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To examine health care burden, pregnancy outcomes and impact of high risk medical conditions among pregnancy hospitalizations during influenza season. Length of stay, hospitalization charges, and delivery complications were compared between hospitalizations with and without respiratory illness and compared by presence of high risk medical conditions. Length of stay and hospital charges were significantly increased among respiratory illness hospitalizations versus non-respiratory hospitalizations. Among respiratory illness hospitalization, the odds of intrauterine fetal demise were increased (adjusted odds ratio (aOR) 2.50, 95 % confidence interval (CI) 1.97–3.18). Among live births, there were higher odds of preterm delivery (aOR 3.82, 95 % CI 3.53–4.14), cesarean delivery (aOR 3.47, 95 % CI 3.22–3.74), and fetal distress (aOR 2.33, 95 % CI 2.15–2.52). The presence of high risk medical conditions did not impact pregnancy outcomes. Among pregnant women hospitalized during influenza season, those with respiratory illness were more likely than those without respiratory illness to have poor perinatal outcomes, regardless of the presence of high risk conditions. Efforts to minimize influenza morbidity, including universal vaccination and early antiviral therapy should be promoted among all pregnant women.

Objectives The accuracy of maternal morbidity estimates from hospital discharge data may be influenced by incomplete identification of deliveries. In maternal/infant health studies, obstetric deliveries are often identified only by the maternal outcome of delivery code (International Classification of Diseases code = V27). We developed an enhanced delivery identification method based on additional delivery-related codes and compared the performance of the enhanced method with the V27 method in identifying estimates of deliveries as well as estimates of maternal morbidity. Methods The enhanced and standard V27 methods for identifying deliveries were applied to data from the 1998–2004 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationwide representative survey of U.S. hospitalizations. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to examine predictors of deliveries not identified using the V27 method. Results The enhanced method identified 958,868 (3.4%) more deliveries than the 27,128,539 identified using the V27 code alone. Severe complications including major puerperal infections (OR = 3.1, 95% CI 2.8–3.4), hysterectomy (OR = 6.0, 95% CI 5.3–6.8), sepsis (OR = 11.9, 95% CI 10.3–13.6) and respiratory distress syndrome (OR = 16.6, 95% CI 14.4–19.2) were strongly associated with deliveries not identified by the V27 method. Nationwide prevalence rates of severe maternal complications were underestimated with the V27 method compared to the enhanced method, ranging from 9% underestimation for major puerperal infections to 40% underestimation for respiratory distress syndrome. Conclusion Deliveries with severe obstetric complications may be more likely to be missed using the V27 code. Researchers should be aware that selecting deliveries from hospital stay records by V27 codes alone may affect the accuracy of their findings.