Short-term Birth Sequelae of the 1918-20 Influenza Pandemic in the United States: State-Level Analysis

This paper illuminates short-term birth sequelae of the influenza pandemic of 1918–20 in the USA using monthly data on births and all-cause deaths for 19 US states in conjunction with data on maternal deaths, stillbirths, and premature births. The data on births and all-cause deaths are adjusted for seasonal and trend effects, and the residual components of the two time series coinciding with the timing of peak influenza mortality are examined for these sequelae. Notable findings include 1) a drop in births in the three months following peak mortality, 2) a reversion in births to normal levels occurring 5–7 months after peak mortality, and 3) a steep drop in births occurring 9–10 months after peak mortality. Interpreted in the context of parallel data showing elevated premature births, stillbirths, and maternal mortality during times of peak influenza mortality, these findings suggest that the main impacts of the 1918–20 influenza on reproduction occurred through 1) impaired conceptions, possibly due to effects on fertility and behavioral changes, 2) an increase in the preterm delivery rate during the peak of the pandemic, and 3) elevated maternal and fetal mortality, resulting in late-term losses in pregnancy