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Acute maternal infection and risk of pre-eclampsia: a population-based case-control study.

Minassian C, Thomas SL, Williams DJ, Campbell O, Smeeth L - PLoS ONE (2013)

Bottom Line: We found no association with maternal respiratory tract infection (adjusted odds ratio 0.91;0.72-1.16).Further adjustment for maternal smoking and pre-pregnancy body mass index made no difference to our findings.Maternal antibiotic prescriptions are also associated with an increased risk.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Infection in pregnancy may be involved in the aetiology of pre-eclampsia. However, a clear association between acute maternal infection and pre-eclampsia has not been established. We assessed whether acute urinary tract infection, respiratory tract infection, and antibiotic drug prescriptions in pregnancy (a likely proxy for maternal infection) are associated with an increased risk of pre-eclampsia.

Methods and findings: We used a matched nested case-control design and data from the UK General Practice Research Database to examine the association between maternal infection and pre-eclampsia. Primiparous women aged at least 13 years and registered with a participating practice between January 1987 and October 2007 were eligible for inclusion. We selected all cases of pre-eclampsia and a random sample of primiparous women without pre-eclampsia (controls). Cases (n=1533) were individually matched with up to ten controls (n=14236) on practice and year of delivery. We calculated odds ratios and 95% confidence intervals for pre-eclampsia comparing women exposed and unexposed to infection using multivariable conditional logistic regression. After adjusting for maternal age, pre-gestational hypertension, diabetes, renal disease and multifetal gestation, the odds of pre-eclampsia were increased in women prescribed antibiotic drugs (adjusted odds ratio 1.28;1.14-1.44) and in women with urinary tract infection (adjusted odds ratio 1.22;1.03-1.45). We found no association with maternal respiratory tract infection (adjusted odds ratio 0.91;0.72-1.16). Further adjustment for maternal smoking and pre-pregnancy body mass index made no difference to our findings.

Conclusions: Women who acquire a urinary infection during pregnancy, but not those who have a respiratory infection, are at an increased risk of pre-eclampsia. Maternal antibiotic prescriptions are also associated with an increased risk. Further research is required to elucidate the underlying mechanism of this association and to determine whether, among women who acquire infections in pregnancy, prompt treatment or prophylaxis against infection might reduce the risk of pre-eclampsia.

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Related in: MedlinePlus

Identification of study participants included in the primary analysis: A) cases (n = 1533); B) controls (n = 14236).
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pone-0073047-g001: Identification of study participants included in the primary analysis: A) cases (n = 1533); B) controls (n = 14236).

Mentions: To help ensure cases and controls were primiparous, we excluded women with evidence for an earlier completed pregnancy (e.g. a record of “previous caesarean section” before their earliest delivery record). To distinguish cases of pre-eclampsia from women with essential or secondary hypertension which became clinically apparent during pregnancy, we excluded women with no evidence of high blood pressure until pregnancy but whose hypertension did not resolve six to 12 months post-delivery. The identification of cases and controls for inclusion in the study is illustrated in Figure 1.


Acute maternal infection and risk of pre-eclampsia: a population-based case-control study.

Minassian C, Thomas SL, Williams DJ, Campbell O, Smeeth L - PLoS ONE (2013)

Identification of study participants included in the primary analysis: A) cases (n = 1533); B) controls (n = 14236).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3760871&req=5

pone-0073047-g001: Identification of study participants included in the primary analysis: A) cases (n = 1533); B) controls (n = 14236).
Mentions: To help ensure cases and controls were primiparous, we excluded women with evidence for an earlier completed pregnancy (e.g. a record of “previous caesarean section” before their earliest delivery record). To distinguish cases of pre-eclampsia from women with essential or secondary hypertension which became clinically apparent during pregnancy, we excluded women with no evidence of high blood pressure until pregnancy but whose hypertension did not resolve six to 12 months post-delivery. The identification of cases and controls for inclusion in the study is illustrated in Figure 1.

Bottom Line: We found no association with maternal respiratory tract infection (adjusted odds ratio 0.91;0.72-1.16).Further adjustment for maternal smoking and pre-pregnancy body mass index made no difference to our findings.Maternal antibiotic prescriptions are also associated with an increased risk.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Infection in pregnancy may be involved in the aetiology of pre-eclampsia. However, a clear association between acute maternal infection and pre-eclampsia has not been established. We assessed whether acute urinary tract infection, respiratory tract infection, and antibiotic drug prescriptions in pregnancy (a likely proxy for maternal infection) are associated with an increased risk of pre-eclampsia.

Methods and findings: We used a matched nested case-control design and data from the UK General Practice Research Database to examine the association between maternal infection and pre-eclampsia. Primiparous women aged at least 13 years and registered with a participating practice between January 1987 and October 2007 were eligible for inclusion. We selected all cases of pre-eclampsia and a random sample of primiparous women without pre-eclampsia (controls). Cases (n=1533) were individually matched with up to ten controls (n=14236) on practice and year of delivery. We calculated odds ratios and 95% confidence intervals for pre-eclampsia comparing women exposed and unexposed to infection using multivariable conditional logistic regression. After adjusting for maternal age, pre-gestational hypertension, diabetes, renal disease and multifetal gestation, the odds of pre-eclampsia were increased in women prescribed antibiotic drugs (adjusted odds ratio 1.28;1.14-1.44) and in women with urinary tract infection (adjusted odds ratio 1.22;1.03-1.45). We found no association with maternal respiratory tract infection (adjusted odds ratio 0.91;0.72-1.16). Further adjustment for maternal smoking and pre-pregnancy body mass index made no difference to our findings.

Conclusions: Women who acquire a urinary infection during pregnancy, but not those who have a respiratory infection, are at an increased risk of pre-eclampsia. Maternal antibiotic prescriptions are also associated with an increased risk. Further research is required to elucidate the underlying mechanism of this association and to determine whether, among women who acquire infections in pregnancy, prompt treatment or prophylaxis against infection might reduce the risk of pre-eclampsia.

Show MeSH
Related in: MedlinePlus