Maternal infection and risk of intrapartum death: a population based observational study in South Asia

BMC Pregnancy and Childbirth

Anthony Costello³  Prasanta Tripathy²  Kishwar Azad¹  Edward Fottrell³  Andrew Copas⁶  Matthew Ellis⁵  Audrey Prost³  Nadine Seward³  Azusa Iwamoto⁴ 

[1] Perinatal Care Project, Bangladesh Diabetic Samity, Diabetic Association of Bangladesh, Dhaka, Bangladesh;Ekjut, Ward, Number 17, Plot 556B, Potka, Po-Chakradharpur, District West Singhbhum, Jharkhand 833102, India;UCL Institute for Global Health, University College London, 30 Guilford St, London WC1N 1EH, UK;Bureau of International Medical Cooperation, Japan, National Center for Global Health and Medicine, Medicine 1-21-1, Toyama, Shinjuku-ku, Tokyo, Japan;Centre for Child and Adolescent Health, School of Social and Community Medicine, Oakfield House, Oakfield Grove, University of Bristol, Bristol BS28 2BN, UK;UCL Centre for Sexual Health and HIV Research, Institute of Epidemiology & Health Care, University College London, London, UK

关键词: Resource-poor;    Low-income countries;    Neonatal mortality;    Prolonged rupture of membranes;    Intrapartum-related neonatal death;    Double hit hypothesis;    Maternal infection;   

Others  :  1131839
DOI  :  10.1186/1471-2393-13-245

 received in 2013-01-24, accepted in 2013-12-17,  发布年份 2013

【 摘 要 】

Background

Approximately 1.2 million stillbirths occur in the intrapartum period, and a further 717,000 annual neonatal deaths are caused by intrapartum events, most of which occur in resource poor settings. We aim to test the ‘double-hit’ hypothesis that maternal infection in the perinatal period predisposes to neurodevelopmental sequelae from an intrapartum asphyxia insult, increasing the likelihood of an early neonatal death compared with asphyxia alone. This is an observational study of singleton newborn infants with signs of intrapartum asphyxia that uses data from three previously conducted cluster randomized controlled trials taking place in rural Bangladesh and India.

Methods

From a population of 81,778 births in 54 community clusters in rural Bangladesh and India, we applied mixed effects logistic regression to data on 3890 singleton infants who had signs of intrapartum asphyxia, of whom 769 (20%) died in the early neonatal period. Poor infant condition at five minutes post-delivery was our proxy measure of intrapartum asphyxia. We had data for two markers of maternal infection: fever up to three days prior to labour, and prolonged rupture of membranes (PROM). Cause-specific verbal autopsy data were used to validate our findings using previously mentioned mixed effect logistic regression methods and the outcome of a neonatal death due to intrapartum asphyxia.

Results

Signs of maternal infection as indicated by PROM, combined with intrapartum asphyxia, increased the risk of an early neonatal death relative to intrapartum asphyxia alone (adjusted odds ratio (AOR) 1.28, 95% CI 1.03 – 1.59). Results from cause-specific verbal autopsy data verified our findings where there was a significantly increased odds of a early neonatal death due to intrapartum asphyxia in newborns exposed to both PROM and intrapartum asphyxia (AOR: 1.52, 95% CI 1.15 – 2.02).

Conclusions

Our data support the double-hit hypothesis for signs of maternal infection as indicated by PROM. Interventions for pregnant women with signs of infection, to prevent early neonatal deaths and disability due to asphyxia, should be investigated further in resource-poor populations where the chances of maternal infection are high.

