Table 3. Summary of included studies on the burden of disease of respiratory syncytial virus in pregnant people.
| Author, year (reference), country | Study design | Study period | Population | Outcome definition | Results |
|---|---|---|---|---|---|
| Medically attended RSV respiratory tract infection | |||||
| Hause et al., 2019 ((22)) US |
Cross-sectional study | 2015/11/03–2016/05/10 | Pregnant women and people in their 2nd or 3rd trimester enrolled prospectively during their regular prenatal visits (n=155) | Lab-confirmed acute respiratory illness | Seven of 65 (11%) pregnant women and people with ARI at their initial enrollment and eight of 77 (10%) pregnant women and people with ARI during the study period (initial or re-enrollment) had PCR-confirmed RSV infection Four (50%) PCR-confirmed RSV ARI cases reported symptoms of a LRTI, one was hospitalized RSV had an attack rate of 10%–13% among ambulatory pregnant women and people receiving routine prenatal care during the respiratory virus season |
| Hause et al., 2018 ((23)) US |
Cross-sectional study | 2015/10/01–2016/05/10 | Pregnant women and people in their 2nd or 3rd trimester enrolled prospectively during their regular prenatal visits (n=155) | RSV infection was determined by PCR or serology | Of the 81 ARI cases, 52 (64%) respiratory pathogens were detected: The most frequently detected viruses were rhinovirus (n=22; 27%), coronavirus (n=14; 17%) and RSV (n=8; 10%) 12 patients had fever; 17 had symptoms of LRTI Of the seven cases with fever in the ALRTI group, three were RSV-positive (one had HRV coinfection) Of those patients with LRTI, two reported decreased fetal heart rate and one RSV-positive case was hospitalized for respiratory illness |
| RSV respiratory tract infection with hospitalization | |||||
| Regan et al., 2018 ((24)) Australia, Canada (ON), Israel and the US |
Retrospective database study | 2010–2016 | Pregnant women and people aged 18–50 years who were admitted to hospital with an ARFI (n=1,604,206 pregnant women and people) | A RSV-positive ARFI hospitalization was defined as a positive RT-PCR test result within three days of hospital admission | 13,694 hospitalized acute respiratory tract/febrile illness; 846 tested for RSV and influenza 2.5% (n=21) tested positive for RSV 51% (n=430) tested positive for influenza Fewer than 1% tested positive for both influenza and RSV |
| Nowalk et al., 2022 ((25)) US |
Population-based retrospective aggregate cohort study | 2015/09/01–2018/08/31 | Adults ages 18–64 years, 65 years and older and including pregnant women and people (n=13,174 pregnant women and people) | Aggregate data used to determine population-based RSV hospital burden | RSV burden of hospitalization ranged from 0 to 808 per 100,000 pregnant women and people: • 2015–2016: no hospitalized cases of RSV among pregnant women and people • 2016–2017: 431 per 100,000 • 2017–2018: 808 per 100,000 Average burden from 2015 to 2018 of 620/100,000 in pregnant women and people which was higher than the burden for non-pregnant adults 18 years and older (n=320/100,000) |
| Hause et al., 2021 ((26)) US |
Retrospective case series | 2010/08/01–2017/04/30 | Pregnant women and people aged 14–49 years who tested positive for RSV and were hospitalized for RSV infection during pregnancy (n=10) | Variable | 275,349 pregnant women and people; 1,057 tested for RSV; 25 (2%) tested positive; 10 hospitalized during pregnancy and tested positive within two weeks prior to or during hospitalization Diagnoses: pneumonia/atelectasis (n=5), upper respiratory tract infection (n=2), asthma exacerbation (n=2), respiratory failure (n=2), sepsis (n=2) Six had obstetrical complications (one exacerbation of pre-existing short cervix with preterm labour, three preterm contractions (two of which had co-infections), one induction for preeclampsia); one preterm birth; one ICU admission/mechanical ventilation |
| RSV respiratory tract infection with intensive care unit admissions | |||||
| Hause et al., 2021 ((26)) US |
Retrospective case series | 2010/08/01–2017/04/30 | Pregnant women and people whose pregnancy ended in live birth (n=10) | Hospitalization during pregnancy and positive RSV test by culture or PCR | 275,349 pregnant women and people; 1,057 tested for RSV; 25 (2%) tested positive; 10 hospitalized during pregnancy and tested positive within two weeks prior to or during hospitalization One of 10 (10%) required ICU admission and mechanical ventilation |
| Wheeler et al., 2015 ((27)) US |
Case series | Winter 2014 | Antepartum RSV infection treated at single tertiary care facility (n=3) | N/A | Two of three cases required ICU admission and mechanical ventilation; all three cases complicated by pre-existing lung conditions (asthma, comorbid influenza, group A streptococcus infection) |
| Deshmukh et al., 2014 ((28)) UK |
Case report | Not stated | 40-year-old pregnant person (n=1) | N/A | Pregnant person admitted to hospital in UK requiring ICU admission, mechanical ventilation, and emergency C-section at 33 weeks for maternal reasons (RSV pneumonitis and sepsis) |
| Preterm labour/birth with RSV infection | |||||
| Regan et al., 2018 ((24)) Australia, Canada (ON), Israel and the US |
Retrospective database study | 2010–2016 | Pregnant women and people 18–50 years of age who were admitted to hospital with an ARFI (n=1,604,206 pregnant women and people) | A RSV-positive ARFI hospitalization was defined as a positive RT-PCR test result within three days of hospital admission | 13,694 hospitalized acute respiratory tract/febrile illness; 846 tested for RSV; 2.5% (n=21) tested positive by RT-PCR No difference in preterm, small-for-gestational age and low birth weight births between RSV-positive and RSV-negative participants Association observed between RSV positivity and subsequent preterm birth (p=0.034): • RSV-positive participants, 29% • RSV-negative participants, 15% |
| Chu et al., 2016 ((29)) Nepal |
Prospective randomized trial | April 2011–May 2014 | Pregnant women and people in the 2nd trimester of pregnancy and followed until six months postpartum (n=3,693; 14 RSV illness episodes over 3,554 person-year surveillance) | RSV-positive tests were determined by rt-PCR | Seven (50%) pregnant participants sought care for RSV illness; none died Of the seven (50%) illness episodes during pregnancy, all had live births with two (29%) preterm births and a median birth weight of 3,060 grams. This compares to 469 (13%) preterm births and a median birth weight of 2,790 grams in persons without RSV during pregnancy |
| Hause et al., 2021 ((26)) US |
Retrospective case series | 2010/08/01–2017/04/30 | Pregnant women and people whose pregnancy ended in live birth (n=10) | Hospitalization during pregnancy and positive RSV test by culture or PCR | 275,349 pregnant women and people; 1,057 tested for RSV; 25 (2%) tested positive; 10 hospitalized during pregnancy and tested positive within two weeks prior to or during hospitalization One of 10 (10%) participants had pneumonia and preeclampsia and was induced between 36 and 37 weeks |
Abbreviations: ALRTI, acute lower respiratory tract infection; ARFI, acute respiratory infection or febrile illness; ARI, acute respiratory infection; HRV, human rhinovirus; ICU, intensive care unit; LRTI, lower respiratory tract infection; N/A, not applicable; ON, Ontario; PCR, polymerase chain reaction; RSV, respiratory syncytial virus; rt-PCR, real-time polymerase chain reaction; RT-PCR, reverse transcription polymerase chain reaction; UK, United Kingdom; US, United States