Evaluating the Protective Effects of Influenza Vaccination in Pregnant Women and Their Infants: An Umbrella Review
Abstract
Background: Maternal influenza immunization is a primary strategy for protecting mothers and infants under six months, though its comprehensive efficacy and safety profiles undergo continuous evaluation. However, the reliability of current evidence is moderated by varying degrees of primary study overlap across existing reviews.
Methods: Five electronic databases—PubMed, Embase, Web of Science, ProQuest, and Scopus—were systematically searched up to August 2024. Study eligibility and quality were assessed using the ROBIS tool. To ensure the integrity of the findings and address potential primary study overlap, the Corrected Covered Area (CCA) formula was applied.
Results: Eleven systematic reviews and meta-analyses were evaluated. Maternal influenza vaccination may reduce the risk of laboratory-confirmed influenza (LCI) in both mothers and infants; however, no clear effect was observed on influenza-like illness (ILI). Vaccination is generally associated with a reduced risk of fetal mortality and no consistent evidence suggests a significant increase in congenital anomalies or spontaneous abortion. Maternal influenza vaccination may modestly reduce preterm birth risk, shows no clear effect on small for gestational age, and is associated with reduced low birth weight (LBW). The studies on influenza vaccination in pregnant women showed high overlap for LCI (0.66), infant LCI (0.50), and varying overlap for stillbirth (0.38), congenital anomalies (0.28), spontaneous abortion (0.23), premature birth (0.13), SGA (0.27), and LBW (0.14).
Conclusion: Influenza vaccination during pregnancy effectively reduces LCI in mothers and infants without increasing adverse neonatal outcomes, though its impact on ILI remains inconsistent. Due to high study overlap and variable quality, further large-scale research is required to confirm effects on preterm birth and congenital anomalies.
1. Tapia MD, Sow SO, Tamboura B, et al (2016). Maternal immunisation with trivalent inactivated influenza vaccine for prevention of influenza in infants in Mali: a prospective, active-controlled, observer-blind, randomised phase 4 trial. Lancet Infect Dis, 16 (9):1026-1035.
2. Nordin JD, Kharbanda EO, Benitez GV, et al (2013). Maternal safety of trivalent inactivated influenza vaccine in pregnant women. Obstet Gynecol, 121 (3):519-525.
3. McMillan M, Kralik D, Porritt K, et al (2014). Influenza vaccination during pregnancy: A systematic review of effectiveness and safety. JBI Database System Rev Implement Rep, 12 (6):281-381.
4. Mak TK, Mangtani P, Leese J, et al (2008). Influenza vaccination in pregnancy: current evidence and selected national policies. Lancet Infect Dis, 8 (1):44-52.
5. Madhi SA, Cutland CL, Kuwanda L, et al (2014). Influenza vaccination of pregnant women and protection of their infants. N Engl J Med, 371 (10):918-931.
6. Steinhoff MC, Katz J, Englund JA, et al (2017). Year-round influenza immunisation during pregnancy in Nepal: a phase 4, randomised, placebo-controlled trial. Lancet Infect Dis, 17 (9):981-989.
7. Jarvis J, Dorey RB, Warricker FD, et al (2020). The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: Systematic review and meta-analysis. Vaccine, 38 (7):1601-1613.
8. Quach THT, Mallis NA, Cordero JF (2020). Influenza Vaccine Efficacy and Effectiveness in Pregnant Women: Systematic Review and Meta-analysis. Matern Child Health J, 24 (2):229-240.
9. Yuen CYS, Tarrant M (2014). Determinants of uptake of influenza vaccination among pregnant women–a systematic review. Vaccine, 32 (36):4602-4613.
10. Choi GJ, Kang H (2022). The umbrella review: a useful strategy in the rain of evidence. Korean J Pain, 35 (2):127-128.
11. Becker L, Oxman A (2011). Chapter 22: Overviews of reviews In: Higgins JPT, Green S (editors): Cochrane Handbook for Systematic Reviews of Interventions Version 510 (updated March 2011) The Cochrane Collaboration, 2011.
12. Whiting P, Savović J, Higgins JP, et al (2016). ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 69:225-234.
13. Pieper D, Antoine S-L, Mathes T, et al (2014). Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol, 67 (4):368-375.
