Abstract
Objective
Intrapartum antibiotic prophylaxis (IAP) is a standard of care for rectovaginal carriers of Group B Streptococcus (GBS). IAP is considered efficacious in preventing early-onset neonatal GBS disease, however the long-term health implications of carriage and IAP on offspring are unknown. Our objective was to determine whether known maternal GBS and the associated IAP impacts long term respiratory infections (RI) in offspring.
Study Design
A population-based cohort study was conducted between 1991-2014 comparing incidence of pediatric hospitalizations due to common RI in offspring of mothers with and without known GBS carriage. We excluded twins, deliveries of fetuses with major anatomical or chromosomal abnormalities, Rh iso-immunization, labor complications, and serious maternal infections during pregnancy. Follow-up time was calculated from birth to either an event, death, age 18, or to the end of the study period (censored). Kaplan-Meier survival analysis was used to estimate cumulative incidence of RI, and a Cox proportional hazards model was used to estimate adjusted hazard ratios (aHR) for the long-term independent RI risk, controlling for relevant confounders.
Results
During the study period there were 173,757 term vaginal deliveries, 2.4% (4,252) of which were in GBS+ garvidas. Significantly higher crude occurrences of otitis media, Influenza-like illness, and viral RI were found in offspring of GBS+ mothers (Table), as well as higher cumulative incidence of these infections (Figure). The Cox model confirmed an association between known maternal GBS colonization and pediatric RI that could not be attributed to maternal age, preterm delivery, maternal diabetic disorder, and hypertensive disorder (for otitis aHR =1.4; 95% CI 1.2-1.7; p=0.001).
Conclusion
Maternal GBS colonization, and consequent IAP, is an independent risk factor for pediatric long-term RI. Plausible explanation may be modulation of the maternal microbiome by antimicrobials with indirect effects on neonatal microbiome, neonatal antimicrobial exposure via placental passage or lactation, or other, yet undetermined, common risk factors for GBS carriage and mucosal infections.
Intrapartum antibiotic prophylaxis (IAP) is a standard of care for rectovaginal carriers of Group B Streptococcus (GBS). IAP is considered efficacious in preventing early-onset neonatal GBS disease, however the long-term health implications of carriage and IAP on offspring are unknown. Our objective was to determine whether known maternal GBS and the associated IAP impacts long term respiratory infections (RI) in offspring.
Study Design
A population-based cohort study was conducted between 1991-2014 comparing incidence of pediatric hospitalizations due to common RI in offspring of mothers with and without known GBS carriage. We excluded twins, deliveries of fetuses with major anatomical or chromosomal abnormalities, Rh iso-immunization, labor complications, and serious maternal infections during pregnancy. Follow-up time was calculated from birth to either an event, death, age 18, or to the end of the study period (censored). Kaplan-Meier survival analysis was used to estimate cumulative incidence of RI, and a Cox proportional hazards model was used to estimate adjusted hazard ratios (aHR) for the long-term independent RI risk, controlling for relevant confounders.
Results
During the study period there were 173,757 term vaginal deliveries, 2.4% (4,252) of which were in GBS+ garvidas. Significantly higher crude occurrences of otitis media, Influenza-like illness, and viral RI were found in offspring of GBS+ mothers (Table), as well as higher cumulative incidence of these infections (Figure). The Cox model confirmed an association between known maternal GBS colonization and pediatric RI that could not be attributed to maternal age, preterm delivery, maternal diabetic disorder, and hypertensive disorder (for otitis aHR =1.4; 95% CI 1.2-1.7; p=0.001).
Conclusion
Maternal GBS colonization, and consequent IAP, is an independent risk factor for pediatric long-term RI. Plausible explanation may be modulation of the maternal microbiome by antimicrobials with indirect effects on neonatal microbiome, neonatal antimicrobial exposure via placental passage or lactation, or other, yet undetermined, common risk factors for GBS carriage and mucosal infections.
| Original language | English |
|---|---|
| Pages (from-to) | S440 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 218 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2018 |