Placental Chorioamnionitis at Term: Epidemiology and Follow-Up in Childhood

Abstract

The objective was to identify histologic chorioamnionitis ("amnionitis") in the placental disc at term and to investigate associations with demographic, lifestyle, and pregnancy factors and with allergic diseases, atopy, and intelligence quotients in childhood. The setting was a population-based case control study of small-for-gestational age infants at term. One thousand and twelve placentas were assessed histologically for amniocentric inflammation of fetal and/or maternal origin using conservative criteria. Data were collected at birth by maternal interview and from medical records. Follow-up data were obtained from 439 and 418 children at 3.5 and 7 years of age, respectively. Amnionitis was identified in 145 placentas (14.3%), with maternal reaction in 97.2% and fetal reaction in 48.3%. In multivariable analysis any amnionitis was significantly associated with a time from membrane rupture to delivery of 6 to 12 hours, but not with times beyond 12 hours, a duration of total labor exceeding 12 hours, ethnicity (incidences ranging from 8.8% in Indians to 23.5% in Chinese), male infant gender, and anaesthesia during labor, and amnionitis was negatively associated with induction of labor. No associations were found with later allergic disease, atopy, or intelligence quotients. This high incidence of histologic amnionitis at term is similar to historical estimates, despite large reductions in time-related risk factors during labor. Significant ethnic variations contribute to the high incidence and are unexplained, but variation in genetic polymorphisms for susceptibility factors is a possibility. "Silent" histologic amnionitis is a frequent cause of fetal immune activation with potential effects in later life.