Abstract
Objective
The association between maternal chorioamnionitis and short-term pediatric morbidity is well established. Little is known regarding the potential impact on long term pediatric morbidity. In this study, we aimed to evaluate long-term pediatric neurological morbidity in the offspring following maternal chorioamnionitis.
Study Design
A population-based retrospective cohort analysis was performed comparing the risk for long-term neurological morbidity (up to the age of 18 years) in children born between the years 1991-2014 to parturients with and without maternal chorioamnionitis. Neurological morbidity evaluated included hospitalizations of the offspring during childhood associated with a predefined set of ICD-9 codes including different neurological morbidities, as was recorded in the hospital files. Multiple pregnancies and fetal congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare the cumulative neurological morbidity over the study period and a Cox regression model was employed to control for confounders.
Results
During the study period, 238,622 newborns were included in the long-term analysis. Of them, 0.5% (n=1,303) were born to mothers with chorioamnionitis. Neurological diagnoses associated with hospitalization occurred in 3.1% of the cohort (n=7,466). Total neurological morbidity (up to the age of 18 years) was not significantly more common in the chorioamnionitis group (3.8% vs. 3.1% respectively, OR 1.2, 95%CI 0.9-1.6, p=0.147). However, a significant association was noted between maternal chorioamnionitis and cerebral palsy in the offspring (0.5% vs. 0.1%, OR 5.8, 95% CI 2.5-13.0, p=0.001; Table). The survival curve revealed a significantly higher cumulative risk of cerebral palsy related hospitalizations (Log rank p value<0.001, Figure) in the exposed group, and in the Cox proportional hazards model, controlled for preterm delivery, birthweight, maternal factors and mode of delivery, the association between chorioamnionitis and cerebral palsy in the offspring remained significant (adjusted HR=2.8, 95% CI 1.2-6.4, p=0.016).
Conclusion
Maternal chorioamnionitis is significantly associated with an elevated risk for cerebral palsy in the offspring, independent of other birth circumstances such as preterm delivery and birthweight.
The association between maternal chorioamnionitis and short-term pediatric morbidity is well established. Little is known regarding the potential impact on long term pediatric morbidity. In this study, we aimed to evaluate long-term pediatric neurological morbidity in the offspring following maternal chorioamnionitis.
Study Design
A population-based retrospective cohort analysis was performed comparing the risk for long-term neurological morbidity (up to the age of 18 years) in children born between the years 1991-2014 to parturients with and without maternal chorioamnionitis. Neurological morbidity evaluated included hospitalizations of the offspring during childhood associated with a predefined set of ICD-9 codes including different neurological morbidities, as was recorded in the hospital files. Multiple pregnancies and fetal congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare the cumulative neurological morbidity over the study period and a Cox regression model was employed to control for confounders.
Results
During the study period, 238,622 newborns were included in the long-term analysis. Of them, 0.5% (n=1,303) were born to mothers with chorioamnionitis. Neurological diagnoses associated with hospitalization occurred in 3.1% of the cohort (n=7,466). Total neurological morbidity (up to the age of 18 years) was not significantly more common in the chorioamnionitis group (3.8% vs. 3.1% respectively, OR 1.2, 95%CI 0.9-1.6, p=0.147). However, a significant association was noted between maternal chorioamnionitis and cerebral palsy in the offspring (0.5% vs. 0.1%, OR 5.8, 95% CI 2.5-13.0, p=0.001; Table). The survival curve revealed a significantly higher cumulative risk of cerebral palsy related hospitalizations (Log rank p value<0.001, Figure) in the exposed group, and in the Cox proportional hazards model, controlled for preterm delivery, birthweight, maternal factors and mode of delivery, the association between chorioamnionitis and cerebral palsy in the offspring remained significant (adjusted HR=2.8, 95% CI 1.2-6.4, p=0.016).
Conclusion
Maternal chorioamnionitis is significantly associated with an elevated risk for cerebral palsy in the offspring, independent of other birth circumstances such as preterm delivery and birthweight.
| Original language | English GB |
|---|---|
| Pages (from-to) | S174-S175 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 218 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2018 |