Systemic inflammation in the extremely low gestational age newborn following maternal genitourinary infections

Abstract

Problem: Gestational genitourinary infections are associated with lifelong disabilities, but it is unknown if neonatal inflammation is involved.

Method: Mothers of 914 infants born before 28th gestation week reported cervical/vaginal infection (CVI), and/or urine/bladder/kidney infection (UTI), or neither. Inflammation proteins measured in baby's blood on postnatal days 1, 7, and 14 were considered elevated if in the top quartile for gestational age. Logistic regression models adjusting for potential confounders assessed odds ratios.

Results: Compared to mothers with neither UTI/CVI, those with CVI were more likely to have infants with elevated CRP, SAA, MPO, IL-1β, IL-6, IL-6R, TNF-α, RANTES, ICAM-3, E-selectin, and VEGF-R2 on day 1; those with UTI were more likely to have infants with elevated MPO, IL-6R, TNF-R1, TNF-R2, and RANTES on day 7. Placental anaerobes and genital mycoplasma were more common in pregnancies with CVI.

Conclusion: Gestational UTI/CVI should be targeted for preventing systemic inflammation in the very preterm newborn.

Keywords: Acute phase proteins; cervicitis; cytokines; placental microbiome; preterm birth; vaginitis.

Figure 1

Elevations of inflammation-associated proteins in the peripheral blood of newborns whose mothers acknowledged any UTI (uterine tract infection) or CVI (cervicovaginal infection) assessed as odds ratios (OR) and 95% confidence intervals of having top quatile protein concentrations for gestation age and day of blood collection. The reference group of each infection consisted of newborns whose mother denied both UTI and CVI (day 1, n=621, day 7, n=631). All ORs are adjusted for gestational age category, Black race, and public insurance. Odds ratios with 95% confidence intervals that do not include 1.0 are bolded.