Abstract
Objective
Chorioamnionitis is a clinical diagnosis given during labor based on the presence of fever and other signs of intrauterine infection. Animal studies suggest that maternal exposure to inflammation/infection alters subsequent offspring immune response. In humans, conflicting data exist regarding the long-term consequences of intrauterine exposure to infection for the offspring. This study was aimed to evaluate the long-term pediatric infectious morbidity of children born to mothers diagnosed with chorioamnionitis during labor
Study Design
A population-based cohort analysis was performed comparing all deliveries of women with and without a diagnosis of chorioamnionitis between 1991-2014 at a single regional tertiary medical center. Offspring hospitalizations up to the age of 18 years involving infectious morbidities were evaluated according to a predefined set of ICD-9 codes, including: respiratory, gastrointestinal and urinary tract infections, pneumonia and bronchiolitis, sepsis, meningitis, otitis and selected viral infections. Kaplan-Meier survival curves were used to compare cumulative hospitalization incidence between the groups, and a Cox proportional hazards model was used to control for confounders
Results
During the study period, 238,622 deliveries met the inclusion criteria. Of them, 0.5% (n=1,303) were among mothers diagnosed with chorioamnionitis. While the total infectious-related hospitalization rate was comparable between the groups (10.8% vs. 10.0%, p=0.33, Table), offspring of mothers diagnosed with chorioamnionitis during labor exhibited higher rates of sepsis (0.5% vs. 0.1%, OR=3.74, 95% CI 1.66-8.41, p<0.01) and meningitis (0.7% vs. 0.3%, OR=2.27, 95% CI 1.17-4.39, p=0.01) following the initial postpartum discharge. Likewise, the Kaplan-Meier survival curves showed higher cumulative incidences of sepsis and meningitis in offspring of mothers with chorioamnionitis (Figure 1a and 1b; log rank<0.01 and log rank=0.02, respectively). Using a Cox proportional hazards model controlled for maternal age, the association remained significant for both sepsis (adjusted HR=3.7, 95% CI 1.6-8.4, p <0.01) and meningitis (adjusted HR=2.2, 95% CI 1.1-4.2, p=0.02)
Conclusion
Chorioamnionitis appears to be a risk factor for long-term infectious morbidity of the offspring and specifically sepsis and meningitis
Chorioamnionitis is a clinical diagnosis given during labor based on the presence of fever and other signs of intrauterine infection. Animal studies suggest that maternal exposure to inflammation/infection alters subsequent offspring immune response. In humans, conflicting data exist regarding the long-term consequences of intrauterine exposure to infection for the offspring. This study was aimed to evaluate the long-term pediatric infectious morbidity of children born to mothers diagnosed with chorioamnionitis during labor
Study Design
A population-based cohort analysis was performed comparing all deliveries of women with and without a diagnosis of chorioamnionitis between 1991-2014 at a single regional tertiary medical center. Offspring hospitalizations up to the age of 18 years involving infectious morbidities were evaluated according to a predefined set of ICD-9 codes, including: respiratory, gastrointestinal and urinary tract infections, pneumonia and bronchiolitis, sepsis, meningitis, otitis and selected viral infections. Kaplan-Meier survival curves were used to compare cumulative hospitalization incidence between the groups, and a Cox proportional hazards model was used to control for confounders
Results
During the study period, 238,622 deliveries met the inclusion criteria. Of them, 0.5% (n=1,303) were among mothers diagnosed with chorioamnionitis. While the total infectious-related hospitalization rate was comparable between the groups (10.8% vs. 10.0%, p=0.33, Table), offspring of mothers diagnosed with chorioamnionitis during labor exhibited higher rates of sepsis (0.5% vs. 0.1%, OR=3.74, 95% CI 1.66-8.41, p<0.01) and meningitis (0.7% vs. 0.3%, OR=2.27, 95% CI 1.17-4.39, p=0.01) following the initial postpartum discharge. Likewise, the Kaplan-Meier survival curves showed higher cumulative incidences of sepsis and meningitis in offspring of mothers with chorioamnionitis (Figure 1a and 1b; log rank<0.01 and log rank=0.02, respectively). Using a Cox proportional hazards model controlled for maternal age, the association remained significant for both sepsis (adjusted HR=3.7, 95% CI 1.6-8.4, p <0.01) and meningitis (adjusted HR=2.2, 95% CI 1.1-4.2, p=0.02)
Conclusion
Chorioamnionitis appears to be a risk factor for long-term infectious morbidity of the offspring and specifically sepsis and meningitis
| Original language | American English |
|---|---|
| Pages (from-to) | S419-S420 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 220 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2019 |