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Outcomes of Pandemic Influenza in Pregnancy

14 juni 2011 bijgewerkt door: Dalhousie University

Outcomes of Pandemic Influenza in Pregnancy: an Observational Cohort Study

We propose to follow a cohort of pregnant and post-partum Canadian women through the fall and winter of 2009/2010 and the anticipated second and third waves of the current pandemic in order to better understand the incidence, complications and risk factors for severe disease due to H1N1 influenza in pregnant women, and to contribute data on the safety and effectiveness of antivirals and vaccines in this population.

The primary hypotheses to be tested are:

(i) pandemic influenza infection in the second and third trimester of pregnancy is associated with an increase in adverse fetal outcomes (fetal loss, stillbirth, neonatal mortality, significant neonatal morbidity, prematurity) (ii) close contact with young children (<2 yrs) at home or work is the most important risk factor for influenza in pregnant women (iii) higher scores on a scale of community infection prevention (a combination of self-reported hand hygiene adherence, avoidance of ill persons and avoidance of crowds) are protective against influenza (iv) receipt of seasonal influenza vaccine from 2007 to 2009 will increase the risk of illness due to influenza A(H1N1)v in the second and third waves of the pandemic.

(v) pandemic influenza vaccine is effective in preventing symptomatic influenza in pregnant women.

(vi) vaccination of pregnant women against a particular strain of influenza protects their infants against influenza infection in the first six months of life.

Studie Overzicht

Toestand

Onbekend

Conditie

Gedetailleerde beschrijving

Subjects will be consented to participate in the study. They will complete a web-based baseline questionnaire. Participants will be given a nasal swab kit with instructions for obtaining swabs. Baseline blood (10mls) will be drawn for influenza serology and for measurement of total IgG and IgG subtypes. An email will be sent to each participant within 24 hours of their enrolment to welcome them to the study.

Participants will be asked to complete a weekly diary using web-based data entry. An email will be sent to each participant every Monday during the study reminding the participant to complete their weekly diary and to report and submit a nasal swab if they have any symptoms of an acute respiratory illness. Reminder emails will be sent 48 hours later if the weekly form remains incomplete. Participants will be telephoned if forms remain incomplete for three weeks. Weekly emails will also be used to update participants about vaccine availability, current vaccine recommendations, and any changes in expert recommendations for pregnant women.

Once every four weeks additional questions will be asked on the weekly survey. If any participant develops symptoms compatible with an acute viral respiratory illness they will be asked to collect and submit a nasal swab as soon as possible after the onset of symptoms and to complete an illness starting the day of symptom onset and ending when all symptoms are either absent or mild, or for 3 days, whichever is longer. Subjects will be notified if results are positive for influenza along with the local Medical Officer of Health. Treatment for influenza will be discussed with each infected participant by a physician investigator.

Repeat serology and blood for total IgG and IgG subtype will be drawn at the time of delivery to the six week post partum. Women will notify the study when they are admitted for delivery or termination of pregnancy and will be interviewed either in person at the hospital, or over the telephone within 3 weeks of delivery. A chart review will be performed to identify any complications at delivery or termination, and to record neonatal outcomes. Post-partum, mothers will continue their own weekly and illness diaries and weekly diaries for their infants will be added.

Pregnant women requiring hospital admission for influenza in hospitals participating in surveillance for the Toronto Invasive Bacterial Diseases Network (TIBDN) and Serious Outcomes Surveillance (SOS) for the PHAC/CIHR Influenza Research Network (PCIRN), as well as pregnant women with influenza admitted to intensive care units as part of the Canadian Critical Care Clinical Trials Group Influenza Surveillance System (ICU-Flu) will be approached. Risk factor data from the baseline and weekly questionnaires will be collected retrospectively from these women. With consent, women will be followed to delivery/termination, and the same information collected regarding neonatal outcomes as was collected for other women in the cohort.

An email will be sent to all participating women requesting their consideration of three additional parts of the study:

  1. A questionnaire of development (the 8 month Ages and Stages® Questionnaire; see attached) to be completed by the parent
  2. An assessment with a physical examination at 7-9 months of age by a trained physician or a nurse practitioner
  3. Permission for the study to contact parents in the future about further follow-up.

Mothers will also be asked to book an appointment for the 7-9 month assessment. Mothers who do not wish to have a pediatrician assessment will be asked over the telephone if they have any questions they wish to have answered about the study or the Ages and Stages® questionnaire, and if they consent to contact for future long term follow-up studies. If the child's score on the Ages and Stages® questionnaire raises a concern, mothers will be offered the chance to discuss this with a study physician, to have the results shared with her child's physician and/or to be referred to a pediatrician.

Participants may choose to withdraw from the study at any time. When they do so, they will be asked if the data and blood samples that have been provided can be kept and used for study purposes. If a patient withdraws and cannot be contacted data that has been obtained will be retained, and blood will be used for the immediate study purpose, but will not be used for future studies.

