Authors’ contributions
JSL and YPZ conceived the study and revised the manuscript critically
for important intellectual content. MA made substantial contributions to
its design, acquisition, analysis and interpretation of data. CC and HYJ
participated in the design, acquisition, analysis and interpretation of
data. All authors read and approved the final manuscript.
AIM: Influenza infection poses a severe threat to pregnant
mothers, and antiviral treatment is recommended. However, the safety of
neuraminidase-inhibitor antiviral medications during pregnancy has not
been well described.
METHODS: A systematic review and meta-analysis were performed
to evaluate the adverse neonatal outcomes associated with exposure to
neuraminidase inhibitors during pregnancy. The PubMed, Embase, and
Cochrane Library databases were searched to identify potential studies
for inclusion.
RESULTS: Nine cohort studies that estimated adverse neonatal
outcomes associated with exposure to neuraminidase-inhibitor medication
during pregnancy were included. Exposure to a neuraminidase inhibitor
during pregnancy was not associated with an increased risk of congenital
malformation (odds ratio [OR] 0.9, 95% confidence interval [CI]
0.72–1.12, P = 0.341), low Apgar score (OR 0.96, 95% CI 0.77–1.2, P =
0.733), or preterm birth (OR 0.99, 95% CI 0.89–1.09, P = 0.771)
compared with no exposure. However, exposure to a neuraminidase
inhibitor was associated with a reduced risk of low birth weight (OR
0.79, 95% CI 0.68–0.92, P = 0.002) and giving birth to a
small-for-gestational-age infant (OR 0.78, 95% CI 0.69–0.88, P
< 0.001). Further analyses limited to oseltamivir exposure
were consistent with the overall results.
CONCLUSION: Exposure to neuraminidase-inhibitor medication
during pregnancy does not appear to be associated with adverse neonatal
outcomes. We recommend further studies to investigate this association,
which will help clinicians determine whether to prescribe a
neuraminidase inhibitor during pregnancy.
Keywords: flu, antiviral, prenatal, maternal.