Abstract
Rates of maternal sepsis are increasing, and prior studies of maternal sepsis have focused on immediate maternal morbidity and mortality associated with sepsis during delivery admission. There are no data on pregnancy outcomes among individuals who recover from their infections prior to delivery. To describe perinatal outcomes among patients with antepartum sepsis who did not deliver during their infection hospitalization. This retrospective cohort study was conducted using data from August 1, 2012, to August 1, 2018, at an academic referral center in San Francisco, California. Included patients were all individuals with nonanomalous, singleton pregnancies who delivered after 20 weeks' gestation during the study period. Data were analyzed from March 2020 through March 2021. Antepartum admission for infection with clinical concern for sepsis and hospital discharge prior to delivery. The primary outcome was a composite of perinatal outcomes associated with placental dysfunction and consisted of 1 or more of the following: fetal growth restriction, oligohydramnios, hypertensive disease of pregnancy, cesarean delivery for fetal indication, child who is small for gestational age, or stillbirth. Among 14 565 patients with nonanomalous singleton pregnancies (mean [SD] age at delivery, 33.1 [5.2] years), 59 individuals (0.4%) were in the sepsis group and 14 506 individuals (99.6%) were in the nonsepsis group; 8533 individuals (59.0%) were nulliparous. Patients with sepsis, compared with patients in the reference group, were younger (mean [SD] age at delivery, 30.6 [5.7] years vs 33.1 [5.2] years; P < .001), were more likely to have pregestational diabetes (5 individuals [8.5%] vs 233 individuals [1.6%]; P = .003), and had higher mean (SD) pregestational body mass index scores (26.1 [6.1] vs 24.4 [5.9]; P = .03). In the sepsis group, the most common infections were urinary tract infections (24 patients [40.7%]) and pulmonary infections (22 patients [37.3%]). Among patients with sepsis, 5 individuals (8.5%) were admitted to the intensive care unit, the mean (SD) gestational age at infection was 24.6 (9.0) weeks, and the median (interquartile range) time from infection to delivery was 82 (42-147) days. Antepartum sepsis was associated with higher odds of placental dysfunction (21 patients [35.6%] vs 3450 patients [23.8%]; odds ratio, 1.77; 95% CI, 1.04-3.02; P = .04). On multivariable logistic regression analysis, antepartum sepsis was an independent factor associated with placental dysfunction (adjusted odds ratio, 1.88; 95% CI, 1.10-3.23; P = .02) after adjusting for possible confounders. This study found that pregnancies complicated by antepartum sepsis were associated with higher odds of placental dysfunction. These findings suggest that increased antenatal surveillance should be considered for these patients.
Highlights
Maternal sepsis is the second leading cause of maternal mortality in the United States.[1]
On multivariable logistic regression analysis, antepartum sepsis was an independent factor associated with placental dysfunction after adjusting for possible confounders
These findings suggest that increased antenatal surveillance should be considered for these patients
Summary
Maternal sepsis is the second leading cause of maternal mortality in the United States.[1] Among all maternal deaths in the US, 13% are attributed to infection or sepsis, with case fatality rates as high as 10% to 30% in the obstetric population.[2,3,4] Pregnant patients may be susceptible to rapid progression to sepsis and septic shock due to pregnancy-specific physiologic, mechanical, and immunological adaptations.[5] Rates of sepsis during pregnancy and the puerperium are increasing, with 1 population-based study in Texas[6] finding a 2-fold increase in pregnancy-associated sepsis, from 11 incidences per 10 000 deliveries in 2001 to 26 incidences per 10 000 deliveries in 2010. Little is known about the association of sepsis with long-term pregnancy outcomes, among individuals who recover from their infections prior to delivery
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