14. Cuningham W, Geard N, Fielding JE, et al (2019). Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis. Influenza Other Respir Viruses, 13 (5):438-452.
15. Siu W, Sinilaite A, Papenburg J (2024). Summary of the National Advisory Committee on Immunization (NACI) Updated Guidance on Influenza Vaccination During Pregnancy. Can Commun Dis Rep, 50(3-4):86-92.
16. Nakabembe E, Cooper J, Amaral K, et al (2024). The safety and immunogenicity of vaccines administered to pregnant women living with HIV: a systematic review and meta-analysis. EClinicalMedicine, 69: 102448.
17. McMillan M, Porritt K, Kralik D, et al (2015). Influenza vaccination during pregnancy: a systematic review of fetal death, spontaneous abortion, and congenital malformation safety outcomes. Vaccine, 33 (18):2108-17.
18. Fell DB, Platt RW, Lanes A, et al (2015). Fetal death and preterm birth associated with maternal influenza vaccination: systematic review. BJOG, 122 (1):17-26.
19. Jeong S, Jang EJ, Jo J, Jang S (2019). Effects of maternal influenza vaccination on adverse birth outcomes: A systematic review and Bayesian meta-analysis. PLoS One, 14 (8):e0220910.
20. Zhang C, Wang X, Liu D, et al (2018). A systematic review and meta-analysis of fetal outcomes following the administration of influenza A/H1N1 vaccination during pregnancy. Int J Gynaecol Obstet, 141 (2):141-150.
21. Nunes MC, Aqil AR, Omer SB, et al (2016). The Effects of Influenza Vaccination during Pregnancy on Birth Outcomes: A Systematic Review and Meta-Analysis. Am J Perinatol, 33 (11):1104-1114.
22. Nunes MC, Madhi SA (2018). Influenza vaccination during pregnancy for prevention of influenza confirmed illness in the infants: A systematic review and meta-analysis. Hum Vaccin Immunother, 14 (3):758-766.
23. Wolfe DM, Fell D, Garritty C, et al (2023). Safety of influenza vaccination during pregnancy: a systematic review. BMJ Open, 13 (9):e066182.
24. de Bruin O, Phijffer E, Ahmadizar F, et al (2023). Are maternal vaccines effective and safe for mothers and infants? A systematic review and meta-analysis of randomised controlled trials. BMJ Glob Health, 8 (10):e012376.
25. Polyzos KA, Konstantelias AA, Pitsa CE, et al (2015). Maternal Influenza Vaccination and Risk for Congenital Malformations: A Systematic Review and Meta-analysis. Obstet Gynecol, 126(5): 1075-1084.
26. Bratton KN, Wardle MT, Orenstein WA, et al (2015). Maternal influenza immunization and birth outcomes of stillbirth and spontaneous abortion: A systematic review and meta-analysis. Clin Infect Dis, 60 (5):e11-19.
27. Giles ML, Krishnaswamy S, Macartney K, et al(2019). The safety of inactivated influenza vaccines in pregnancy for birth outcomes: a systematic review. Hum Vaccin Immunother, 15 (3):687-699.
28. Hansen KP, Benn CS, Aamand T, et al (2021). Does Influenza Vaccination during Pregnancy Have Effects on Non-Influenza Infectious Morbidity? A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Vaccines (Basel), 9 (12):1452.
29. Trotta F, Da Cas R, Alegiani SS, et al (2014). Evaluation of safety of A/H1N1 pandemic vaccination during pregnancy: cohort study. BMJ, 348: g3361.
30. Chambers C, Louik C, Jones K, et al (2015). Safety of Seasonal Influenza Vaccines in Pregnancy: VAMPSS Update: 20. Pharmacoepidemiol Drug Saf, 24.
31. Heikkinen T, Young J, van Beek E, et al (2012). Safety of MF59-adjuvanted A/H1N1 influenza vaccine in pregnancy: a comparative cohort study. Am J Obstet Gynecol, 207 (3):177. e1-e8.
32. Rubinstein F, Micone P, Bonotti A, et al (2013). Influenza A/H1N1 MF59 adjuvanted vaccine in pregnant women and adverse perinatal outcomes: multicentre study. BMJ, 346: f393.
33. Källén B, Olausson P (2012). Vaccination against H1N1 influenza with Pandemrix® during pregnancy and delivery outcome: a Swedish register study. BJOG, 119 (13):1583-1590.
