Nothing Special   »   [go: up one dir, main page]
Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Predictors of antepartum maternal sepsis and effects on neonatal outcomes: a population-based cohort study

Journal of Perinatology volume 43, pages 752–757 (2023)Cite this article

Subjects

Abstract

Objective

To examine the relationship between maternal sepsis, type of infection, and short-term neonatal outcomes.

Study design

We conducted a retrospective cohort study investigating pregnancies between 2005 and 2008 in California with antepartum maternal sepsis diagnosis. Comparisons were made between sepsis cases and controls, using chi-squared or Fisher’s exact test. Multivariable logistic regression was performed, adjusting for maternal characteristics.

Results

Several maternal characteristics were associated with increased odds of maternal sepsis. Both obstetric and non-obstetric infections were associated with maternal sepsis (p < 0.001). The positive predictive value of maternal sepsis for preterm delivery was 55.03%. Neonates born to maternal sepsis patients had a higher risk of developing neonatal complications including neonatal shock.

Conclusion

Maternal sepsis was associated with neonatal complications. Efforts to reduce maternal sepsis may improve neonatal outcomes. Further studies are required for a better understanding of these associations and whether prevention or more rapid diagnosis and treatment can lower these risks.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Relationship between maternal characteristics and maternal sepsis.
Fig. 2: Relationship between type of maternal infections and maternal sepsis.
Fig. 3: Relationship between maternal sepsis and neonatal outcomes.

Similar content being viewed by others

Data availability

The dataset analyzed during the current study is available through the California Department of Public Health.

References

  1. CDC. Trends in pregnancy-related mortality in the United States: 1987–2017 [Internet]. cdc.gov; 2020 [cited 2022 Mar 18]. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm#causes

  2. Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-Related Mortality in the United States, 1998 to 2005. Obstet Gynecol. 2010;116:1302–9.

    Article  PubMed  Google Scholar 

  3. Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-Related Mortality in the United States, 2006–2010. Obstet Gynecol. 2015;125:5–12.

    Article  PubMed  Google Scholar 

  4. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011–2013. Obstet Gynecol. 2017;130:366–73.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal Sepsis Mortality and Morbidity During Hospitalization for Delivery: Temporal Trends and Independent Associations for Severe Sepsis. Anesth Analg. 2013;117:944–50.

    Article  PubMed  Google Scholar 

  6. Kendle AM, Salemi JL, Tanner JP, Louis JM. Delivery-associated sepsis: trends in prevalence and mortality. Am J Obstet Gynecol. 2019;220:391.e1–391.e16.

    Article  PubMed  Google Scholar 

  7. Al-Ostad G, Kezouh A, Spence AR, Abenhaim HA. Incidence and risk factors of sepsis mortality in labor, delivery and after birth: Population-based study in the USA: Sepsis mortality in labor and delivery. J Obstet Gynaecol Res. 2015;41:1201–6.

    Article  PubMed  Google Scholar 

  8. Bobetsis YA, Graziani F, Gürsoy M, Madianos PN. Periodontal disease and adverse pregnancy outcomes. Periodontol 2000. 2020;83:154–74.

    Article  PubMed  Google Scholar 

  9. Hacker FM, Whalen PS, Lee VR, Caughey AB. Maternal and fetal outcomes of pancreatitis in pregnancy. Am J Obstet Gynecol. 2015;213:568.e1–568.e5.

    Article  PubMed  Google Scholar 

  10. Farkash E, Weintraub AY, Sergienko R, Wiznitzer A, Zlotnik A, Sheiner E. Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes. Eur J Obstet Gynecol Reprod Biol. 2012;162:24–7.

    Article  PubMed  Google Scholar 

  11. Knowles S, O’Sullivan N, Meenan A, Hanniffy R, Robson M. Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG Int J Obstet Gynaecol. 2015;122:663–71.

    Article  CAS  Google Scholar 

  12. Blauvelt CA, Nguyen KC, Cassidy AG, Gaw SL. Perinatal Outcomes Among Patients With Sepsis During Pregnancy. JAMA Netw Open. 2021;4:e2124109.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bauer ME, Housey M, Bauer ST, Behrmann S, Chau A, Clancy C, et al. Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women: A Multicenter Case–Control Study. Anesth Analg. 2019;129:1613–20.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Han X, Du H, Cao Y, Zhang Y, Zhang J, Zhang L, et al. Association of histological and clinical chorioamnionitis with perinatal and neonatal outcome. J Matern Fetal Neonatal Med. 2021;34:794–802.