Studietype

Observationeel

Inschrijving (Werkelijk)

200

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Canada
    • Alberta
      • Calgary, Alberta, Canada
        • University Of Calgary
      • Edmonton, Alberta, Canada
        • University of Edmonton
    • British Columbia
      • Vancouver, British Columbia, Canada
        • British Columbia's Women's and Children's Hospital
    • Nova Scotia
      • Halifax, Nova Scotia, Canada, B3K 6R8
        • Queen Elizabeth Ii Health Sciences Centre
    • Ontario
      • Hamilton, Ontario, Canada
        • McMaster University
      • Ottawa, Ontario, Canada
        • Public Health Agency of Canada
      • Toronto, Ontario, Canada
        • Mount Sinai Hospital
    • Quebec
      • Montreal, Quebec, Canada
        • Laval University

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Kind
  • Volwassen
  • Oudere volwassene

Accepteert gezonde vrijwilligers

Ja

Geslachten die in aanmerking komen voor studie

Vrouw

Bemonsteringsmethode

Niet-waarschijnlijkheidssteekproef

Studie Bevolking

800 pregnant women followed through pregnancy during second and third waves of the 2009 influenza pandemic, and 2009/10 influenza season. Forty percent are high risk pregnancies: either for maternal influenza complications (eg. underlying asthma, gestational diabetes mellitus in prior pregnancies) or high risk for obstetrical complications (eg. prior premature birth, multiple pregnancies). Recruitment from Halifax, Quebec City, Toronto, Hamilton, Calgary, Edmonton, and Vancouver. Plan to enroll all women before the beginning of the second wave; however, enrolment of women <20 weeks pregnant will continue at each site until the second wave has peaked locally.

Beschrijving

Inclusion Criteria:

  • Participants must:

    1. be and pregnant, and, at the time of enrolment, not more than 30 weeks gestation.
    2. be greater than or equal to 16 years of age
    3. give written informed consent prior to entry
    4. be available for follow-up during the study period
    5. have convenient access to a computer with internet access
    6. know basic skills for use of the internet
    7. have the ability to complete questionnaires in either English or French

Exclusion Criteria:

  • None

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Influenza A(H1N1)v infection: will be as diagnosed by polymerase chain reaction(PCR) from nasal or nasopharyngeal (NP) swabs, and/or seroconversion to influenza A(H1H1)v.
Tijdsspanne: October 2009 to June 2010

Primary analysis for risk factors for infection will consider only symptomatic infection, defined as acute respiratory illness/ influenza like illness (fever (at least one measured T>=38°C) and cough and one other local or systemic symptom compatible with influenza) during the pregnancy with seroconversion to A(H1N1)v not explained by vaccination. Seroconversion defined as a 4 fold increase in hemagglutination inhibition titer from 1st to 2nd serum sample.

Symptoms compatible with influenza defined as fever, cough, coryza, generalized myalgias, sore throat, headache, severe fatigue.
October 2009 to June 2010

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Adverse fetal/neonatal outcome.
Tijdsspanne: October 2009-June 2010
Fetal loss >12 weeks, stillbirth, neonatal mortality, significant neonatal morbidity, prematurity, or low birth weight, stillbirth, neonatal mortality, prematurity, live birth at less than 37 weeks gestational age, low birth weight, significant neonatal morbidity, severe congenital malformation, complicated influenza infection.
October 2009-June 2010

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Dalhousie University

Medewerkers

Canadian Institutes of Health Research (CIHR)

Onderzoekers

  • Hoofdonderzoeker: Shelly McNeil, MD FRCPC, Dalhousie University, Halifax, NS
  • Hoofdonderzoeker: Emmanuel Bujold, MD, Laval University, Montreal, Quebec
  • Hoofdonderzoeker: Allison McGeer, MD FRCPC, University of Toronto, Toronto, Ontario
  • Hoofdonderzoeker: Mark Loeb, MD, McMaster University, Hamiton, Ontario
  • Hoofdonderzoeker: Marie Louie, MD, University of Calgary, Calgary, Alberta
  • Hoofdonderzoeker: George Zahariadis, MD, University of Alberta, Edmonton, Alberta
  • Hoofdonderzoeker: Deborah Money, MDFRCSC, University of British Columbia, Vancouver, British Columbia
  • Hoofdonderzoeker: Rachel Rodin, MD, Public Health Agency of Canada, Ottawa, Ontario

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 september 2009

Studie voltooiing (Verwacht)

1 september 2012

Studieregistratiedata

Eerst ingediend

23 maart 2011

Eerst ingediend dat voldeed aan de QC-criteria

23 maart 2011

Eerst geplaatst (Schatting)

24 maart 2011

Updates van studierecords

Laatste update geplaatst (Schatting)

15 juni 2011

Laatste update ingediend die voldeed aan QC-criteria

14 juni 2011

Laatst geverifieerd

1 juni 2011

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 114231

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