34. Deinard AS, Ogburn Jr P (1981). A/NJ/8/76 influenza vaccination program: effects on maternal health and pregnancy outcome. Am J Obstet Gynecol, 140 (3):240-245.
35. Pasternak B, Svanström H, Mølgaard-Nielsen D, et al (2012). Risk of adverse fetal outcomes following administration of a pandemic influenza A (H1N1) vaccine during pregnancy. JAMA, 308 (2):165-174.
36. Lin T-H, Lin S-Y, Lin C-H, et al (2012). AdimFlu-S® influenza A (H1N1) vaccine during pregnancy: the Taiwanese pharmacovigilance survey. Vaccine, 30 (16):2671-2675.
37. Zaman K, Roy E, Arifeen SE, et al (2008). Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med, 359 (15):1555-1564.
38. Cleary BJ, Rice Ú, Eogan M, et al (2014). 2009 A/H1N1 influenza vaccination in pregnancy: uptake and pregnancy outcomes–a historical cohort study. Eur J Obstet Gynecol Reprod Biol, 178:163-168.
39. Launay O, Krivine A, Charlier C, et al (2012). Low rate of pandemic A/H1N1 2009 influenza infection and lack of severe complication of vaccination in pregnant women: a prospective cohort study. PLoS One, 7 (12):e52303.
40. Ma F, Zhang L, Jiang R, et al (2014). Prospective cohort study of the safety of an influenza A (H1N1) vaccine in pregnant Chinese women. Clin Vaccine Immunol, 21 (9):1282-1287.
41. Sheffield JS, Greer LG, Rogers VL, et al (2012). Effect of influenza vaccination in the first trimester of pregnancy. Obstet Gynecol, 120 (3):532-537.
42. Louik C, Ahrens K, Kerr S, et al (2013). Risks and safety of pandemic H1N1 influenza vaccine in pregnancy: exposure prevalence, preterm delivery, and specific birth defects. Vaccine, 31 (44):5033-5040.
43. Oppermann M, Fritzsche J, Weber-Schoendorfer C, et al (2012). A (H1N1) v2009: a controlled observational prospective cohort study on vaccine safety in pregnancy. Vaccine, 30 (30):4445-4452.
44. Munoz FM, Eckert LO, Katz MA, et al (2015). Key terms for the assessment of the safety of vaccines in pregnancy: Results of a global consultative process to initiate harmonization of adverse event definitions. Vaccine, 33 (47):6441-6452.
45. McHugh L, Andrews RM, Lambert SB, et al (2017). Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy, 2012–2014: The FluMum study. Vaccine, 35 (10):1403-1409.
46. Ludvigsson JF, Ström P, Lundholm C, et al (2016). Risk for congenital malformation with H1N1 influenza vaccine: a cohort study with sibling analysis. Ann Intern Med, 165 (12):848-855.
47. Mackenzie IS, MacDonald TM, Shakir S, et al (2012). Influenza H1N1 (swine flu) vaccination: a safety surveillance feasibility study using self‐reporting of serious adverse events and pregnancy outcomes. Br J Clin Pharmacol, 73 (5):801-811.
48. Fabiani M, Bella A, Rota MC, et al (2015). A/H1N1 pandemic influenza vaccination: a retrospective evaluation of adverse maternal, fetal and neonatal outcomes in a cohort of pregnant women in Italy. Vaccine, 33 (19):2240-2247.
49. Richards JL, Hansen C, Bredfeldt C, et al (2013). Neonatal outcomes after antenatal influenza immunization during the 2009 H1N1 influenza pandemic: impact on preterm birth, birth weight, and small for gestational age birth. Clin Infect Dis, 56 (9):1216-1222.
50. Baum U, Leino T, Gissler M, et al (2015). Perinatal survival and health after maternal influenza A (H1N1) pdm09 vaccination: A cohort study of pregnancies stratified by trimester of vaccination. Vaccine, 33 (38):4850-4857.
51. Cantu J, Biggio J, Jauk V, et al (2013). Selective uptake of influenza vaccine and pregnancy outcomes. J Matern Fetal Neonatal Med, 26 (12):1207-1211.
52. Fell DB, Sprague AE, Liu N, et al (2012). H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes. Am J Public Health, 102 (6):e33-e40.
