Maternal Influenza A Virus Infection Induces Antiviral and Immune Dysregulation in the Placenta and Fetus Without Vertical Transmission

Influenza A virus (IAV) infection during pregnancy is associated with stillbirth and preterm birth, possibly by disrupting placental and fetal immunity. To investigate this, pregnant pigtail macaques were inoculated with IAV [A/California/07/2009 (H1N1)] and examined at necropsy 5 days post-infection (N=11) versus uninfected controls (N=16). Stillbirth occurred in 18% of infected pregnancies but not in controls. While vertical transmission was not observed, low levels of viral RNA were detected in two placentas. Maternal IAV infection was associated with increased placental IL-1β and IFN-β levels and an upregulated type I interferon and integrated stress transcriptional response. Fetuses exposed to IAV had greater frequencies of innate immune cells in lymph nodes and CD4+ T cells in lungs. These results suggest that placental and fetal immune environments undergo immune activation independent of the severity of maternal lung infection. Influenza vaccination during pregnancy may protect against potentially harmful effects on fetal development.