The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

Ricardo P Tedesco,Rafael B Galvão,Jose Paulo Guida,Renato Passini-Júnior,Giuliane J Lajos,Marcelo L Nomura,Patricia M Rehder,Tabata Z Dias,Renato T Souza,Jose G Cecatti

doi:10.6061/clinics/2020/e1508

Abstract

OBJECTIVES:Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB.METHODS:This was a secondary analysis of a multicenter cross-sectional study with a nested case–control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated.RESULTS:The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups.CONCLUSION:Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.

Highlights

Preterm birth (PTB), defined as birth occurring before the completion of 37 weeks of gestation, is currently a priority in obstetrics and perinatal care owing to its association with neonatal death and long-term morbidity [1]
The study protocol and main results have been previously reported [9,10,11,12]. This analysis focuses on the development of maternal infection, type of PTB, and factors possibly associated with maternal infection and neonatal outcomes (fetal and neonatal mortality, Apgar score, birth weight, intubation, use of surfactant, neonatal intensive care unit (NICU) admission, ventilatory support, neonatal morbidity, neonatal sepsis, cerebral hemorrhage, and necrotizing enterocolitis)
More than 50% of these women reported urinary tract infection during pregnancy and 35% had their treatment documented on medical charts

Summary

Introduction

Preterm birth (PTB), defined as birth occurring before the completion of 37 weeks of gestation, is currently a priority in obstetrics and perinatal care owing to its association with neonatal death and long-term morbidity [1]. The estimated global rate of PTB is 10.6% of all pregnancies. In Latin America, PTB leads to complications in 9.8% of all pregnancies. Brazil has the ninth highest PTB rate (11.2%) [2]. No potential conflict of interest was reported

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