53. Håberg SE, Trogstad L, Gunnes N, et al (2013). Risk of fetal death after pandemic influenza virus infection or vaccination. N Engl J Med, 368 (4):333-340.
54. Beau A, Hurault-Delarue C, Vidal S, et al (2014). Pandemic A/H1N1 influenza vaccination during pregnancy: a comparative study using the EFEMERIS database. Vaccine, 32 (11):1254-1258.
55. Dodds L, MacDonald N, Scott J, et al (2012). The association between influenza vaccine in pregnancy and adverse neonatal outcomes. J Obstet Gynaecol Can, 34 (8):714-720.
56. Nordin JD, Kharbanda EO, Benitez GV, et al (2014). Maternal influenza vaccine and risks for preterm or small for gestational age birth. J Pediatr, 164 (5):1051-1057. e2.
57. Adedinsewo DA, Noory L, Bednarczyk RA, et al (2013). Impact of maternal characteristics on the effect of maternal influenza vaccination on fetal outcomes. Vaccine, 31 (49):5827-5833.
58. Omer SB, Clark DR, Madhi SA, et al (2020). Efficacy, duration of protection, birth outcomes, and infant growth associated with influenza vaccination in pregnancy: a pooled analysis of three randomised controlled trials. Lancet Respir Med, 8 (6):597-608.
59. Legge A, Dodds L, MacDonald NE, et al (2014). Rates and determinants of seasonal influenza vaccination in pregnancy and association with neonatal outcomes. CMAJ, 186 (4):E157-E164.
60. Olsen SJ, Mirza SA, Vonglokham P, et al (2016). The effect of influenza vaccination on birth outcomes in a cohort of pregnant women in Lao PDR, 2014–2015. Clin Infect Dis, 63 (4):487-494.
61. Ahrens KA, Louik C, Kerr S, et al (2014). Seasonal influenza vaccination during pregnancy and the risks of preterm delivery and small for gestational age birth. Paediatr Perinat Epidemiol, 28 (6):498-509.
62. Zerbo O, Modaressi S, Chan B, et al (2017). No association between influenza vaccination during pregnancy and adverse birth outcomes. Vaccine, 35 (24):3186-3190.
63. Mohammed H, Roberts CT, Grzeskowiak LE, et al (2020). Safety and protective effects of maternal influenza vaccination on pregnancy and birth outcomes: A prospective cohort study. EClinicalMedicine, 26: 100522.
64. Veroniki AA, Thirugnanasampanthar SS, Konstantinidis M, et al (2024). Trivalent and quadrivalent seasonal influenza vaccine in adults aged 60 and older: a systematic review and network meta-analysis. BMJ Evid Based Med, 29(4):239-254.
65. Myers ER, Misurski DA, Swamy GK (2011). Influence of timing of seasonal influenza vaccination on effectiveness and cost-effectiveness in pregnancy. Am J Obstet Gynecol, 204 (6 Suppl 1):S128-40.
2. Nordin JD, Kharbanda EO, Benitez GV, et al (2013). Maternal safety of trivalent inactivated influenza vaccine in pregnant women. Obstet Gynecol, 121 (3):519-525.
3. McMillan M, Kralik D, Porritt K, et al (2014). Influenza vaccination during pregnancy: A systematic review of effectiveness and safety. JBI Database System Rev Implement Rep, 12 (6):281-381.
4. Mak TK, Mangtani P, Leese J, et al (2008). Influenza vaccination in pregnancy: current evidence and selected national policies. Lancet Infect Dis, 8 (1):44-52.
5. Madhi SA, Cutland CL, Kuwanda L, et al (2014). Influenza vaccination of pregnant women and protection of their infants. N Engl J Med, 371 (10):918-931.
6. Steinhoff MC, Katz J, Englund JA, et al (2017). Year-round influenza immunisation during pregnancy in Nepal: a phase 4, randomised, placebo-controlled trial. Lancet Infect Dis, 17 (9):981-989.
7. Jarvis J, Dorey RB, Warricker FD, et al (2020). The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: Systematic review and meta-analysis. Vaccine, 38 (7):1601-1613.
8. Quach THT, Mallis NA, Cordero JF (2020). Influenza Vaccine Efficacy and Effectiveness in Pregnant Women: Systematic Review and Meta-analysis. Matern Child Health J, 24 (2):229-240.
