Prenatal inflammation is associated with adverse neonatal outcomes - 24/02/14

Doi : 10.1016/j.ajog.2013.12.024

Jamie A. Bastek, MD, MSCE ^a,^⁎ , Anita L. Weber, PhD ^b, Meghan A. McShea, BS ^a, Meghan E. Ryan, BA ^a, Michal A. Elovitz, MD ^a
^a Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
^b Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

^∗Reprints: Jamie A. Bastek, MD, MSCE, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce St, 585 Dulles Bldg, Philadelphia, PA 19104.

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Abstract

Objective

The purpose of this study was to determine whether prenatal inflammation (as assessed by clinical chorioamnionitis, maternal temperature >38°C, or histologic chorioamnionitis) is associated with a composite adverse neonatal outcome.

Study Design

We performed a prospective cohort study of women at 22 weeks to 33 weeks 6 days' gestation with symptoms of labor (April 2009 to March 2012). Relevant maternal and neonatal exposures and outcomes were recorded. Multivariable logistic regression was performed to determine the association between prenatal inflammation and neonatal outcomes that were controlled for potential confounders.

Results

We analyzed 871 mother-infant pairs. The preterm birth rate was 42.0%. When we controlled for infant sex and modified the data by gestational age at delivery, prenatal inflammation remains a significant risk factor for adverse neonatal outcomes, despite advancing gestational age: clinical chorioamnionitis at 32 weeks' gestation (odds ratio [OR], 3.12; 95% confidence interval [CI], 1.02–9.52], at 36 weeks' gestation (OR, 8.88; 95% CI, 4.32–18.25), and at 40 weeks' gestation (OR, 25.30; 95% CI, 9.25–69.19); maternal temperature >38°C at 32 weeks' gestation (OR, 3.18; 95% CI, 0.66–15.42), at 36 weeks gestation (OR, 8.40; 95% CI, 3.60–19.61), and at 40 weeks gestation (OR, 22.19; 95% CI, 8.15–60.44); histologic chorioamnionitis at 32 weeks gestation (OR, 1.25; 95% CI, 0.64–2.46), at 36 weeks gestation (OR, 2.56; 95% CI, 1.54–4.23), and at 40 weeks gestation (OR, 5.23; 95% CI, 1.95–13.99).

Conclusion

The protective association with advancing gestational age is diminished when prenatal inflammation is present.

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Key words : adverse neonatal outcome, chorioamnionitis, placenta, prenatal inflammation, preterm birth

Plan

Materials and Methods

Strengths and limitations

	Supported by a March of Dimes grant (21-FY08-539; principal investigator, M.A.E.).
	The authors report no conflict of interest.
	Cite this article as: Bastek JA, Weber AL, McShea MA, et al. Prenatal inflammation is associated with adverse neonatal outcomes. Am J Obstet Gynecol 2014;210:••••.