Maternal fever during labor and long-term infectious morbidity of the offspring

Abstract

Maternal intrapartum fever (i.e., fever of over 38.0°C encountered just before or during delivery) can lead to a variety of maternal and neonatal complications and is attributed to various etiologies including benign infectious and non-infectious processes. In this study we sought to evaluate whether intrapartum fever carries an impact on the long-term infectious morbidity of the offspring. A population-based cohort analysis including deliveries between the years 1991 to 2014 in a tertiary referral hospital was conducted. Incidence of hospitalizations of the offspring up to the age of 18 years due to various infectious conditions was compared between pregnancies complicated by intrapartum fever, and those who were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for baseline selected confounders. During the study period, 249,840 pregnancies met the inclusion criteria. Of those, 407 (0.2%) were accompanied by intrapartum fever. Hospitalization rate of the offspring due to bacterial infections (0.7% vs. 0.1%; OR=5.35, 95% CI 1.7-16.73; p=0.02), ear, nose and throat infections (2.9% vs. 1.5%; OR=2.03, 95% CI 1.14-3.61; p=0.014) and total infectious morbidity (14.7% vs. 11.0%; OR=1.4, 95% CI 1.06-1.84; p=0.017) was higher among the exposed group (Table), as was the cumulative incidence of hospitalizations presented in the Kaplan-Meier survival curve (log rank p=0.005; Figure). This association remained significant after controlling for potential confounders (including gestational age, maternal age, hypertensive disorders of pregnancy and diabetes mellitus) using a Cox proportional hazards model (adjusted HR = 1.36; 95% CI 1.05–1.76, p=0.018). Maternal fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections, as it is linked to higher rates of long-term infectious morbidity of the offspring.View Large Image Figure ViewerDownload Hi-res image Download (PPT)