9. Yuen CYS, Tarrant M (2014). Determinants of uptake of influenza vaccination among pregnant women–a systematic review. Vaccine, 32 (36):4602-4613.
10. Choi GJ, Kang H (2022). The umbrella review: a useful strategy in the rain of evidence. Korean J Pain, 35 (2):127-128.
11. Becker L, Oxman A (2011). Chapter 22: Overviews of reviews In: Higgins JPT, Green S (editors): Cochrane Handbook for Systematic Reviews of Interventions Version 510 (updated March 2011) The Cochrane Collaboration, 2011.
12. Whiting P, Savović J, Higgins JP, et al (2016). ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 69:225-234.
13. Pieper D, Antoine S-L, Mathes T, et al (2014). Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol, 67 (4):368-375.
14. Cuningham W, Geard N, Fielding JE, et al (2019). Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis. Influenza Other Respir Viruses, 13 (5):438-452.
15. Siu W, Sinilaite A, Papenburg J (2024). Summary of the National Advisory Committee on Immunization (NACI) Updated Guidance on Influenza Vaccination During Pregnancy. Can Commun Dis Rep, 50(3-4):86-92.
16. Nakabembe E, Cooper J, Amaral K, et al (2024). The safety and immunogenicity of vaccines administered to pregnant women living with HIV: a systematic review and meta-analysis. EClinicalMedicine, 69: 102448.
17. McMillan M, Porritt K, Kralik D, et al (2015). Influenza vaccination during pregnancy: a systematic review of fetal death, spontaneous abortion, and congenital malformation safety outcomes. Vaccine, 33 (18):2108-17.
18. Fell DB, Platt RW, Lanes A, et al (2015). Fetal death and preterm birth associated with maternal influenza vaccination: systematic review. BJOG, 122 (1):17-26.
19. Jeong S, Jang EJ, Jo J, Jang S (2019). Effects of maternal influenza vaccination on adverse birth outcomes: A systematic review and Bayesian meta-analysis. PLoS One, 14 (8):e0220910.
20. Zhang C, Wang X, Liu D, et al (2018). A systematic review and meta-analysis of fetal outcomes following the administration of influenza A/H1N1 vaccination during pregnancy. Int J Gynaecol Obstet, 141 (2):141-150.
21. Nunes MC, Aqil AR, Omer SB, et al (2016). The Effects of Influenza Vaccination during Pregnancy on Birth Outcomes: A Systematic Review and Meta-Analysis. Am J Perinatol, 33 (11):1104-1114.
22. Nunes MC, Madhi SA (2018). Influenza vaccination during pregnancy for prevention of influenza confirmed illness in the infants: A systematic review and meta-analysis. Hum Vaccin Immunother, 14 (3):758-766.
23. Wolfe DM, Fell D, Garritty C, et al (2023). Safety of influenza vaccination during pregnancy: a systematic review. BMJ Open, 13 (9):e066182.
24. de Bruin O, Phijffer E, Ahmadizar F, et al (2023). Are maternal vaccines effective and safe for mothers and infants? A systematic review and meta-analysis of randomised controlled trials. BMJ Glob Health, 8 (10):e012376.
25. Polyzos KA, Konstantelias AA, Pitsa CE, et al (2015). Maternal Influenza Vaccination and Risk for Congenital Malformations: A Systematic Review and Meta-analysis. Obstet Gynecol, 126(5): 1075-1084.
26. Bratton KN, Wardle MT, Orenstein WA, et al (2015). Maternal influenza immunization and birth outcomes of stillbirth and spontaneous abortion: A systematic review and meta-analysis. Clin Infect Dis, 60 (5):e11-19.
27. Giles ML, Krishnaswamy S, Macartney K, et al(2019). The safety of inactivated influenza vaccines in pregnancy for birth outcomes: a systematic review. Hum Vaccin Immunother, 15 (3):687-699.
28. Hansen KP, Benn CS, Aamand T, et al (2021). Does Influenza Vaccination during Pregnancy Have Effects on Non-Influenza Infectious Morbidity? A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Vaccines (Basel), 9 (12):1452.
