title: Risk management of seasonal influenza during pregnancy: current perspectives.
abstract: Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009-2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women.
authors.affiliation: The Department of Obstetrics and Gynecology, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
keywords: antiviral medications; knowledge; vaccination
references.citation: PLoS Med. 2011 May;8(5):e1000441
references.pmid: 21655318
references.citation: BMJ. 2009 Dec 08;339:b5106
references.pmid: 19995812
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S116-23
references.pmid: 21492827
references.citation: J Obstet Gynaecol Can. 2007 Aug;29(8):622-9
references.pmid: 17714614
references.citation: Am J Obstet Gynecol. 2011 Jul;205(1):10-8
references.pmid: 21345415
references.citation: N Engl J Med. 2008 Oct 9;359(15):1555-64
references.pmid: 18799552
references.citation: J Obstet Gynaecol Can. 2010 May;32(5):443-447
references.pmid: 20500952
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S58-63
references.pmid: 21457913
references.citation: Expert Rev Vaccines. 2010 Dec;9(12):1411-22
references.pmid: 21105777
references.citation: JAMA. 2010 Dec 1;304(21):2360-1
references.pmid: 21119083
references.citation: Am J Obstet Gynecol. 2011 Nov;205(5):473.e1-9
references.pmid: 21861964
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S112-5
references.pmid: 21345408
references.citation: J Obstet Gynaecol Can. 2008 May;30(5):404-10
references.pmid: 18505664
references.citation: Vaccine. 2011 Aug 26;29(37):6358-65
references.pmid: 21596080
references.citation: Am J Obstet Gynecol. 1959 Dec;78:1172-5
references.pmid: 13824729
references.citation: Am J Obstet Gynecol. 2012 Apr;206(4):339.e1-8
references.pmid: 22306303
references.citation: Obstet Gynecol. 2013 Apr;121(4):741-749
references.pmid: 23635673
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S141-8
references.pmid: 21492825
references.citation: J Antimicrob Chemother. 2010 Jul;65(7):1330-46
references.pmid: 20488984
references.citation: J Obstet Gynaecol Can. 2010 Mar;32(3):232-7
references.pmid: 20500967
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S124-7
references.pmid: 21640229
references.citation: BMJ. 2011 Jun 14;342:d3214
references.pmid: 21672992
references.citation: Epidemiol Infect. 2012 Jul;140(7):1316-27
references.pmid: 21920067
references.citation: J Infect Dis. 1993 Sep;168(3):647-56
references.pmid: 8354906
references.citation: Clin Infect Dis. 2014 Feb;58(4):449-57
references.pmid: 24280090
references.citation: Obstet Gynecol. 2010 Oct;116(4):949-955
references.pmid: 20859160
references.citation: Matern Child Health J. 2011 Nov;15(8):1203-9
references.pmid: 20936337
references.citation: MMWR Recomm Rep. 2004 May 28;53(RR-6):1-40
references.pmid: 15163927
references.citation: N Engl J Med. 2010 Apr 29;362(17):1644-6
references.pmid: 20427817
references.citation: Ann Intern Med. 2011 Dec 6;155(11):733-41
references.pmid: 22147712
references.citation: CMAJ. 2012 Apr 3;184(6):645-53
references.pmid: 22353593
references.citation: Obstet Gynecol. 2012 Mar;119(3):631-9
references.pmid: 22353963
references.citation: J Infect Dis. 2011 Oct 15;204(8):1157-64
references.pmid: 21917887
references.citation: N Engl J Med. 2010 Jan 7;362(1):27-35
references.pmid: 20032319
references.citation: J Obstet Gynaecol Can. 2009 Feb;31(2):120-5
references.pmid: 19327210
references.citation: CMAJ. 2007 Feb 13;176(4):463-8
references.pmid: 17296958
references.citation: Obstet Gynecol. 2006 Jun;107(6):1315-22
references.pmid: 16738158
references.citation: J Infect Dis. 2012 Dec 1;206(11):1670-3
references.pmid: 22984116
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S107-11
references.pmid: 21419386
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S54-7
references.pmid: 21640231
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S89-93
references.pmid: 21492824
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Aug 19;60(32):1078-82
