Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women
Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women
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DOI：
10.1503/cmaj.061435
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发表时间：
2007-02-13
影响因子：
14.6
通讯作者：
MacDonald, Noni
中科院分区：
文献类型：
--
作者：
Dodds, Linda;McNeil, Shelly A.;MacDonald, Noni
背景：流感大流行期间孕妇的死亡人数过多，但流感在非大流行年份的影响尚不清楚。我们评估了在非大流行流感季节暴露对孕妇因呼吸道疾病住院率和就诊率的影响。方法：我们对新斯科舍省的孕妇进行了一项为期13年（1990 - 2002）的以人群为基础的队列研究。我们比较了妊娠三个月流感季节因呼吸道疾病住院和就诊的比率，与妊娠前一年流感季节的比率和非流感季节的比率。用泊松回归分析估计比率和95%置信区间（ci）。结果：在研究队列中的134 188名孕妇中，510名（0.4%）因怀孕期间的呼吸系统疾病住院，33 775名（25.2%）因怀孕期间的相同原因就诊。在流感季节，与妊娠前一年相比，有合并症的妊娠晚期住院率为7.9 (95% CI 5.0 - 12.5)，无合并症的妊娠晚期住院率为5.1 （95% CI 3.6 - 7.3）。在流感季节，无合并症的妊娠晚期妇女的住院率为每10 000个妇女月7.4例，而在围流感季节和非流感季节分别为每10 000个妇女月5.4例和3.1例。有合并症的妇女的相应比率分别为44.9、9.3和18.9 / 10000妇女月。只有6.7%的有合并症的妇女接受了流感免疫接种。解释：我们的数据支持有合并症的孕妇在流感季节应接种流感疫苗的建议，无论其妊娠阶段。由于流感季节因呼吸道疾病住院的孕妇中没有合并症的人数也有所增加，因此所有孕妇都可能受益于流感疫苗接种。
Background: Excess deaths have occurred among pregnant women during influenza pandemics, but the impact of influenza during nonpandemic years is unclear. We evaluated the impact of exposure during nonpandemic influenza seasons on the rates of hospital admissions and physician visits because of respiratory illness among pregnant women.Methods: We conducted a 13-year ( 1990 - 2002) population-based cohort study involving pregnant women in Nova Scotia. We compared rates of hospital admissions and physician office visits because of respiratory illness during the influenza season in each trimester of pregnancy with rates during the influenza season in the year before pregnancy and with rates in non-influenza seasons. Poisson regression analyses were performed to estimate rate ratios and 95% confidence intervals (CIs).Results: Of 134 188 pregnant women in the study cohort, 510 (0.4%) were admitted to hospital because of a respiratory illness during pregnancy and 33 775 (25.2%) visited their physician for the same reason during pregnancy. During the influenza seasons, the rate ratio of hospital admissions in the third trimester compared with admissions in the year before pregnancy was 7.9 ( 95% CI 5.0 - 12.5) among women with comorbidities and 5.1 ( 95% CI 3.6 - 7.3) among those without comorbidities. The rate of hospital admissions in the third trimester among women without comorbidities was 7.4 per 10 000 woman-months during the influenza season, compared with 5.4 and 3.1 per 10 000 woman-months during the peri- and non-influenza seasons respectively. Corresponding rates among women with comorbidities were 44.9, 9.3 and 18.9 per 10 000 woman-months. Only 6.7% of women with comorbidities had received influenza immunization.Interpretation: Our data support the recommendation that pregnant women with comorbidities should receive influenza vaccination regardless of their stage of pregnancy during the influenza season. Since hospital admissions because of respiratory illness during the influenza season were also increased among pregnant women without comorbidities, all pregnant women are likely to benefit from influenza vaccination.