Paradoxical long-term impact of maternal influenza infection on neonates and infants

Joon Young Song,Sung Won Han,Min-Jeong Oh,Hee Jin Cheong,Min Joo Choi,Keon Vin Park,Ji Yun Noh,Geum Joon Cho,Woo Joo Kim

doi:10.1186/s12879-020-05236-8

Joon Young Song, Sung Won Han + Show 7 more

Open Access

https://doi.org/10.1186/s12879-020-05236-8

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Abstract

BackgroundPregnant women are at high risk of influenza-related morbidity and mortality. In addition, maternal influenza infection may lead to adverse birth outcomes. However, there is insufficient data on long-term impact of maternal influenza infection.MethodsThis study was conducted to assess the impact of maternal influenza infection on birth outcomes and long-term influence on infants by merging the Korea National Health Insurance (KNHI) claims database and National Health Screening Program for Infants and Children (NHSP-IC). Mother-offspring pairs were categorized by maternal influenza infection based on the ICD-10 code.ResultsMultivariate analysis revealed that maternal influenza infection significantly increased the risk of preterm birth (OR 1.408) and low birth weight (OR 1.198) irrespective of gestational age. The proportion of low birth weight neonates was significantly higher in influenza-infected women compared to those without influenza. However, since the fourth health screening (30–80 months after birth), the fraction of underweight was no longer different between children from influenza-infected and non-infected mothers, whereas the rates of overweight increased paradoxically in those born to mothers with influenza infection.ConclusionsMaternal influenza infection might have long-term effects on the health of children and adolescents even after infancy.

Highlights

Pregnant women are at high risk of influenza-related morbidity and mortality
The present study aims to assess the impact of maternal influenza infection on birth outcomes stratified by pregnancy period, and the long-term influence on infants up to 80 months after birth
Demographic and clinical characteristics of the study population A total of 1,721,078 pregnant women delivered during the study period from 2007 to 2010 in South Korea according to Korea National Health Insurance (KNHI) records (Fig. 1)

Summary

Introduction

Pregnant women are at high risk of influenza-related morbidity and mortality. In addition, maternal influenza infection may lead to adverse birth outcomes. Physiological changes and immune adaptations occur during pregnancy to accommodate the fetus, resulting in impaired cell-mediated immunity [1] These immune alterations impair pathogen clearance, and physiological adaptations including weight gain, increased cardiac output, decreased lung volume and hormonal changes increase the risk of severe infections in pregnant women [1, 2]. Pregnant women are at high risk of influenza-related morbidity and mortality. They are more likely to have severe infections and complications, leading to hospitalization and mortality. The mortality rate in pregnant women was high in the 1918, 1957 and 2009 influenza pandemics [3].

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