Neonatal outcomes after neuraminidase inhibitor use during pregnancy: A meta-analysis of cohort studies

Abstract

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 =.341), low Apgar score (OR 0.96, 95% CI 0.77-1.2, P =.733) or preterm birth (OR 0.99, 95% CI 0.89-1.09, P =.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 =.002) and giving birth to a small-for-gestational-age infant (OR 0.78, 95% CI 0.69-0.88, P