29. Trotta F, Da Cas R, Alegiani SS, et al (2014). Evaluation of safety of A/H1N1 pandemic vaccination during pregnancy: cohort study. BMJ, 348: g3361.
30. Chambers C, Louik C, Jones K, et al (2015). Safety of Seasonal Influenza Vaccines in Pregnancy: VAMPSS Update: 20. Pharmacoepidemiol Drug Saf, 24.
31. Heikkinen T, Young J, van Beek E, et al (2012). Safety of MF59-adjuvanted A/H1N1 influenza vaccine in pregnancy: a comparative cohort study. Am J Obstet Gynecol, 207 (3):177. e1-e8.
32. Rubinstein F, Micone P, Bonotti A, et al (2013). Influenza A/H1N1 MF59 adjuvanted vaccine in pregnant women and adverse perinatal outcomes: multicentre study. BMJ, 346: f393.
33. Källén B, Olausson P (2012). Vaccination against H1N1 influenza with Pandemrix® during pregnancy and delivery outcome: a Swedish register study. BJOG, 119 (13):1583-1590.
34. Deinard AS, Ogburn Jr P (1981). A/NJ/8/76 influenza vaccination program: effects on maternal health and pregnancy outcome. Am J Obstet Gynecol, 140 (3):240-245.
35. Pasternak B, Svanström H, Mølgaard-Nielsen D, et al (2012). Risk of adverse fetal outcomes following administration of a pandemic influenza A (H1N1) vaccine during pregnancy. JAMA, 308 (2):165-174.
36. Lin T-H, Lin S-Y, Lin C-H, et al (2012). AdimFlu-S® influenza A (H1N1) vaccine during pregnancy: the Taiwanese pharmacovigilance survey. Vaccine, 30 (16):2671-2675.
37. Zaman K, Roy E, Arifeen SE, et al (2008). Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med, 359 (15):1555-1564.
38. Cleary BJ, Rice Ú, Eogan M, et al (2014). 2009 A/H1N1 influenza vaccination in pregnancy: uptake and pregnancy outcomes–a historical cohort study. Eur J Obstet Gynecol Reprod Biol, 178:163-168.
39. Launay O, Krivine A, Charlier C, et al (2012). Low rate of pandemic A/H1N1 2009 influenza infection and lack of severe complication of vaccination in pregnant women: a prospective cohort study. PLoS One, 7 (12):e52303.
40. Ma F, Zhang L, Jiang R, et al (2014). Prospective cohort study of the safety of an influenza A (H1N1) vaccine in pregnant Chinese women. Clin Vaccine Immunol, 21 (9):1282-1287.
41. Sheffield JS, Greer LG, Rogers VL, et al (2012). Effect of influenza vaccination in the first trimester of pregnancy. Obstet Gynecol, 120 (3):532-537.
42. Louik C, Ahrens K, Kerr S, et al (2013). Risks and safety of pandemic H1N1 influenza vaccine in pregnancy: exposure prevalence, preterm delivery, and specific birth defects. Vaccine, 31 (44):5033-5040.
43. Oppermann M, Fritzsche J, Weber-Schoendorfer C, et al (2012). A (H1N1) v2009: a controlled observational prospective cohort study on vaccine safety in pregnancy. Vaccine, 30 (30):4445-4452.
44. Munoz FM, Eckert LO, Katz MA, et al (2015). Key terms for the assessment of the safety of vaccines in pregnancy: Results of a global consultative process to initiate harmonization of adverse event definitions. Vaccine, 33 (47):6441-6452.
45. McHugh L, Andrews RM, Lambert SB, et al (2017). Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy, 2012–2014: The FluMum study. Vaccine, 35 (10):1403-1409.
46. Ludvigsson JF, Ström P, Lundholm C, et al (2016). Risk for congenital malformation with H1N1 influenza vaccine: a cohort study with sibling analysis. Ann Intern Med, 165 (12):848-855.
47. Mackenzie IS, MacDonald TM, Shakir S, et al (2012). Influenza H1N1 (swine flu) vaccination: a safety surveillance feasibility study using self‐reporting of serious adverse events and pregnancy outcomes. Br J Clin Pharmacol, 73 (5):801-811.
48. Fabiani M, Bella A, Rota MC, et al (2015). A/H1N1 pandemic influenza vaccination: a retrospective evaluation of adverse maternal, fetal and neonatal outcomes in a cohort of pregnant women in Italy. Vaccine, 33 (19):2240-2247.
