The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study.

Helen Dolk, JM Luteijn, Marie-Claude Addor, Larraitz Arriola, Fabrizio Bianchi, Ester Garne, Babak Khoshnood, Vera Nelen, Amanda Neville, Annette Queisser-Luft, J Rankin, Catherine Rounding, Christine Verellen-Dumoulin, HEK de Walle, Diana Wellesley, B Wreyford, L Yevtushok, Lolkje de Jong-van den Berg, J Morris

Research output: Contribution to journalArticle

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Abstract

BACKGROUND:
In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of congenital anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons.

METHODS:
We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal congenital anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the congenital anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies.

RESULTS:
There was no evidence for an increased overall prevalence of congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons.

CONCLUSIONS:
Our data do not suggest an overall association of pandemic or seasonal influenza with congenital anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.
LanguageEnglish
Pages853-861
JournalEpidemiology
Volume26
Issue number6
DOIs
Publication statusPublished - 26 Nov 2015

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Pandemics
Human Influenza
Pregnancy
Embryonic and Fetal Development
Tricuspid Atresia
Tetralogy of Fallot
Ventricular Heart Septal Defects
Registries
Pathologic Constriction

Cite this

Dolk, Helen ; Luteijn, JM ; Addor, Marie-Claude ; Arriola, Larraitz ; Bianchi, Fabrizio ; Garne, Ester ; Khoshnood, Babak ; Nelen, Vera ; Neville, Amanda ; Queisser-Luft, Annette ; Rankin, J ; Rounding, Catherine ; Verellen-Dumoulin, Christine ; de Walle, HEK ; Wellesley, Diana ; Wreyford, B ; Yevtushok, L ; de Jong-van den Berg, Lolkje ; Morris, J. / The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study. In: Epidemiology. 2015 ; Vol. 26, No. 6. pp. 853-861.
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title = "The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study.",
abstract = "BACKGROUND:In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of congenital anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons.METHODS:We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal congenital anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the congenital anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies.RESULTS:There was no evidence for an increased overall prevalence of congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons.CONCLUSIONS:Our data do not suggest an overall association of pandemic or seasonal influenza with congenital anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.",
author = "Helen Dolk and JM Luteijn and Marie-Claude Addor and Larraitz Arriola and Fabrizio Bianchi and Ester Garne and Babak Khoshnood and Vera Nelen and Amanda Neville and Annette Queisser-Luft and J Rankin and Catherine Rounding and Christine Verellen-Dumoulin and {de Walle}, HEK and Diana Wellesley and B Wreyford and L Yevtushok and {de Jong-van den Berg}, Lolkje and J Morris",
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Dolk, H, Luteijn, JM, Addor, M-C, Arriola, L, Bianchi, F, Garne, E, Khoshnood, B, Nelen, V, Neville, A, Queisser-Luft, A, Rankin, J, Rounding, C, Verellen-Dumoulin, C, de Walle, HEK, Wellesley, D, Wreyford, B, Yevtushok, L, de Jong-van den Berg, L & Morris, J 2015, 'The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study.', Epidemiology, vol. 26, no. 6, pp. 853-861. https://doi.org/10.1097/EDE.0000000000000372

The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study. / Dolk, Helen; Luteijn, JM; Addor, Marie-Claude; Arriola, Larraitz; Bianchi, Fabrizio; Garne, Ester; Khoshnood, Babak; Nelen, Vera; Neville, Amanda; Queisser-Luft, Annette; Rankin, J; Rounding, Catherine; Verellen-Dumoulin, Christine; de Walle, HEK; Wellesley, Diana; Wreyford, B; Yevtushok, L; de Jong-van den Berg, Lolkje; Morris, J.

In: Epidemiology, Vol. 26, No. 6, 26.11.2015, p. 853-861.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study.

AU - Dolk, Helen

AU - Luteijn, JM

AU - Addor, Marie-Claude

AU - Arriola, Larraitz

AU - Bianchi, Fabrizio

AU - Garne, Ester

AU - Khoshnood, Babak

AU - Nelen, Vera

AU - Neville, Amanda

AU - Queisser-Luft, Annette

AU - Rankin, J

AU - Rounding, Catherine

AU - Verellen-Dumoulin, Christine

AU - de Walle, HEK

AU - Wellesley, Diana

AU - Wreyford, B

AU - Yevtushok, L

AU - de Jong-van den Berg, Lolkje

AU - Morris, J

PY - 2015/11/26

Y1 - 2015/11/26

N2 - BACKGROUND:In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of congenital anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons.METHODS:We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal congenital anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the congenital anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies.RESULTS:There was no evidence for an increased overall prevalence of congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons.CONCLUSIONS:Our data do not suggest an overall association of pandemic or seasonal influenza with congenital anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.

AB - BACKGROUND:In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of congenital anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons.METHODS:We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal congenital anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the congenital anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies.RESULTS:There was no evidence for an increased overall prevalence of congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons.CONCLUSIONS:Our data do not suggest an overall association of pandemic or seasonal influenza with congenital anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.

U2 - 10.1097/EDE.0000000000000372

DO - 10.1097/EDE.0000000000000372

M3 - Article

VL - 26

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JO - Epidemiology

T2 - Epidemiology

JF - Epidemiology

SN - 1044-3983

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