references.pmid: 21849964
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Sep 9;60(35):1193-6
references.pmid: 21900872
references.citation: Am J Public Health. 2012 Jun;102(6):e33-40
references.pmid: 22515877
references.citation: Am J Obstet Gynecol. 2011 Feb;204(2):146.e1-7
references.pmid: 20965490
references.citation: Clin Infect Dis. 2010 Mar 1;50(5):686-90
references.pmid: 20100064
references.citation: Can Commun Dis Rep. 2013 Oct 10;39(ACS-4):1-37
references.pmid: 31701948
references.citation: Am J Perinatol. 2004 Aug;21(6):333-9
references.pmid: 15311370
references.citation: Clin Infect Dis. 2010 Dec 15;51(12):1355-61
references.pmid: 21058908
references.citation: Obstet Gynecol. 2009 Nov;114(5):981-987
references.pmid: 20168097
references.citation: CMAJ. 2009 Jul 7;181(1-2):55-8
references.pmid: 19528139
references.citation: Vaccine. 2011 Dec 6;29(52):9649-54
references.pmid: 22036887
references.citation: J Infect Dis. 2011 Sep 15;204(6):854-63
references.pmid: 21849282
references.citation: Clin Infect Dis. 2013 May;56(9):1216-22
references.pmid: 23378281
references.citation: Br J Clin Pharmacol. 2012 May;73(5):801-11
references.pmid: 22082196
references.citation: MMWR Morb Mortal Wkly Rep. 2005 Oct 21;54(41):1050-2
references.pmid: 16237376
references.citation: CMAJ. 2010 Mar 9;182(4):349-55
references.pmid: 20159893
references.citation: Obstet Gynecol. 2010 Apr;115(4):717-726
references.pmid: 20308830
references.citation: N Engl J Med. 2013 Jan 24;368(4):333-40
references.pmid: 23323868
references.citation: PLoS One. 2012;7(3):e33048
references.pmid: 22457731
references.citation: J Obstet Gynaecol Can. 2012 Aug;34(8):714-720
references.pmid: 22947404
references.citation: Pharmacoepidemiol Drug Saf. 2011 Oct;20(10):1030-4
references.pmid: 21774030
references.citation: Int J Epidemiol. 1973 Autumn;2(3):229-35
references.pmid: 4359832
references.citation: Obstet Gynecol. 2000 Jul;96(1):81-4
references.pmid: 10862847
references.citation: J Clin Microbiol. 1979 Aug;10(2):184-7
references.pmid: 583151
references.citation: Am J Obstet Gynecol. 2011 Jun;204(6 Suppl 1):S84-8
references.pmid: 21492826
references.citation: Am J Obstet Gynecol. 2013 Apr;208(4):293.e1-7
references.pmid: 23333544
references.citation: MMWR Morb Mortal Wkly Rep. 2010 Dec 3;59(47):1541-5
references.pmid: 21124293
references.citation: Obstet Gynecol. 2010 Apr;115(4):711-716
references.pmid: 20308829
references.citation: Health Technol Assess. 2010 Jul;14(34):109-82
references.pmid: 20630123
references.citation: Am J Obstet Gynecol. 2013 Aug;209(2):130.e1-9
references.pmid: 23583838
references.citation: MMWR Morb Mortal Wkly Rep. 2009 May 15;58(18):497-500
references.pmid: 19444154
references.citation: Am J Obstet Gynecol. 2006 Apr;194(4):1200; author reply 1201
references.pmid: 16580337
references.citation: J Infect Dis. 1979 Aug;140(2):141-6
references.pmid: 479636
references.citation: Am J Epidemiol. 1998 Dec 1;148(11):1094-102
references.pmid: 9850132
references.citation: BJOG. 2000 Oct;107(10):1282-9
references.pmid: 11028582
references.citation: JAMA. 2010 Apr 21;303(15):1517-25
references.pmid: 20407061
references.citation: Arch Pediatr Adolesc Med. 2011 Feb;165(2):104-11
references.pmid: 20921345
references.citation: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD002744
references.pmid: 17253479
references.citation: Clin Infect Dis. 2013 May;56(10):1488-97
references.pmid: 23378284
references.citation: Obstet Gynecol. 2013 Apr;121(4):734-740
references.pmid: 23635672
references.citation: Transfus Med Rev. 2006 Jul;20(3):181-9
references.pmid: 16787826
references.citation: Am J Obstet Gynecol. 2012 Sep;207(3):177.e1-8
references.pmid: 22939717
references.citation: Can J Infect Dis Med Microbiol. 2012 Winter;23(4):e79-92
references.pmid: 24294283
references.citation: Obstet Gynecol. 2003 Apr;101(4):704-10
references.pmid: 12681874
references.citation: Lancet. 2009 Aug 8;374(9688):451-8
references.pmid: 19643469