49. Richards JL, Hansen C, Bredfeldt C, et al (2013). Neonatal outcomes after antenatal influenza immunization during the 2009 H1N1 influenza pandemic: impact on preterm birth, birth weight, and small for gestational age birth. Clin Infect Dis, 56 (9):1216-1222.
50. Baum U, Leino T, Gissler M, et al (2015). Perinatal survival and health after maternal influenza A (H1N1) pdm09 vaccination: A cohort study of pregnancies stratified by trimester of vaccination. Vaccine, 33 (38):4850-4857.
51. Cantu J, Biggio J, Jauk V, et al (2013). Selective uptake of influenza vaccine and pregnancy outcomes. J Matern Fetal Neonatal Med, 26 (12):1207-1211.
52. Fell DB, Sprague AE, Liu N, et al (2012). H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes. Am J Public Health, 102 (6):e33-e40.
53. Håberg SE, Trogstad L, Gunnes N, et al (2013). Risk of fetal death after pandemic influenza virus infection or vaccination. N Engl J Med, 368 (4):333-340.
54. Beau A, Hurault-Delarue C, Vidal S, et al (2014). Pandemic A/H1N1 influenza vaccination during pregnancy: a comparative study using the EFEMERIS database. Vaccine, 32 (11):1254-1258.
55. Dodds L, MacDonald N, Scott J, et al (2012). The association between influenza vaccine in pregnancy and adverse neonatal outcomes. J Obstet Gynaecol Can, 34 (8):714-720.
56. Nordin JD, Kharbanda EO, Benitez GV, et al (2014). Maternal influenza vaccine and risks for preterm or small for gestational age birth. J Pediatr, 164 (5):1051-1057. e2.
57. Adedinsewo DA, Noory L, Bednarczyk RA, et al (2013). Impact of maternal characteristics on the effect of maternal influenza vaccination on fetal outcomes. Vaccine, 31 (49):5827-5833.
58. Omer SB, Clark DR, Madhi SA, et al (2020). Efficacy, duration of protection, birth outcomes, and infant growth associated with influenza vaccination in pregnancy: a pooled analysis of three randomised controlled trials. Lancet Respir Med, 8 (6):597-608.
59. Legge A, Dodds L, MacDonald NE, et al (2014). Rates and determinants of seasonal influenza vaccination in pregnancy and association with neonatal outcomes. CMAJ, 186 (4):E157-E164.
60. Olsen SJ, Mirza SA, Vonglokham P, et al (2016). The effect of influenza vaccination on birth outcomes in a cohort of pregnant women in Lao PDR, 2014–2015. Clin Infect Dis, 63 (4):487-494.
61. Ahrens KA, Louik C, Kerr S, et al (2014). Seasonal influenza vaccination during pregnancy and the risks of preterm delivery and small for gestational age birth. Paediatr Perinat Epidemiol, 28 (6):498-509.
62. Zerbo O, Modaressi S, Chan B, et al (2017). No association between influenza vaccination during pregnancy and adverse birth outcomes. Vaccine, 35 (24):3186-3190.
63. Mohammed H, Roberts CT, Grzeskowiak LE, et al (2020). Safety and protective effects of maternal influenza vaccination on pregnancy and birth outcomes: A prospective cohort study. EClinicalMedicine, 26: 100522.
64. Veroniki AA, Thirugnanasampanthar SS, Konstantinidis M, et al (2024). Trivalent and quadrivalent seasonal influenza vaccine in adults aged 60 and older: a systematic review and network meta-analysis. BMJ Evid Based Med, 29(4):239-254.
65. Myers ER, Misurski DA, Swamy GK (2011). Influence of timing of seasonal influenza vaccination on effectiveness and cost-effectiveness in pregnancy. Am J Obstet Gynecol, 204 (6 Suppl 1):S128-40.
| Files | ||
| Issue | Vol 54 No 12 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Influenza Vaccine Infant Safety Efficacy | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ostadahmadi Z, Boccalini S, Modabberi M-R, Behzadi A. Evaluating the Protective Effects of Influenza Vaccination in Pregnant Women and Their Infants: An Umbrella Review. Iran J Public Health. 2025;54(12):2634-2646.
