Are fetal arrhythmias associated with maternal influenza viral infections during pregnancy?—A systematic review and report of two cases

Abstract

Are fetal arrhythmias associated with maternal influenza viral infections during pregnancy?—A systematic review and report of two cases Bassam H. Rimawi1,* , Laura Edwards2 , Blair Robinson3 , James Edwards1 1Maternal-Fetal Medicine, WakeMed Health & Hospital, Raleigh, NC 27610, USA 2Neonatology, WakeMed Health & Hospital, Raleigh, NC 27610, USA 3Pediatric Cardiology, WakeMed Health & Hospital, Raleigh, NC 27610, USA *Correspondence: Brimawi@wakemed.org (Bassam H. Rimawi) Academic Editor: Michael H. Dahan Submitted: 25 October 2021 Revised: 19 November 2021 Accepted: 13 December 2021 Published: 8 March 2022 Abstract Background: Influenza virus infection during pregnancy is associated with adverse pregnancy outcomes, including congenital anomalies early in pregnancy; however, fetal arrhythmias have not been previously described in these pregnant women. In non-pregnant women, influenza viral infections are associated with arrhythmias and limited data exists regarding fetal arrhythmias secondary to maternal influenza infection. Methods: We performed an online systematic literature review, using PubMed, Google Scholar and Medline search engines to identify all listed publications that meet our inclusion criteria and identified a total of 40 articles. We reviewed abstracts, case reports, case series, surveillance or outbreak reports and observational cohort studies, and exlcuded non-English articles, as well as any unpublished reports, narrative reviews, irrelevant topics, and letter or editorials. We proposed to answer whether or not there is a possible association between maternal acquisition of influenza infection and fetal arrhythmias? Using the data search engines listed above, we identified a total of 40 articles through this search, of which 39 articles that did not meet our inclusion criteria. Thus, we identified only a single article that illustrated the key findings pertaining to our systematic review. In addition, we describe a case series of two additional cases. Results: Three cases were identified that demonstrate a possible association between maternal acquisition of influenza infection and fetal arrhythmias. In our case series, both cases required antiarrhythmic treatment during pregnancy and postnatally to achieve cardioversion to normal sinus rhythm. Neither of these pregnant women received vaccination against influenza at the time of their initial presentation. Conclusions: Fetal arrhythmias can lead to adverse pregnancy outcomes and can be treated early to allow for pregnancy prolongation and overall well-being improvement and chance for intact survival for the fetus and neonate. Based on our systematic review findings and current case series described here, we believe that there is a possible association between maternal influenza infection and fetal arrhythmias, thus, it seems reasonable to assess for concurrent maternal influenza infection in cases of fetal arrhythmias should other maternal symptoms be present for this infection. Larger observational studies are needed to assess if there truly is an association and whether or not a causal link can be established. Keywords: Arrhythmias; Pregnancy; Fetus; Neonate; Influenza