    Article  PubMed  Google Scholar 

  15. Bastek JA, Weber AL, McShea MA, Ryan ME, Elovitz MA. Prenatal inflammation is associated with adverse neonatal outcomes. Am J Obstet Gynecol. 2014;210:450.e1–450.e10.

    Article  PubMed  Google Scholar 

  16. Craig AM, Dotters-Katz S, Kuller JA, Thompson JL. Listeriosis in Pregnancy: A Review. Obstet Gynecol Surv. 2019;74:362–8.

    Article  PubMed  Google Scholar 

  17. Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, et al. Listeriosis in human pregnancy: a systematic review. J Perinat Med [Internet]. 2011;39. https://www.degruyter.com/document/doi/10.1515/jpm.2011.035/html

  18. Charlier C, Perrodeau É, Leclercq A, Cazenave B, Pilmis B, Henry B, et al. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis. 2017;17:510–9.

    Article  PubMed  Google Scholar 

  19. Bonet M, Brizuela V, Abalos E, Cuesta C, Baguiya A, Chamillard M, et al. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lancet Glob Health. 2020;8:e661–71.

    Article  Google Scholar 

  20. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017;376:2235–44.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shields A, de Assis V, Halscott T. Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis. Obstet Gynecol. 2021;138:289–304.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Escobar MF, Echavarría MP, Zambrano MA, Ramos I, Kusanovic JP. Maternal sepsis. Am J Obstet Gynecol MFM. 2020;2:100149.

    Article  PubMed  Google Scholar 

  23. Serafim R, Gomes JA, Salluh J, Póvoa P. A Comparison of the Quick-SOFA and Systemic Inflammatory Response Syndrome Criteria for the Diagnosis of Sepsis and Prediction of Mortality. Chest. 2018;153:646–55.

    Article  PubMed  Google Scholar 

  24. Cagino SG, Burke AA, Letner DR, Leizer JM, Zelig CM. Quick Sequential Organ Failure Assessment: Modifications for Identifying Maternal Morbidity and Mortality in Obstetrical Patients. Am J Perinatol. 2022;39:001–7.

    Article  Google Scholar 

  25. Bonet M, Nogueira Pileggi V, Rijken MJ, Coomarasamy A, Lissauer D, Souza JP, et al. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation. Reprod Health. 2017;14:67.

    Article  PubMed  PubMed Central  Google Scholar 

  26. American College of Obstetricians and Gynecologists. Committee Opinion No. 614: Management of pregnant women with presumptive exposure to Listeria monocytogenes. Obstet Gynecol. 2014;124:1241–4.

  27. Glaser AP, Schaeffer AJ. Urinary Tract Infection and Bacteriuria in Pregnancy. Urol Clin North Am. 2015;42:547–60.

    Article  PubMed  Google Scholar 

  28. Grette K, Cassity S, Holliday N, Rimawi BH. Acute pyelonephritis during pregnancy: a systematic review of the aetiology, timing, and reported adverse perinatal risks during pregnancy. J Obstet Gynaecol. 2020;40:739–48.

    Article  PubMed  Google Scholar 

  29. Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009;34:407–13.

    Article  CAS  PubMed  Google Scholar 

  30. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103–20.

  31. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 171: Management of Preterm Labor. Obstet Gynecol. 2016;128:e155–64.

  32. Albright CM, Mehta ND, Rouse DJ, Hughes BL. Sepsis in Pregnancy: Identification and Management. J Perinat Neonatal Nurs. 2016;30:95–105.

    Article  PubMed  Google Scholar 

Download references

Funding

Dr SLG was supported by the National Institutes of Health (NIAID K08AI141728).

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA

    Nida Ozarslan, Stephanie L. Gaw & Arianna G. Cassidy

  2. Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA

    Aaron B. Caughey

Authors
  1. Nida Ozarslan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie L. Gaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arianna G. Cassidy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aaron B. Caughey
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr SLG and Dr ABC conceptualized and designed the study, carried out the initial analysis, critically reviewed and revised the paper. Dr NO and Dr AGC drafted the initial paper, reviewed, and revised the paper. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Aaron B. Caughey.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ozarslan, N., Gaw, S.L., Cassidy, A.G. et al. Predictors of antepartum maternal sepsis and effects on neonatal outcomes: a population-based cohort study. J Perinatol 43, 752–757 (2023). https://doi.org/10.1038/s41372-023-01696-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-023-01696-3

Search

Advanced search

Quick links