Meconium stained amniotic fluid and offspring long term neurological health - a population based analysis

Objective
Meconium stained amniotic fluid (MSAF), recently found not to be sterile as previously thought, may affect newborn brain development by several mechanism. We investigated the possible impact of MSAF on the occurrence of neurological related hospitalizations in the offspring throughout childhood.

Study Design
In this population-based cohort analysis, all singleton deliveries occurring between 1991-2014 at a single tertiary medical center were included. The study groups were defined based on lack or presence of MSAF during labor. A Kaplan-Meier analysis was constructed for evaluation of cumulative hospitalization rate due to neurological morbidity (such as autism, cerebral palsy, developmental disorders, etc.) over the 18 years of follow-up, and a Cox proportional hazards model was used to study the association between MSAF and neurological morbidity while controlling for potential confounders.

Results
During the study period 242,342 deliveries met the inclusion criteria. A total of 7,543 hospitalizations due to neurological morbidity were documented with a rate of 3.2% (1,152) in children exposed to MSAF as compared with 3.1% (6,391) in the unexposed group (odds ratio 1.05 95%CI 0.98-1.12, p=0.149). The survival curve (Figure) showed comparable cumulative hospitalization rates in both groups (log rank p=0.349). The Cox analysis, controlled for maternal diabetes and hypertension, gestational age, and maternal age, demonstrated MSAF exposure not to be an independent risk factor for neurological morbidity during childhood in the offspring (adjusted HR=1.025, 0.962-1.092). This was also true when analyzed for preterm deliveries only (adjusted HR=1.194, 0.906-1.572).