Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
PLoS One. 2024 Nov 13;19(11):e0313653. doi: 10.1371/journal.pone.0313653. eCollection 2024.
Risk factors for influenza complications in women are poorly understood. We examined the association between pregnancy outcomes and risk of influenza hospitalization up to three decades later.
We analyzed a cohort of 1,421,531 pregnant women who delivered in Quebec, Canada between 1989 and 2021. Patients were followed over time beginning at the first delivery. The main exposure measures included obstetric complications such as preeclampsia, gestational diabetes, and preterm birth. The main outcome was influenza hospitalization up to 32 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obstetric complications and risk of influenza hospitalization following pregnancy.
A total of 4,016 women were hospitalized for influenza during 32 years of follow-up. Influenza hospitalization was more frequent among women with pregnancy complications than women without complications (18.0 vs 14.1 per 100,000 person-years). Compared with no pregnancy complication, women with gestational diabetes (HR 1.48, 95% CI 1.30-1.69), preeclampsia (HR 1.45, 95% CI 1.28-1.65), placental abruption (HR 1.36, 95% CI 1.12-1.66), preterm birth (HR 1.40, 95% CI 1.27-1.55), cesarean section (HR 1.22, 95% CI 1.13-1.31), and severe maternal morbidity (HR 1.43, 95% CI 1.22-1.68) had a greater risk of influenza hospitalization later in life. These pregnancy outcomes were associated with severe influenza infections requiring critical care.
Women with pregnancy complications have an elevated risk of severe influenza complications later in life and have potential to benefit from seasonal vaccination to prevent influenza hospitalization.
女性流感并发症的风险因素尚未得到充分了解。我们研究了妊娠结局与流感住院风险之间的关联，这种关联可在 30 年后显现。
我们分析了 1989 年至 2021 年期间在加拿大魁北克省分娩的 1421531 名孕妇的队列。自首次分娩开始，患者会随着时间推移被持续追踪。主要暴露指标包括子痫前期、妊娠期糖尿病和早产等产科并发症。主要结局是 32 年后的流感住院。我们使用调整后的 Cox 回归模型来估计产科并发症与妊娠后流感住院风险之间的关联的风险比（HR）和 95%置信区间（CI）。
在 32 年的随访期间，共有 4016 名女性因流感住院。与无并发症的女性相比，有妊娠并发症的女性流感住院更为常见（每 100000 人年 18.0 例比 14.1 例）。与无妊娠并发症相比，患有妊娠期糖尿病（HR 1.48，95%CI 1.30-1.69）、子痫前期（HR 1.45，95%CI 1.28-1.65）、胎盘早剥（HR 1.36，95%CI 1.12-1.66）、早产（HR 1.40，95%CI 1.27-1.55）、剖宫产（HR 1.22，95%CI 1.13-1.31）和严重产妇发病（HR 1.43，95%CI 1.22-1.68）的女性在以后的生活中发生流感住院的风险更高。这些妊娠结局与需要重症监护的严重流感感染有关。
有妊娠并发症的女性在以后的生活中患严重流感并发症的风险增加，有潜力通过季节性疫苗接种预防流感住院。
