Maternal urinary tract infection during pregnancy and long- term neurological morbidity of the offspring

Objective
Maternal urinary tract infection (UTI) has been associated with adverse pregnancy outcomes, especially preterm delivery. As preterm delivery has been associated with long- term neurological morbidity of the offspring, we opted to determine whether being born to a mother with UTI during the pregnancy increases the risk for long-term neurological morbidity of the offspring, regardless of gestational age.

Study Design
A population-based cohort study comparing long-term neurological morbidity of offspring of mothers with and without UTI during pregnancy was conducted. All singleton deliveries between the years 1991-2014 in a tertiary medical center were included. Cases of perinatal mortality, children with congenital malformations or chromosomal abnormalities and multiple pregnancies were excluded from the study. The study groups were followed until 18 of age for neurological-related morbidity. A Kaplan-Meier survival curve was used to compare cumulative incidence of long- term neurological morbidity, and a Cox proportional hazards model was constructed to control for confounders.

Results
During the study period, 242,342 deliveries met the inclusion criteria, of them 3.3% (n=8002) were of mothers with UTI during the pregnancy. The cumulative incidence of long-term neurological morbidity was higher in offspring born to mothers with UTI during the pregnancy as compared with those without UTI during the pregnancy (Kaplan-Meier log rank test P< 0.001, Figure). Using a Cox proportional hazards model, controlling for confounders such as maternal age, hypertensive disorders and gestational age, being born to mother with UTI during pregnancy was found to be an independent risk factor for long-term neurological morbidity of the offspring (adjusted HR1.33, 95% CI 1.18-1.51; P< 0.001; Table).

Conclusion
Being born to a mother with UTI during the pregnancy is independently associated with a higher risk for long-term neurological morbidity of the offspring. This association may possibly be explained by altered immune function during pregnancy.