Febrile Rhinovirus Illness During Pregnancy Is Associated With Low Birth Weight in Nepal

Abstract

Background: Adverse birth outcomes, including low birth weight (LBW), defined as <2500 grams, small-for-gestational-age (SGA), and prematurity, contribute to 60%-80% of infant mortality worldwide and may be related to infections during pregnancy. The aim of this study was to assess whether febrile human rhinovirus (HRV) illness is associated with adverse birth outcomes.

Methods: Active household-based weekly surveillance was performed for respiratory illness episodes in pregnant women as part of a community-based, prospective, randomized trial of maternal influenza immunization in rural Nepal. Rhinovirus (HRV) febrile illness episodes were defined as fever plus cough, sore throat, runny nose, and/or myalgia with HRV detected on mid-nasal swab. Multivariate regression analysis evaluated the association between febrile HRV respiratory illness and adverse birth outcomes.

Results: Overall, 96 (3%) of 3693 pregnant women had HRV-positive febrile respiratory illnesses. Infants born to pregnant women with HRV febrile illness had a 1.6-fold increased risk of being LBW compared with those with non-HRV febrile illness (28 of 96 [38%] vs 109 of 458 [24%]; relative risk [RR], 1.6; 95% confidence interval [CI], 1.1-2.3). No difference in risk of LBW was observed between infants born to mothers with non-HRV febrile respiratory illness and those without respiratory illness during pregnancy (109 of 458 [24%] vs 552 of 2220 [25%], respectively; RR, 1.0; 95% CI, 0.8-1.2).

Conclusions: Febrile illness due to rhinovirus during pregnancy was associated with increased risk of LBW in a rural South Asian population. Interventions to reduce the burden of febrile respiratory illness due to rhinovirus during pregnancy may have a significant impact on LBW and subsequent infant mortality.

Keywords: Nepal; low birth weight; pregnancy; preterm birth; rhinovirus..

Figure 1.

Frequency of low birth weight based on maternal respiratory illness status during pregnancy. Bar plot comparing pregnant women with febrile rhinovirus respiratory illness (black) vs pregnant women with febrile respiratory illness due to another respiratory virus (dark gray) vs pregnant women without febrile respiratory illness during pregnancy (light gray). HRV, human rhinovirus.

Figure 2.

Seasonality of febrile respiratory illness among pregnant and postpartum women. Bar graph showing month of year (x-axis) and number of febrile respiratory illness episodes in pregnant and postpartum women (y-axis). Light gray represents total febrile respiratory illness episodes, and black represents febrile rhinovirus respiratory illness episodes. HRV, human rhinovirus.