【 授权许可】

   
2013 Iwamoto et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Wall SN, Lee ACC, Carlo W, et al.: Reducing intrapartum-related deaths in low and middle-income countries – what works? Semin Perinatol 2010, 34:395-407.
• [2]Liu L, Johnson H, Cousens S, et al.: For the child health epidemiology reference groups of WHO and unicef. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012, 379(9832):2151-2161.
• [3]WHO: Basic Newborn Resuscitation: A Practical Guide. Geneva: World Health Organization; 1997. Available: http://www.who.int/maternal_child_adolescent/documents/who_rht_msm_981/en/ webcite
• [4]Black RE, Cousens S, Johnson HL, et al.: Child health epidemiology reference group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010, 375(9730):1969-1987.
• [5]Lawn J, Shibuya K, Stein C: No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ 2005, 83(6):409-417.
• [6]WHO: The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.
• [7]Chowdhury H, Thompson S, Ali M, Yunus M, Streatfield P: Causes of neonatal deaths in a rural subdistrict of Bangladesh: implications for intervention. J Health Popul Nutr 2010, 28(4):375-382.
• [8]Ellis M, Azad K, Banerjee B, et al.: Intrapartum-related stillbirths and neonatal deaths in rural Bangladesh: a prospective, community-based cohort study. Pediatrics 2011, 127(5):.. Available at: here: http://pediatrics.aappublications.org/content/127/5/e1182.full.pdf+html webcite
• [9]Bang AT, Bang RA, Baitule SB, Reddy HM, Deshmukh MD: Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitating with mouth-to-mouth, tube-mask or bag-mask. J Perinatol 2005, 25:S82-S91.
• [10]Darmstadt GL, Choi Y, Arifeen SE, et al.: For the Bangladesh projahnmo-2 (mirzapur) study group. Evaluation of a cluster-randomized controlled trial of a package of community-based maternal and newborn interventions in Mirzapur, Bangladesh. PLoS One 2010, 5(3):e9696.
• [11]Lee ACC, Mullany LC, Tielsch JM, et al.: Risk factors for neonatal mortality due to birth asphyxia in Southern Nepal: a prospective, community-based cohort study. Pediatrics 2008, 121(5):.. Available at: http://www.pediatrics.org/cgi/content/full/121/5/e1381 webcite
• [12]Badawi N, Kurinczuk JJ, Keogh JM, et al.: Intrapartum risk factors for newborn encephalopathy: the Western Australian case–control study. BMJ 1998, 317:1554-1558.
• [13]Lieberman E, Lang J, Richardson D, Frigoletto F, Heffner L, Cohen M: Intrapartum maternal fever and neonatal outcome. Pediatrics 2000, 105(1):8-13.
• [14]Wu Y: Systematic review of chorioamnionitis and cerebral palsy. Ment Retard Dev Disabil Res Rev 2002, 8(1):25-29.
• [15]Neufeld M, Frigon C, Graham A, Mueller B: Maternal infection and risk of cerebral palsy in term and preterm infants. J Perinatol 2005, 25(2):108-113.
• [16]Ellis M, Manandhar N, Manandhar D, Costello A: Risk factors for neonatal encephalopathy in Kathmandu Nepal, a developing country: unmatched case–control study. BMJ 2000, 320(7244):1229-1236.
• [17]Cerebral P: Epidemiology and Causal Pathways. In Epidemiology and Causal Pathways edited by Fiona Stanley. Edited by Fiona S, Eve B, Eva A. London, England: MacKeith Press; 2000:251. ISBN 1 898683 204
• [18]Peebles DM, Wyatt JS: Synergy between antenatal exposure to infection and intrapartum events in causation of perinatal brain injury at term. Br J Obstet Gynaecol 2002, 109:737-739.
• [19]Eklind S, Mallard C, Leverin AL, et al.: Bacterial endotoxin sensitizes the immature brain to hypoxic-ischaemic injury. Eur J Neurosci 2001, 13(6):1101-1106.
• [20]Cunningham FG, Leveno KJ, Bloom SL, GilstrapIII LC, Wenstrom KD: Williams Obstetrics. 22nd edition. New York: McGraw Hill Companies Inc.; 2005.
• [21]Shalak LF, Laptook AR, Jafri HS, Ramilio O, Perlman JM: Clinical chorioamnionitis, elevated cytokines, and brain injury in term infants. Pediatrics 2002, 110(4):673-68.
• [22]Kendall G, Peebles D: Acute fetal hypoxia: the modulating effect of infection. Early Hum Dev 2005, 81(1):27-34.
• [23]Tripathy P, Nair N, Barnett S, et al.: Effect of a participatory intervention with women’s groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial. Lancet 2010, 375(9721):1182-1192.
• [24]Azad K, Barnett S, Banerjee B, et al.: Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial. Lancet 2010, 375(9721):1193-1202.
• [25]Barnett S, Nair N, Tripathy P, et al.: A prospective key informant surveillance system to measure maternal mortality - findings from indigenous populations in Jharkhand and Orissa. BMC Pregnancy Childbirth 2008, 8:6. 10.1186/1471-2393-8-6 BioMed Central Full Text
• [26]Fottrell E, Azad K, Kuddus A, et al.: The effect of increased coverage of participatory women’s groups on neonatal mortality in Bangladesh. JAMA Pediatr 2013, 167(9):816-824. 10.1001/jamapediatrics.2013.2534
• [27]World Health Organisation: International Classification of Diseases, 10th Revision (ICD-10). Geneva; 2007.
• [28]World Health Organisation: Integrated Management of Pregnancy and Childbirth. A guide for essential practice. Geneva: Pregnancy, Childbirth and Newborn Care; 2006.
• [29]Von Elm E, Altman DG, Egger M, et al.: Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007, 335(7624):806-808.
• [30]Byass P, Chandramohan D, Clark SJ, D’Ambruoso L, Fottrell E, Graham WJ, Herbst AJ, Hodgson A, Hounton S, Kahn K, Krishnan A, Leitao J, Odhiambo F, Sankoh OA, Tollman SM: Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool. Glob Health Action 2012, 5:19281.
• [31]StataCorp: Stata Statistical Software: Release 11. College Station. Texas: Stata Corp LP; 2009.
• [32]Stewart M, Festin K, Festin M: Validation of women’s reporting and recall of major obstetric complications treated at Philippine General Hospital. Int J Gynaecol Obstet 1996, 27(1):29-35.
• [33]Ronsmans C, Achadi E, Cohen S, Zazri A: Women’s recall of obstetric complications in South Kalimantan. Indones Stud Fam Plann 1997, 28(3):203-214.
• [34]Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY: Williams Obstetrics. 23rd edition. New York: McGraw-Hill Companies Inc; 2010:605-645.
• [35]Hamer DH, Singh MP, Wylie BJ: Burden of malaria in pregnancy in Jharkhand State. India Malar J 2009, 8:210. BioMed Central Full Text
• [36]Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L: Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005, 365(9463):977-988.
• [37]Rijken M, McGready R, Boel M: Malaria in pregnancy in the Asia-Pacific region. Lancet 2012, 12(1):75-88.
• [38]Nayak K, Khatri M, Gupta B: Spectrum of vivax malaria in pregnancy and its outcome: a hospital-based study. J Vector Borne Dis 2009, 46(4):299-302.
• [39]Flenady V, King JF: Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database Syst Rev 2002, (3):.. Art. No.: CD001807. doi:10.1002/14651858.CD001807