Outcomes Associated With Influenza-Like Illness in the Peripartum Period [14I

Abstract

INTRODUCTION: Influenza-like illness (ILI) is defined as fever + cough +/- sore throat. Among women who present with these symptoms, influenza is in the differential diagnosis. This study spans 5 years following the 2009 H1N1 epidemic and aims to investigate characteristics of peripartum women with ILI, to identify risk factors for severe disease and to identify influenza-related maternal and neonatal complications. METHODS: Using microbiology data from Brigham and Women’s Hospital between 2012 and 2016, a retrospective analysis was done among peripartum women with influenza tests available. RESULTS: One hundred and twenty nine women were tested. Fourteen percent (14.0%) had a positive influenza test, of whom 10 (55.6%) had received an influenza vaccine during pregnancy. Rates of antiviral treatment were higher in women with positive tests (88.9% vs 12.6%, P<.05). Sixty five women (50.3%) were hospitalized for non-obstetric (pneumonia and asthma exacerbation) and obstetric complications. Nine (13.8%) were admitted to the ICU. The odds of an ICU admission were higher for women who were immunosuppressed (OR 2.3, 95% CI 1.1-4.8). Women with positive tests were more likely to have respiratory failure (11.1% vs 0.9%, P=.051). CONCLUSION: A small proportion of women presenting with ILI had laboratory-confirmed influenza. This may reflect the poor sensitivity of the test or another viral or bacterial illness. The low rate of influenza immunization during pregnancy highlights the need for further education of providers and patients. Maternal outcomes can be improved by having a high index of suspicion and promptly treating women with ILI.