Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

A multicenter cohort study of pregnancy outcomes among women with laboratory-confirmed H1N1 influenza

Journal of Perinatology volume 33, pages 939–943 (2013)Cite this article

Subjects

Abstract

Objective:

To evaluate associations between laboratory-confirmed 2009 H1N1 influenza infection and obstetric and neonatal outcomes.

Study design:

A multicenter cohort study was performed comparing laboratory-confirmed cases of 2009 H1N1 infection during pregnancy (N=142) with matched controls (N=710). Subanalysis was also performed comparing severely infected (hospitalized) women with controls.

Result:

No outcome differences were noted in comparing all women with H1N1 with controls. Women with severe infection had a higher incidence of delivering a small for gestational age (SGA) infant: 18.8% (6/32) versus 7.4% (52/707), adjusted odds ratio 2.35 (95% confidence interval 1.03, 5.36, P=0.02). Mean birth weight was 3013.0 g among severely infected women and 3223.3 g in controls (P=0.08), and incidence of preterm delivery was 25.0% (8/32) and 11.6% (82/710) (P=0.08), respectively.

Conclusion:

Pregnant women with mild clinical illness secondary to 2009 H1N1 were not at a greater risk of adverse pregnancy outcomes. However, severely infected women were more likely to deliver SGA infants.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Harris JW . Influenza occurring in pregnant women. JAMA 1919; 72: 978–980.

    Article  Google Scholar 

  2. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; 374: 451–458.

    Article  Google Scholar 

  3. Louie JK, Acosta M, Jamieson DJ, Honein MA . Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med 2010; 362: 27–35.

    Article  CAS  Google Scholar 

  4. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA 2010; 303: 1517–1525.

    Article  CAS  Google Scholar 

  5. Maravi-Poma E, Martin-Loeches I, Regidor E, Laplaza C, Cambra K, Aldunate S et al. Severe 2009 A/H1N1v influenza in pregnant women in Spain. Crit Care Med 2011; 39: 945–951.

    Article  Google Scholar 

  6. Dede FS, Celen S, Bilgin S, Ure G, Ozcan AO, Buzgan T et al. Maternal deaths associated with H1N1 influenza virus infection in Turkey: a whole-of-population report. BJOG 2011; 118: 1216–1222.

    Article  CAS  Google Scholar 

  7. McNeil SA, Dodds LA, Fell DB, Allen VM, Halperin BA, Steinhoff MC et al. Effect of respiratory hospitalization during pregnancy on infant outcomes. Am J Obstet Gynecol 2011; 204: S54–S57.

    Article  Google Scholar 

  8. Hansen C, Desai S, Bredfeldt C, Cheetham C, Gallagher M, Li DK et al. A large, population-based study of 2009 pandemic influenza A virus subtype H1N1 infection diagnosis during pregnancy and outcomes for mothers and neonates. J Infect Dis 2012; 206: 1260–1268.

    Article  Google Scholar 

  9. Omer SB, Goodman D, Steinhoff MC, Rochat R, Klugman KP, Stoll BJ et al. Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med 2011; 8: e1000441.

    Article  CAS  Google Scholar 

  10. Steinhoff MC, Omer SB, Roy E, Raqib R, Dodd C, Breiman RF et al. Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial. CMAJ 2012; 184: 645–653.

    Article  Google Scholar 

  11. ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ 2010; 340: c1279.

    Article  Google Scholar 

  12. Miller AC, Safi F, Hussain S, Subramanian RA, Elamin EM, Sinert R . Novel influenza A(H1N1) virus among gravid admissions. Arch Intern Med 2010; 170: 868–873.

    Article  Google Scholar 

  13. Fisher BM, Scott J, Hart J, Winn VD, Gibbs RS, Lynch AM . Behaviors and perceptions regarding seasonal and H1N1 influenza vaccination during pregnancy. Am J Obstet Gynecol 2011; 204: S107–S111.

