Abstract
BackgroundChorioamnionitis is a frequent complication of pregnancy and is known to be associated with serious adverse post-natal outcomes including death. However, the assessment of fetal well-being in labor in the context of chorioamnionitis is often challenging because of fetal tachycardia. Identifying specific risk factors for adverse neonatal outcomes in the context of chorioamnionitis could therefore be of paramount importance. This study aimed to determine if maternal and fetal risk factors for increased neonatal mortality and early neonatal mortality are modified in the context of chorioamnionitis in term pregnancies.MethodsA retrospective population-based cohort study using the United States birth/infant death public file from 2011 to 2013 was performed, including all live births at 37 weeks gestation and beyond. Interaction between chorioamnionitis and maternal demographic variables as well as labor and delivery potential risk factors were analyzed for association with neonatal death (< 28 days) and early neonatal death (< 7 days) using multivariate logistic regressions.ResultsAmong 9,034,428 live births, the prevalence of chorioamionitis was 1.29% (95% CI 1.28–1.30%). The incidence of neonatal death and early neonatal death were 0.09 and 0.06% in the chorioamnionitis group versus 0.06 and 0.04% in the no chorioamnionitis group (p = 0.0003 and < 0.0001), respectively. Smoking was significantly associated with neonatal death and early neonatal death in the context of chorioamnionitis (OR 2.44, CI:1.34–4.43/ 2.36 CI:1.11–5.01) but was either less strongly or not associated in the absence of chorioamnionitis (OR 1.24, CI:1.14–1.35/0.93, CI:0.82–1.05). The association between gestational age (37 weeks compared to 39 weeks) and neonatal death was more important in the context of chorioamnionitis (OR = 3.19, CI: 1.75–5.82 versus 1.63, CI: 1.49–1.79). Multivariate analysis identified the following risk factors for neonatal death and/or early neonatal death: low maternal education, extreme maternal age, obesity (BMI > 35 kg/m2), late or no prenatal care, diabetes, meconium-stained amniotic fluid, gestational ages other than 39 weeks, neonatal weight < 2500 g and delivery by vacuum or caesarian.ConclusionsSmoking as well as early term have a positive interaction with chorioamnionitis for the risk of neonatal mortality. This should be taken into account when counseling pregnant women and managing laboring pregnant women with suspected chorioamnionitis.
Highlights
Chorioamnionitis is a frequent complication of pregnancy and is known to be associated with serious adverse post-natal outcomes including death
Smoking was significantly associated with early neonatal death in the context of chorioamnionitis but was not associated in the absence of chorioamnionitis
The impact of gestational age (37 weeks compared to 39 weeks) was more important in the context of chorioamnionitis (OR = 3.19, 95% confidence intervals (CI): 1.75–5.82 versus 1.63, 95% CI: 1.49–1.79)
Summary
Chorioamnionitis is a frequent complication of pregnancy and is known to be associated with serious adverse post-natal outcomes including death. Identifying specific risk factors for adverse neonatal outcomes in the context of chorioamnionitis could be of paramount importance. This study aimed to determine if maternal and fetal risk factors for increased neonatal mortality and early neonatal mortality are modified in the context of chorioamnionitis in term pregnancies. Chorioamnionitis is a frequent complication of pregnancy and is known to be associated with serious maternal, fetal and long term-postnatal adverse outcomes including stillbirth, neonatal sepsis, chronic lung and brain neonatal diseases including hypoxic ischemic encephalopathy leading to long-term disabilities as well as maternal post-partum infections and sepsis [1]. Studies have shown that chorioamnionitis was associated with an approximately 2- and 3.5- fold increased odds of neonatal adverse outcomes < 34 and > 34 weeks respectively regardless of chorioamnionitis duration [3]
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