89 - Association of chronic comorbid disease and severe maternal morbidity among pregnant patients with influenza
Saturday, January 30, 2021
10:30 AM – 10:45 AM EST
Objective: Patients with chronic comorbid disease are at increased risk of morbidity and mortality from influenza, and whether this holds for pregnant patients remains to be defined. Our objective was to determine among pregnancies with influenza, whether chronic comorbid disease was associated with an increased risk of maternal morbidity.
Study Design: A cross sectional analysis of delivery hospitalizations complicated by influenza during pregnancy was conducted using the 2000-2015 National Inpatient Sample. Chronic comorbid conditions included chronic hypertension (cHTN), pregestational diabetes (PGDM), obesity, and obstructive lung disease (OLD). The primary outcome was severe maternal morbidity (SMM) defined by Centers for Disease Control and Prevention criteria, and secondarily, complications associated with influenza, including sepsis/shock, acute respiratory distress syndrome (ARDS), and mechanical ventilation/tracheostomy. Log linear models were used, adjusting for patient, hospital, and clinical variables.
Results: Of 62.7 million, 182,228 (0.3%) delivery hospitalizations were complicated by influenza, with a rate over 2-fold higher of 64.7 per 10,000 deliveries for patients with chronic comorbidities versus 24.4 without. Over 1 in 4 (26%, n=47, 273) deliveries with influenza had one or more chronic comorbidities and higher frequencies of SMM (2.7% vs 1.9%), ARDS (0.8% vs. 0.4%), and mechanical ventilation (0.2% vs. 0.1%) with similar rates of shock/sepsis. Among pregnant patients with influenza, those with OLD were at higher risk of SMM (adjusted risk ratio (aRR): 1.18), as well as ARDS (aRR: 1.83) and mechanical ventilation (aRR: 2.45). Patients with cHTN, obesity, and PGDM were also at elevated risks of adverse complications (Table).
Conclusion: Among patients with influenza during pregnancy, chronic comorbid conditions, particularly obstructive lung disease, may increase the risk of maternal morbidity. Further efforts aimed at increasing influenza vaccination in pregnancy for patients with chronic comorbidities as well as optimizing pregnancy care for this population may mitigate this risk.