí, Antoni
FLURISK-INVESTIGATORS
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Embarassades
Influenzavirus
Pregnant women
Influenza viruses
topic Embarassades
Influenzavirus
Pregnant women
Influenza viruses
description Background: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02–7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48–0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75–1.34). Conclusions: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/145341
url https://hdl.handle.net/2445/145341
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1186/s12879-019-4318-3
BMC Infectious Diseases, 2019, num. 19
https://doi.org/10.1186/s12879-019-4318-3
dc.rights.none.fl_str_mv cc by (c) Mertz et al., 2019
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Mertz et al., 2019
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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