Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

Abstract

WHAT'S KNOWN ON THIS SUBJECT: In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.WHAT THIS STUDY ADDS: Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks. abstract OBJECTIVES: We compared the relative effect of hypertensive disorders of pregnancy and chorioamnionitis on adverse neonatal outcomes in very preterm neonates, and studied whether gestational age (GA) modulates these effects. METHODS:A cohort of neonates 23 to 30 weeks' GA, born in 2008 to 2011 in 82 hospitals adhering to the Italian Neonatal Network, was analyzed. Infants born from mothers who had hypertensive disorders (N = 2096) were compared with those born after chorioamnionitis (N = 1510). Statistical analysis employed logistic models, adjusting for GA, hospital, and potential confounders. RESULTS:Overall mortality was higher after hypertension than after chorioamnionitis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.80), but this relationship changed across GA weeks; the OR for hypertension was highest at low GA, whereas from 28 weeks' GA onward, mortality was higher for chorioamnionitis. For other outcomes, the relative risks were constant across GA; infants born after hypertension had an increased risk for bronchopulmonary dysplasia (OR, 2.20; 95% CI, 1.68-2.88) and severe retinopathy of prematurity (OR, 1.48; 95% CI, 1.02-2.15), whereas there was a lower risk for earlyonset sepsis (OR, 0.25; 95% CI,, severe intraventricular hemorrhage (OR, 0.65; 95% CI, periventricular leukomalacia (OR, 0.70; 95% CI,, and surgical necrotizing enterocolitis or gastrointestinal perforation (OR, 0.47; 95% CI, 0.31-0.72).CONCLUSIONS: Mortality and other adverse outcomes in very preterm infants depend on antecedents of preterm birth. Hypertension and chorioamnionitis are associated with different patterns of outcomes; for mortality, the effect changes across GA weeks. Pediatrics 2014;134:e154-e161 AUTHORS:

A machine learning approach to estimating preterm infants survival: development of the Preterm Infants Survival Assessment (PISA) predictor

“…Interactions between risk factors on outcomes such as mortality or morbidity are not rare, as some recent studies have demonstrated, e.g. between GA and chorioamnionitis/pre-eclampsia 29 , or GA and being small-for-GA 30 , or steroid prophylaxis and multiplicity 31 .…”

Meta-analysis of antenatal infection and risk of asthma and eczema

“…[30–32] Previous studies found an increased risk of preterm birth and low birth weight due to maternal infection during pregnancy. [7–9] A comprehensive meta-analysis by Zhao et al [32] showed that antenatal antibiotics were significantly associated with asthma or wheezing in childhood. In the present study, only 3 included studies (1 for eczema and 2 for asthma) reported that maternal infection was significantly associated with asthma and eczema after adjustment for maternal antibiotic usage, [1,2,15] suggesting that maternal infection might be an independent risk factor for asthma in children.…”

“…Maternal infection during pregnancy is associated with maternal morbidity, such as cesarean sections, and fetal and neonatal morbidity, such as premature rupture of membranes, low birth weight, bronchopulmonary dysplasia, and cerebral palsy. [7–9] …”

Necrotising Enterocolitis - epidemiology and imaging

“…166 Several studies, including one meta-analysis, have also indicated that it independently increases the risk of NEC and/or SIP. 114,[131][132][133][134] Others found no association of the severity of chorioamnionitis 167 or presence of histological chorioamnionitis 166 with NEC. NEC occasionally occurs in infants, who have never been fed.…”

“…The latter may be supported by the occurrence of early onset NEC, previously regarded as a characteristic of NEC in term infants, 9 also among infants of low gestational ages. 27 Among the results in paper III, the negative associations with maternal urinary infection and premature rupture of the membranes (PROM), are somewhat surprising, especially as PROM, leading to chorioamnionitis, has been suggested as a risk factor of NEC by several investigators, including one metaanalysis, [131][132][133][134] but contradicted by others. 225,226 Infected amniotic fluid, e.g.…”