    Article  Google Scholar 

  14. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 101: Ultrasonography in pregnancy. Obstet Gynecol 2009; 113: 451–461.

    Article  Google Scholar 

  15. Sanghavi SK, Bullotta A, Husain S, Rinaldo CR . Clinical evaluation of multiplex real-time PCR panels for rapid detection of respiratory viral infections. J Med Virol 2012; 84: 162–169.

    Article  CAS  Google Scholar 

  16. Colorado Disease Control and Environmental Epidemiology Division: Influenza Surveillance: Colorado Department of Public Health and Environment 2009.

  17. Hadlock FP, Harrist RB, Martinez-Poyer J . In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181: 129–133.

    Article  CAS  Google Scholar 

  18. Varner MW, Rice MM, Anderson B, Tolosa JE, Sheffield J, Spong CY et al. Influenza-like illness in hospitalized pregnant and postpartum women during the 2009-2010 H1N1 pandemic. Obstet Gynecol 2011; 118: 593–600.

    Article  Google Scholar 

  19. Steinhoff MC, Omer SB, Roy E, El Arifeen S, Docc C, Breiman RF et al. Neonatal outcomes after influenza immunization during pregnancy: A randomized controlled trial. CMAJ 2012; 184: 645–653.

    Article  Google Scholar 

  20. Hartert TV, Neuzil KM, Shintani AK, Snowden MS, Wood LB, Dittus RS et al. Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season. Am J Obstet Gynecol 2003; 189: 1705–1712.

    Article  Google Scholar 

  21. Yates L, Pierce M, Stephens S, Mill AC, Spark P, Kurinczuk JJ et al. Influenza A/H1N1v in pregnancy: an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mother and infant. Health Technol Assess 2010; 14: 109–182.

    Article  CAS  Google Scholar 

  22. Centers for Disease Control and Prevention (CDC). Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)—United States, April 2009-August 2010. MMWR Morb Mortal Wkly Rep 2011; 60: 1193–1196.

    Google Scholar 

  23. Mendez-Figueroa H, Raker C, Anderson BL . Neonatal characteristics and outcomes of pregnancies complicated by influenza infection during the 2009 pandemic. Am J Obstet Gynecol 2011; 204: S58–S63.

    Article  Google Scholar 

  24. Dubar G, Azria E, Tesniere A, Dupont H, Le Ray C, Baugnon T et al. French experience of 2009 A/H1N1v influenza in pregnant women. PLoS One 2010; 5: e13112.

    Article  Google Scholar 

  25. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 468: Influenza vaccination during pregnancy. Obstet Gynecol 2010; 116: 1006–1007.

    Article  Google Scholar 

  26. Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010; 59: 1–62.

    PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by funding from the Influenza Coordination Unit, Centers for Disease Control and Prevention, Atlanta, GA (www.cdc.gov).

Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    A Naresh, J Catov, J Xu & R H Beigi

  2. Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA

    B M Fisher, J Hart, A M Lynch & R Gibbs

  3. Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA

    K K Hoppe, D Eschenbach & M Gravett

Authors
  1. A Naresh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B M Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K K Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Catov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A M Lynch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R Gibbs
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D Eschenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M Gravett
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. R H Beigi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R H Beigi.

Ethics declarations

Competing interests

Ronald Gibbs served as a consultant to Novartis Vaccines and Diagnostics to review data on the safety of influenza vaccination during the 2009–2010 season. The other authors declare no conflict of interest.

Additional information

The data presented in this manuscript were presented in part at the 38th Annual Meeting of the Infectious Disease Society for Obstetrics and Gynecology in Chicago, Illinois from 11 August to 13 August 2011.

Disclaimer

The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Naresh, A., Fisher, B., Hoppe, K. et al. A multicenter cohort study of pregnancy outcomes among women with laboratory-confirmed H1N1 influenza. J Perinatol 33, 939–943 (2013). https://doi.org/10.1038/jp.2013.110

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.110

Keywords

This article is cited by

Search

Advanced search

Quick links