Maternal Inflammatory Markers Research Articles

PO-0520 Neonatal Meningitis Due To Moraxella Osloensis; Case Report And Review Of The Literature: Abstract PO-0520 Table 1

Introduction Neonatal meningitis causes substantial morbidity and mortality and is commonly caused by GBS. Moraxella osloensis is an aerobic, gram-negative coccobacillus infrequently isolated from CSF. There is little published related to risk factors of M. osloensis infections in the paediatric population. We report a case of Moraxella meningitis a neonate and review of cases in children. Case report A 2 day old neonate was referred for jaundice and bilirubin check. He was noted to be jaundiced and lethargic. He was born at term complicated with maternal pyrexia and raised maternal inflammatory markers. He was discharged on day1 following 12 h of satisfactory observation. A full septic screen was performed on the baby in-view of risk factor for sepsis. The biochemical work-up was suggestive of meningitis. The blood and CSF culture were negative; however the CSF PCR was positive for Moraxella Oslonesis. He was treated with 3 week course of IV cefotaxime and discharged without any acute complications. Discussion A PubMed search yielded 4 published cases of M. osloensis meningitis but none of them presented in the neonatal period. There was 1 published case of neonatal septicemia without meningitis, however there was no specific risk factor identified in any of these patients. In conclusion, although M. osloensis meningitis is rare it may cause severe CNS infection in children we were able to definitely identify the species of the isolates only by using 16S rRNA gene sequencing and extended PCR must be performed on all babies presenting with possible meningitis.

Intersection of complex genetic traits affecting maternal metabolism, fetal metabolism, and neural tube defect risk: Looking for needles in multiple haystacks

Intersection of complex genetic traits affecting maternal metabolism, fetal metabolism, and neural tube defect risk: Looking for needles in multiple haystacks

Maternal inflammatory markers and term labor performance

We sought to examine the relationship between maternal markers of inflammation and labor performance. A nested cohort study was performed utilizing an established cohort of term nulliparous patients. Maternal blood was collected at the onset of regular, painful contractions in patients undergoing labor induction or at admission in patients with spontaneous labor. Levels of cytokines including interleukin (IL)-1, IL-6, and tumor necrosis factor-α were determined using standard multiplex methodology. Maternal demographic data were collected prospectively. Detailed retrospective chart review was performed to extract data on cervical dilation, effacement, and station during labor. Subjects were excluded if they failed to achieve complete dilation. Mixed effects modeling was used to examine the association between serum cytokine quartiles and labor progress in the latent and active phases. In all, 334 women were included in our analysis. The lowest quartile of IL-6 was associated with slower latent labor (P = .001). In contrast, the highest quartiles of IL-1 and tumor necrosis factor-α were associated with slower active labor (P = .03 and .0002, respectively). Proinflammatory activation is important in labor initiation. However, once active labor is established, excess inflammation can be detrimental to efficient labor progress. These data may explain, in part, the known associations among clinical chorioamnionitis, cesarean delivery, and postpartum hemorrhage.

Psychological distress and SSRI use predict variation in inflammatory cytokines during pregnancy

Evidence supports the premise that maternal psychological distress adversely affects pregnancy outcomes and that inflammatory markers and placentally-produced corticotrophin-releasing hormone (pCRH) are likely mediating factors. The primary aim of the study was to explore the associations between maternal psychological distress, use of selective serotonin re-uptake inhibitors, pCRH, and maternal plasma inflammatory markers during pregnancy. Measures of maternal plasma pCRH, Interleukins-1, 6, & 10, C-Reactive Protein, Macrophage Migration Inhibitory Factor, and Tumor Necrosis Factor-α were completed in 100 pregnant women. Measures of depression, anxiety, and perceived stress were completed, as well as collection of demographic/behavioral data, e.g. use of selective serotonin re-uptake inhibitors (SSRIs). Significant correlations were found at 14-20 weeks gestation between IL-6 & 10, and depression, anxiety, and perceived stress. Also at 14 - 20 weeks gestation, IL10 levels were significantly lower in women with 4th quartile pCRH levels and IL1β, IL6, and IL10 were significantly lower among women who took an SSRI during pregnancy. After controlling for maternal age, BMI, pCRH level, and SSRI use, psychological distress remained to explain variation in maternal inflammatory markers. These results might suggest that future research should focus on whether depression and anxiety are effectively being treated during pregnancy, and how such a scenario might contribute to an immune system pathway to poor pregnancy outcome.

Correlation between maternal inflammatory markers and fetomaternal adiposity

Outside pregnancy, both obesity and diabetes mellitus are associated with changes in inflammatory cytokines. Obesity in pregnancy may be complicated by gestational diabetes mellitus (GDM) and/or fetal macrosomia. The objective of this study was to determine the correlation between maternal cytokines and fetomaternal adiposity in the third trimester in women where the important confounding variable GDM had been excluded. Healthy women with a singleton pregnancy and a normal glucose tolerance test at 28weeks gestation were enrolled at their convenience. Maternal cytokines were measured at 28 and 37weeks gestation. Maternal adiposity was assessed indirectly by calculating the Body Mass Index (BMI), and directly by bioelectrical impedance analysis. Fetal adiposity was assessed by ultrasound measurement of fetal soft tissue markers and by birthweight at delivery. Of the 71 women studied, the mean maternal age and BMI were 29.1years and 29.2kg/m2 respectively. Of the women studied 32 (45%) were obese. Of the cytokines, only maternal IL-6 and IL-8 correlated with maternal adiposity. Maternal TNF-α, IL-β, IL-6 and IL-8 levels did not correlate with either fetal body adiposity or birthweight. In this well characterised cohort of pregnant non-diabetic women in the third trimester of pregnancy we found that circulating maternal cytokines are associated with maternal adiposity but not with fetal adiposity.

