Abstract
To test the hypothesis that bacterial infections in pregnancy are related to maternal blood pressure. Bacterial infection was assessed using antibiotic usage as a surrogate and its association with blood pressure in pregnancy tested in the Cambridge Baby Growth Study. Antibiotic usage in pregnancy was self-reported in questionnaires. Blood pressure measurements at four time points in pregnancy were collected from the hospital notes of 622 women. Using all the available blood pressure readings (adjusted for weeks gestation) antibiotic usage was associated with a higher mean arterial blood pressure across pregnancy: antibiotics used 85(84, 87)mmHg vs. no antibiotics used 83 (83, 84) mmHg (β=2.3 (0.6, 4.0) mmHg, p=9.6×10-3, from 621 individuals). Further analysis revealed that antibiotic usage was associated with diastolic (β=2.3 (0.6, 4.0) mmHg; p=7.0×10-3) more than systolic blood pressure (β=1.4(-0.9, 3.7)mmHg; p=0.2). The effect size associated with antibiotic usage appeared to rise slightly after the first trimester. Bacterial infection in pregnancy, as assessed by self-reported antibiotic usage, is associated with small rises in blood pressure.
Highlights
Pre-eclampsia remains a leading cause of maternal and perinatal mortality and morbidity
To investigate this we studied antibiotic usage in pregnancy as a surrogate of bacterial infection exposure, plus urinary tract infection (UTI) exposure, to test the hypothesis that bacterial infection in pregnancy is associated with rises in blood pressure
Associations between Antibiotic Usage at Any Time during Pregnancy and Blood Pressure Antibiotic usage was associated with a higher mean arterial blood pressure in pregnancy as a whole, mean arterial blood pressures over the four readings recorded during pregnancy being: antibiotics used 85 (84, 87) mmHg v. no antibiotics used 83 (83, 84) mmHg (β = 2.3 (0.6, 4.0) mmHg, p = 9.6 x 10-3, from 621 individuals) (Fig. 1)
Summary
Pre-eclampsia remains a leading cause of maternal and perinatal mortality and morbidity. It has been suggested that the link between infection and the development of pre-eclampsia could be at the level of its initiation, due to an increased risk of uteroplacental atherosis (fibrinoid necrosis of the vessel wall with subintimal accumulations of lipophages), and/or its progression, through an increase in the maternal inflammatory response during pregnancy [5]. A number of studies have sought associations between infections in pregnancy and the development of pre-eclampsia. Less is known about potential links between infections and less severe rises in blood pressure in pregnancy To investigate this we studied antibiotic usage in pregnancy as a surrogate of bacterial infection exposure, plus urinary tract infection (UTI) exposure (the commonest form of bacterial infection in pregnancy), to test the hypothesis that bacterial infection in pregnancy is associated with rises in blood pressure
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