Prenatal influenza exposure and cardiovascular events in adulthood
Article first published online: 7 NOV 2013
© 2013 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Influenza and Other Respiratory Viruses
Volume 8, Issue 1, pages 83–90, January 2014
How to Cite
2014) Prenatal influenza exposure and cardiovascular events in adulthood. Influenza and Other Respiratory Viruses 8(1), 83–90.et al. (
- Issue published online: 20 DEC 2013
- Article first published online: 7 NOV 2013
- Manuscript Accepted: 21 SEP 2013
- Clinical Epidemiological Research Foundation
- Aarhus University
- Acute myocardial infarction;
This study examined the association between prenatal exposure to pandemic influenza and cardiovascular events in adulthood.
Using Danish surveillance data to identify months when influenza activity was highest during three previous pandemics (1918, 1957, and 1968), persons were defined as exposed/unexposed based on whether they were in utero during peak months of one of the pandemics. Episodes of acute myocardial infarction (MI) and stroke were identified in the Danish National Registry of Patients covering all Danish hospitals since 1977.
Information from Danish national registries on all persons with a Civil Personal Registry number and birthdates in 1915 through 1922, 1954 through 1960, and 1966 through 1972 was collected.
Main outcome measures
Crude incidence rate ratios (IRRs) were calculated per pandemic. Generalized linear models were fit to estimate IRRs adjusted for sex.
For acute MI, sex-adjusted IRRs for persons in utero during peaks of the 1918, 1957, and 1968 pandemics, compared with those born afterward, were 1·02 (95% confidence interval (CI): 0·99, 1·05), 0·96 (95% CI: 0·87, 1·05), and 1·18 (95% CI: 0·96, 1·45), respectively. For stroke, the corresponding IRRs were 0·99 (95% CI: 0·97, 1·02), 0·99 (95% CI: 0·92, 1·05), and 0·85 (95% CI: 0·77, 0·94), respectively.
There was generally no evidence of an association between prenatal influenza exposure and acute MI or stroke in adulthood. However, survivor bias and left truncation of outcomes for the 1918 pandemic are possible, and the current young ages of persons included in the analyses for the 1957 and 1968 pandemics may warrant later re-evaluation.