Early Childhood Health Outcomes Following In Utero Exposure to Influenza Vaccines: A Systematic Review

A systematic review of the literature indicates exposure to influenza vaccination in utero is not associated with adverse health outcomes in childhood. CONTEXT:Vaccination during pregnancy is an effective strategy for preventing infant disease; however, little is known about early childhood health after maternal vaccination.OBJECTIVES:To systematically review the literature on early childhood health associated with exposure to influenza vaccines in utero.DATA SOURCES:We searched CINAHL Plus, Embase, Medline, Scopus, and Web of Science for relevant articles published from inception to July 24, 2019.STUDY SELECTION:We included studies published in English reporting original data with measurement of in utero exposure to influenza vaccines and health outcomes among children <5 years of age.DATA EXTRACTION:Two authors independently assessed eligibility and extracted data on study design, setting, population, vaccines, outcomes, and results.RESULTS:The search yielded 3647 records, of which 9 studies met the inclusion criteria. Studies examined infectious, atopic, autoimmune, and neurodevelopmental outcomes, and all-cause morbidity and mortality. Authors of 2 studies reported an inverse association between pandemic influenza vaccination and upper respiratory tract infections and all-cause hospitalizations, and authors of 2 studies reported modest increased association between several childhood disorders and pandemic or seasonal influenza vaccination, which, after adjusting for confounding and multiple comparisons, were not statistically significant.LIMITATIONS:Given the small number of studies addressing similarly defined outcomes, meta-analyses were deemed not possible.CONCLUSIONS:Results from the few studies in which researchers have examined outcomes in children older than 6 months of age did not identify an association between exposure to influenza vaccines in utero and adverse childhood health outcomes.