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Association of Maternal Influenza Vaccination During Pregnancy With Early Childhood Health Outcomes

Educational Objective
To understand the benefits of seasonal influenza vaccination administered during pregnancy.
1 Credit CME
Key Points

Question  Is seasonal influenza vaccination in pregnancy associated with adverse childhood health outcomes?

Findings  In this population-based retrospective cohort study that used inverse probability of treatment weighting and included 28 255 children with a mean duration of follow-up of 3.6 years, maternal influenza vaccination during pregnancy was not significantly associated with the risk of immune-related health outcomes (eg, asthma, infections) non–immune-related outcomes (eg, neoplasms, sensory impairment), or nonspecific health outcomes (eg, emergency visits, hospitalizations).

Meaning  Seasonal influenza vaccination in pregnancy was not significantly associated with adverse early childhood health outcomes among offspring.

Abstract

Importance  Seasonal influenza vaccination in pregnancy can reduce influenza illness among pregnant women and newborns. Evidence is limited on whether seasonal influenza vaccination in pregnancy is associated with adverse childhood health outcomes.

Objective  To assess the association between maternal influenza vaccination during pregnancy and early childhood health outcomes.

Design, Setting, and Participants  Retrospective cohort study, using a birth registry linked with health administrative data. All live births in Nova Scotia, Canada, between October 1, 2010, and March 31, 2014, were included, with follow-up until March 31, 2016. Adjusted hazard ratios (HRs) and incidence rate ratios (IRRs) with 95% confidence intervals were estimated while controlling for maternal medical history and other potential confounders using inverse probability of treatment weighting.

Exposures  Seasonal influenza vaccination during pregnancy.

Main Outcomes and Measures  Childhood outcomes studied were immune-related (eg, asthma, infections), non–immune-related (eg, neoplasms, sensory impairment), and nonspecific (eg, urgent or inpatient health care utilization), measured from emergency department and hospitalization databases.

Results  Among 28 255 children (49% female, 92% born at ≥37 weeks’ gestation), 10 227 (36.2%) were born to women who received seasonal influenza vaccination during pregnancy. During a mean follow-up of 3.6 years, there was no significant association between maternal influenza vaccination and childhood asthma (incidence rate, 3.0 vs 2.5 per 1000 person-years; difference, 0.53 per 1000 person-years [95% CI, −0.15 to 1.21]; adjusted HR, 1.22 [95% CI, 0.94 to 1.59]), neoplasms (0.32 vs 0.26 per 1000 person-years; difference, 0.06 per 1000 person-years [95% CI, −0.16 to 0.28]; adjusted HR, 1.26 [95% CI, 0.57 to 2.78]), or sensory impairment (0.80 vs 0.97 per 1000 person-years; difference, −0.17 per 1000 person-years [95% CI, −0.54 to 0.21]; adjusted HR, 0.82 [95% CI, 0.49 to 1.37]). Maternal influenza vaccination in pregnancy was not significantly associated with infections in early childhood (incidence rate, 184.6 vs 179.1 per 1000 person-years; difference, 5.44 per 1000 person-years [95% CI, 0.01 to 10.9]; adjusted IRR, 1.07 [95% CI, 0.99 to 1.15]) or with urgent and inpatient health services utilization (511.7 vs 477.8 per 1000 person-years; difference, 33.9 per 1000 person-years [95% CI, 24.9 to 42.9]; adjusted IRR, 1.05 [95% CI, 0.99 to 1.16]).

Conclusions and Relevance  In this population-based cohort study with mean follow-up duration of 3.6 years, maternal influenza vaccination during pregnancy was not significantly associated with an increased risk of adverse early childhood health outcomes.

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Article Information

Corresponding Author: Deshayne B. Fell, PhD, Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Rd, Centre for Practice Changing Research, Room L-1154, Ottawa, ON K1H 8L1, Canada (dfell@cheo.on.ca).

Accepted for Publication: April 15, 2021.

Author Contributions: Dr Mehrabadi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mehrabadi, Dodds, MacDonald, Benchimol, Ortiz, Sprague, Walsh, Wilson, Fell.

Acquisition, analysis, or interpretation of data: Mehrabadi, Dodds, MacDonald, Top, Benchimol, Kwong, Ortiz, Fell.

Drafting of the manuscript: Mehrabadi, Fell.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Mehrabadi, Dodds, Fell.

Obtained funding: Dodds, Ortiz, Fell.

Administrative, technical, or material support: Dodds, Benchimol, Kwong, Sprague.

Supervision: Wilson, Fell.

Conflict of Interest Disclosures: Dr Top reported receiving consultancy fees from Pfizer and receiving grants from GlaxoSmithKline. Dr Benchimol reported receiving legal consulting fees from Hoffmann La-Roche Limited for matters unrelated to the influenza and other vaccine products. Dr Ortiz reported receiving consultancy fees from Pfizer, Foundation for Influenza, and Seqirus and receiving research support paid to his research unit from the National Institutes of Health, Pfizer, and GlaxoSmithKline. Dr Wilson is CEO of CANImmunize Inc, which hosts a national digital immunization record. No other authors reported disclosures.

Funding/Support: This study was funded by Canadian Institutes of Health Research operating grant AO1-151541.

Role of the Funder/Sponsor: The Canadian Institutes of Health Research had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The data (or portions of the data) used in this report were made available by Health Data Nova Scotia of Dalhousie University. Although this research is based on data obtained from the Nova Scotia Department of Health and Wellness, the observations and opinions expressed are those of the authors and do not represent those of either Health Data Nova Scotia or the Department of Health and Wellness.

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