ArticleThe Lancet. Infectious diseases2021
Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries: a multisite prospective longitudinal cohort study.
Article in The Lancet. Infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT06815250 (Effectiveness of the Influenza and Tdap), which is not on this map. Cited by 57 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effectiveness of the Influenza and Tdap (Tetanus, Diphtheria, Acellular Pertussis) Vaccination Educational and Learning Module (InTroDuce-Programme) in Improving Knowledge and Future Uptake of Vaccination Among Pregnant Mothers in Primary Care Clinics: A Randomised Control Trial Secondary IDs
Who cites it
57 citing papers in PubMed, 2 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- COVID-19 in pregnant women: a systematic review and meta-analysis on the risk and prevalence of pregnancy loss.Human reproduction update · 2024Pooled it
- Pooled it
- Maternal Influenza Infection During Pregnancy and Neuropsychiatric Disorders in Offspring.JAMA network open · 2026Article
- The Impact of Maternal Influenza Infection and Vaccination During Pregnancy on Birth Outcomes.The Pediatric infectious disease journal · 2026Article
- Associations of Influenza Illness During Pregnancy with Pregnancy Loss and Program-Defined Child Health Monitoring Indicator: A Matched Cohort Study.Infectious disease reports · 2026Article
- Article
- Maternal influenza vaccination intention and associated factors among pregnant women in Guizhou Province, China.Human vaccines & immunotherapeutics · 2025Article
- Antenatal Respiratory Syncytial Virus and Human Metapneumovirus Illness Rates Among Pregnant Women in Thailand and the Association Between Antenatal Respiratory Syncytial Virus and Perinatal Outcomes: A Prospective Cohort Study.The Journal of infectious diseases · 2025Article
- Opportunity Screening for Early Detection of Gestational Diabetes: Results from the MERGD Study.Journal of clinical medicine · 2025Article
- Article
- Pre-COVID-19 epidemiology of community respiratory viruses at a single US center reveals sex differences in influenza A and a higher ICU incidence of human metapneumovirus in the elderly population.BMC infectious diseases · 2025Article
- Influenza Activity and Preterm Birth in the Atlanta Metropolitan Area: A Time-Series Analysis from 2010 to 2017.Epidemiology (Cambridge, Mass.) · 2025Article
- A Novel Molecularly Imprinted Electrochemiluminescence Sensor Based on Mxene Quantum Dots for Selective Detection of Oseltamivir in Biological Samples.Molecules (Basel, Switzerland) · 2025Article
- Influenza A virus during pregnancy disrupts maternal intestinal immunity and fetal cortical development in a dose- and time-dependent manner.Molecular psychiatry · 2025Article
- Exploring COVID-19 vaccine attitudes among pregnant women: key factors and strategies to enhance uptake.npj women's health · 2025Article
- Research progress in vaccination during pregnancy.Frontiers in immunology · 2025Review
- Oxidative Stress Induced by Antivirals: Implications for Adverse Outcomes During Pregnancy and in Newborns.Antioxidants (Basel, Switzerland) · 2024Review
- Recent advances in the influenza virus vaccine landscape: a comprehensive overview of technologies and trials.Clinical microbiology reviews · 2024Review
- Preventing Influenza Virus Infection and Severe Influenza Among Pregnant People and Infants.Journal of women's health (2002) · 2024Article
- The added value of serologic testing: A comparison of influenza incidence among pregnant persons based on molecular-based surveillance versus serologic testing.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2024Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
29 authors at 12 institutions in 4 countries.
Funding
Abstract
backgroundInfluenza vaccination during pregnancy prevents influenza among women and their infants but remains underused among pregnant women. We aimed to quantify the risk of antenatal influenza and examine its association with perinatal outcomes.
methodsWe did a prospective cohort study in pregnant women in India, Peru, and Thailand. Before the 2017 and 2018 influenza seasons, we enrolled pregnant women aged 18 years or older with expected delivery dates 8 weeks or more after the season started. We contacted women twice weekly until the end of pregnancy to identify illnesses with symptoms of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing and collected mid-turbinate nasal swabs from symptomatic women for influenza real-time RT-PCR testing. We assessed the association of antenatal influenza with preterm birth, late pregnancy loss (≥13 weeks gestation), small for gestational age (SGA), and birthweight of term singleton infants using Cox proportional hazards models or generalised linear models to adjust for potential confounders.
findingsBetween March 13, 2017, and Aug 3, 2018, we enrolled 11 277 women with a median age of 26 years (IQR 23-31) and gestational age of 19 weeks (14-24). 1474 (13%) received influenza vaccines. 310 participants (3%) had influenza (270 [87%] influenza A and 40 [13%] influenza B). Influenza incidences weighted by the population of women of childbearing age in each study country were 88·7 per 10 000 pregnant woman-months (95% CI 68·6 to 114·8) during the 2017 season and 69·6 per 10 000 pregnant woman-months (53·8 to 90·2) during the 2018 season. Antenatal influenza was not associated with preterm birth (adjusted hazard ratio [aHR] 1·4, 95% CI 0·9 to 2·0; p=0·096) or having an SGA infant (adjusted relative risk 1·0, 95% CI 0·8 to 1·3, p=0·97), but was associated with late pregnancy loss (aHR 10·7, 95% CI 4·3 to 27·0; p<0·0001) and reduction in mean birthweight of term, singleton infants (-55·3 g, 95% CI -109·3 to -1·4; p=0·0445).
interpretationWomen had a 0·7-0·9% risk of influenza per month of pregnancy during the influenza season, and antenatal influenza was associated with increased risk for some adverse pregnancy outcomes. These findings support the added value of antenatal influenza vaccination to improve perinatal outcomes.
fundingUS Centers for Disease Control and Prevention. TRANSLATIONS: For the Thai, Hindi, Marathi and Spanish translations of the abstract see Supplementary Materials section.
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