Vouching for the Fetal Safety of Neuraminidase Inhibitors During Pregnancy

Summary and Comment |
February 28, 2017

Vouching for the Fetal Safety of Neuraminidase Inhibitors During Pregnancy

  1. Anna Wald, MD, MPH

In a large European observational study, treatment of pregnant women with oseltamivir or zanamivir did not cause excess risk for adverse neonatal outcomes or congenital malformations.

  1. Anna Wald, MD, MPH

Influenza infection during pregnancy can lead to severe maternal illness and fetal complications; hence, in the U.S. and Europe, neuraminidase inhibitors are recommended for treatment and occasionally for postexposure prophylaxis in pregnant women. However, in the absence of randomized trials of oseltamivir or zanamivir during pregnancy, safety data are limited. Investigators in Scandinavia and France conducted a population-based observational cohort study to evaluate neonatal outcomes in infants of some 5800 women who had received oseltamivir or zanamivir while pregnant and 692,000 women unexposed during pregnancy. Outcomes included low birthweight, low Apgar scores, preterm birth, neonatal mortality and morbidity, stillbirth, small for gestational age, and congenital malformations.

Adverse outcomes were not significantly more common in offspring of women who received neuraminidase inhibitors. In analyses restricted to women exposed during the first trimester, no excess risk for congenital malformations was observed.

Comment

Treatment with neuraminidase inhibitors prevents influenza-associated morbidity in pregnant women; therefore, placebo-controlled clinical trials of these drugs are not feasible — and observational cohort studies provide the best data to inform clinical decision-making. This large study more than doubles the published data on neuraminidase-inhibitor exposure during pregnancy. In showing no neonatal consequences, the findings should reassure women who acquire influenza during pregnancy but hesitate to take this medication.

Editor Disclosures at Time of Publication

  • Disclosures for Anna Wald, MD, MPH at time of publication Consultant / Advisory board AiCuris; Merck (DSMB) Royalties UpToDate Grant / Research support NIH/National Cancer Institute; NIH/National Institute of Allergy and Infectious Diseases; Genocea Biosciences; Vical Editorial boards Sexually Transmitted Diseases; Sexually Transmitted Infections Leadership positions in professional societies International Society for Sexually Transmitted Diseases Research (Board Member)

Citation(s):

Reader Comments (1)

mbbs,dmrt Physician, Oncology, cochin cancer research center kerala ,india.

good to know ostelmavir is safe in pregnancy outcomes

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.