Risk factors and prediction of complicated flu and acute respiratory viral infections during pregnancy
А.V. ROMANOVSKAYA, N.F. KHVOROSTUKHINA, Е.V. MIKHAILOVA, N.N. STEPANOVA
Saratov State Medical University named after V.I. Razumovsky, Saratov
Contact:
Romanovskaya A.V. ― MD, Associate Professor of the Department of Obstetrics and Gynecology, Pediatric Faculty
Address: 112 Bolshaya Kazachia Str., Saratov, Russian Federation, 410012, tel. +7-905-323-03-02, e-mail: annavictorovna@mail.ru
Objective ― to develop a mathematical model for predicting the risk of developing viral-bacterial pneumonia in pregnant women with influenza and acute respiratory viral infection based on the study of anamnesis and gestation period in the complicated course of viral infectious diseases.
Material and methods. The study included 967 pregnant women (605 with influenza A (H1N1) pdm09, 174 with non-pandemic influenza, 188 ― with acute respiratory viral infection), 308 non-pregnant women ― with similar forms of viral infection (respectively), and 98 healthy pregnant women ― without influenza and acute respiratory viral infection. Statistical processing was performed using Microsoft Excel for Windows 4.0 (Microsoft Corp.) and Statistica (version 6.0) software. A mathematical model for assessing the risk of developing pneumonia and predicting the complications of viral infections during pregnancy is developed based on a consistent method for calculating Bayesian conditional probabilities.
Results. When combined with pregnancy, the frequency of severe course of influenza A (H1N1) pdm09 increases 1.7 times (up to 73.5%), non-pandemic influenza ― 1.5 times (up to 25.1%), and ARVI ― 1.4 times (up to 36.1%). Additional risk factors for severe forms of influenza and acute respiratory viral infections, including those complicated by viral-bacterial pneumonia, are the age of pregnant women over 30 years old, the presence of concomitant somatic pathology (arterial hypertension, respiratory diseases, diabetes mellitus and obesity) and the third trimester of gestation. Based on the identified factors, an expert advisory chart was developed to assess the risk of developing viral bacterial pneumonia in pregnant women against the background of influenza and acute respiratory viral infection. In pregnant women with no risk factors, the likelihood of developing pneumonia did not exceed 13.3%, and in the presence of four factors (influenza A (H1N1) pdm09 + background diseases + III trimester of gestation + age over 30) it increased to 68.2%.
Conclusion. The use in the practical work of doctors of an expert advisory chart for predicting the risk of complications of viral infections in pregnant women will allow timely correction of treatment and diagnostic measures and increase their effectiveness.
Key words: pregnancy, influenza, acute respiratory viral infections, prediction of complications.
(For citation: Romanovskaya А.V., Khvorostukhina N.F., Mikhailova Е.V., Stepanova N.N. Risk factors and prediction of complicated flu and acute respiratory viral infections during pregnancy. Practical medicine. 2019. Vol. 17, №8, P. 74-78)
REFERENCES
- Apresyan S.V., Radzinskiy V.E. Beremennost’ i rody pri ekstragenital’nykh zabolevaniyakh [Pregnancy and childbirth with extragenital diseases]. Moscow: GEOTAR-Media, 2009. 464 p.
- Khvorostukhina N.F., Salov I.A. Beremennost’ i ostrye khirurgicheskie zabolevaniya organov bryushnoy polosti: diagnostika, lechenie, akusherskaya taktika [Pregnancy and acute surgical diseases of the abdominal cavity: diagnosis, treatment, obstetric tactics]. Saratov: Izd-vo Sarat. gos. med. un-ta, 2018. 304 p.
- Romanovskaya A.V., Maleev V.V., Khvorostukhina N.F. The influence of influenza on pregnancy, fetal development and the health status of the newborn. Voprosy ginekologii, akusherstva i perinatologii, 2014, vol. 13, no. 2, pp. 49-53 (in Russ.).
- Belokrinitskaya T.E., Tarbaeva D.A., Trubitsyna A.Yu. Severe forms of influenza in pregnant women: risk factors, clinical features, prevention. Vrach, 2013, no. 2, pp. 32-36 (in Russ.).
- Betsukova A.M. Sravnitel’naya kliniko-laboratornaya kharakteristika grippa A(N3N2) i A(N1N1): avtoref dis. … kand. med. nauk [Comparative clinical and laboratory characteristics of influenza A (H3N2) and A (H1N1). Synopsis of dis. PhD med. sciences]. Moscow: FBUN TsNII Epidemiologii Rospotrebnadzora, 2013. Pp. 8-12.
- Maleev V.V., Mikhaylova E.V., Chudakova T.K. Clinical and epidemiological characteristics of influenza in the post-pandemic period. Saratovskiy nauchno-meditsinskiy zhurnal, 2013, vol. 9, no. 2, pp. 186-192 (in Russ.).
- Regan A.K., Moore H.C., de Klerk N. et al. Seasonal Trivalent Influenza Vaccination During Pregnancy and the Incidence of Stillbirth: Population-Based Retrospective Cohort Study. Clin. Infect. Dis, 2016, vol. 62 (10), rr. 1221-7. doi: 10.1093/cid/ciw082.
- Romanovskaya A.V., Davydov A.I., Khvorostukhina N.F. Features of the course and outcomes of pregnancy with influenza A / H1N1 SWIN. Voprosy ginekologii, akusherstva i perinatologii, 2016, vol. 15, no. 5, pp. 26-31 (in Russ.).
- Baranov I.I., Arslanyan K.N., Nesterova L.A. Influenza in pregnant women. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie, 2018, no. 2 (20), pp. 42-51 (in Russ.).
- Tunheim G., Laake I., Robertson A.H. et al. Antibody levels in a cohort of pregnant women after the 2009 influenza A(H1N1) pandemic: Waning and association with self-reported severity and duration of illness. Influenza Other Respir Viruses, 2019, vol. 13 (2), rr. 191-200. doi: 10.1111/irv.12623.
- Zenin I.V., Popov A.F., Gorelova I.S. et al. Clinical picture of influenza in pregnant women. Epidemiologiya i infektsionnye bolezni, 2018, vol. 23, no. 1, pp. 15-22 (in Russ.).
- Regan A.K., Gibbs R., Bloomfield L., Effler P.V. Estimating influenza vaccine effectiveness using data routinely available in electronic primary care records. Vaccine, 2019, vol. 37 (5), rr. 755-762. doi: 10.1016/j.vaccine.2018.12.006.
- Kalinina Z.P., Dolgiy A.A., Parkov O.V. et al. Assessment of the impact of influenza on pregnancy. Profilakticheskaya i klinicheskaya meditsina, 2017, no. 3 (64), pp. 8-13 (in Russ.).