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Am J Perinatol 2023; 40(03): 326-332
DOI: 10.1055/s-0041-1727218
Original Article

Hospital Admissions from the Emergency Department and Subsequent Critical Care Interventions for Influenza during Pregnancy

Nicole Krenitsky
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Timothy Wen
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Stephanie Cham
2   Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital; Boston, Massachusetts
,
Kartik K. Venkatesh 
3   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Frank Attenello
4   Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
,
William J. Mack
4   Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
,
Mary D'Alton
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Alexander M. Friedman
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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Abstract

Objective The objectives of this study were to determine (1) whether obstetrical patients were more likely to be admitted from the emergency department (ED) for influenza compared with nonpregnant women, and (2) require critical care interventions once admitted.

Study Design Using data from the 2006 to 2011 Nationwide Emergency Department Sample, ED encounters for influenza for women aged 15 to 54 years without underlying chronic medical conditions were identified. Women were categorized as pregnant or nonpregnant using billing codes. Multivariable log linear models were fit to evaluate the relative risk of admission from the ED and the risk of intensive care unit (ICU)-level interventions including mechanical ventilation and central monitoring with pregnancy status as the exposure of interest. Measures of association were described with adjusted risk ratios (aRRs) with 95% confidence intervals (CIs).

Results We identified 15.9 million ED encounters for influenza of which 4% occurred among pregnant women. Pregnant patients with influenza were nearly three times as likely to be admitted as nonpregnant patients (aRR = 2.99, 95% CI: 2.94, 3.05). Once admitted, obstetric patients were at 72% higher risk of ICU-level interventions (aRR = 1.72, 95% CI: 1.61, 1.84). Of pregnant women admitted from the ED, 9.3% required ICU-level interventions such as mechanical ventilation or central monitoring. Older patients and those with Medicare were also at high risk of admission and ICU-level interventions (p < 0.01).

Conclusion Pregnancy confers three times the risk of admission from the ED for influenza and pregnant women are significantly more likely to require ICU-level medical interventions compared with women of similar age. These findings confirm the significant disease burden from influenza in the obstetric population and the public health importance of reducing infection risk.

Key Points

  • Pregnancy confers three times the risk of admission from the ED for influenza.

  • Pregnant women admitted with influenza are significantly more likely to require ICU-level care.

  • Influenza represents a significant disease burden in the obstetric population

Keywords

influenza during pregnancy - maternal critical care - pandemic influenza - maternal emergency care


Publication History

Received: 20 July 2020

Accepted: 02 March 2021

Article published online:
03 May 2021

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