Are biological markers relevant for the diagnosis and the prognosis of preterm premature rupture of membranes (PPROM)?

The preterm premature rupture of membranes (PPROM) is a common condition in pregnant women and is associated with significant maternal and perinatal morbidity. Most of the time, the diagnosis is done during physical examination. However, in 10%-20% of equivocal cases, biological markers are needed to confirm the diagnosis, especially when leakage of fluid is low or intermittent. In these cases, a quick and reliable diagnosis is necessary for applying the appropriate measures to reduce perinatal complications. The prognosis in PPROM is linked to maternal inflammatory markers that might predict perinatal infection, and therefore be helpful to decide the timing of the delivery. Nevertheless, further research is needed to identify robust biological markers for the diagnosis of PPROM in equivocal cases and for the prognosis.

187: Do maternal inflammatory markers correlate with both fetal and maternal adiposity?

187: Do maternal inflammatory markers correlate with both fetal and maternal adiposity?

Depressive symptoms are associated with elevated serum proinflammatory cytokines among pregnant women

Psychosocial stress and depressive symptoms are associated with increased risk of negative perinatal outcomes including preterm delivery and gestational hypertension. Inflammation is a likely mechanism by which distress may promote these outcomes. It is well-established that stress and depressive symptoms are associated with elevated serum inflammatory markers in nonpregnant populations. However, the immune system exhibits significant changes during pregnancy. Thus, the extent to which these findings extend to pregnancy is largely unknown. The current study examined associations among perceived stress, depressive symptoms, and serum inflammatory markers in a sample of 60 pregnant women. Fifty seven percent were African-American, 82% had completed high school or less education, and 63% reported an annual family income below $15,000. Participants completed the Perceived Stress Scale (PSS) and the Center for Epidemiologic Studies Depression Scale (CES-D). Serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were determined using high sensitivity immunoassays. Regression analyses demonstrated that after controlling for pre-pregnancy Body Mass Index (BMI), higher scores on the CES-D were related to significantly higher levels of IL-6 (β=.23, p=.05) and marginally higher TNF-α (β=.24, p=.06). Perceived stress was not significantly related to serum levels of IL-6 or TNF-α. In sum, these results indicate that depressive symptoms are associated with higher levels of maternal serum inflammatory markers during pregnancy. These data are consistent with the contention that depressive symptoms may contribute to negative perinatal outcomes via inflammatory pathways.

199 Diagnostic Prediction Of Maternal Inflammatory Markers For Neonatal Sepsis

Background: Elevated concentration of C-reactive protein(CRP) in the maternal blood is associated with the presence of intrauterine infection. Newborns born of mothers with perinatal infection, whether indicated as chorioamnionitis or positive CRP, have been associated with probable sepsis in early neonatal period. We purport this study to evaluate the diagnostic performance of maternal inflammatory markers, CRP and chorioamnionitis for prediction of neonatal sepsis.Methods: 126 low birth weight newborns(gestation 32±3.2wk, birth weight 1887±623g) and their mothers were recruited. Neonates were divided into sepsis group(65 infants) including both definite(positive blood culture) and probable(negative blood culture but with more than 3 abnormal clinical symptoms) episodes and control(61 infants). Mothers were grouped into histologic chorioamnionitis(n=27), clinical chorioamnionitis(n=18), other infection(n=12), and control(n=69). Mothers were subgrouped into CRP positive(n=32) and CRP negative group(n=94) by CRP 1.86 mg/dL, and calculated relative risk for neonatal sepsis according to maternal condition.Results: Maternal CRP was significantly higher in neonatal sepsis group than in control (2.18±2.79 vs. 1.09±1.29mg/ dl, p=0.0055). Maternal CRP(cutoff value 1.86 mg/dL) had sensitivity 74% and specificity 34% for predicting neonatal sepsis. Maternal CRP positive group had more neonatal sepsis than CRP negative group(69% vs46%, p=0.0245). Relative risk of neonatal sepsis in maternal CRP positive group was 2.61 times(95% CI:1.114– 6.106, p=0.027)) as high as CRP negative group. As maternal CRP increases continuously, the risk for neonatal sepsis increases as 1.31 times(95% CI:1.059–1.626, p=0.013). The relative risk of histologic chorioamnionitis was 2.57, clinical chorioamnionitis 1.21, and other infection 2 for neonatal sepsis, but not significant.Conclusion: The risk of neonatal sepsis significantly increases in the case of positive maternal CRP (more than 1.86 mg/dL). We suggest that maternal CRP should be considered as a risk factor for early neonatal sepsis.