Association of common maternal infections with birth outcomes: a multinational cohort study

Jian-Rong He; Gabriella Tikellis; Ora Paltiel; Mark Klebanoff; Per Magnus; Kate Northstone; Jean Golding; Mary H Ward; Martha S Linet; Sjurdur F Olsen; Gary S Phillips; Stanley Lemeshow; Xiu Qiu; Jane E Hirst; Terence Dwyer

doi:10.1007/s15010-024-02291-0

Association of common maternal infections with birth outcomes: a multinational cohort study

Infection. 2024 May 11. doi: 10.1007/s15010-024-02291-0. Online ahead of print.

Authors

Jian-Rong He^{1

2}, Gabriella Tikellis³, Ora Paltiel⁴, Mark Klebanoff⁵, Per Magnus⁶, Kate Northstone⁷, Jean Golding⁸, Mary H Ward⁹, Martha S Linet¹⁰, Sjurdur F Olsen¹¹, Gary S Phillips¹², Stanley Lemeshow¹³, Xiu Qiu¹⁴, Jane E Hirst^{15

16}, Terence Dwyer^{15

17

18}

Affiliations

¹ Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. jianrong.he@bigcs.org.
² Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK. jianrong.he@bigcs.org.
³ Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia.
⁴ Braun School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
⁵ Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
⁶ Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
⁷ Faculty of Health Sciences, University of Bristol, Bristol, UK.
⁸ Bristol Medical School, Centre for Academic Child Health, Population Health Sciences, University of Bristol, Bristol, UK.
⁹ Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
¹⁰ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
¹¹ Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
¹² Consultant Retired From the Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA.
¹³ Division of Biostatistics, College of Public Health, Ohio State University, Columbus, OH, USA.
¹⁴ Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
¹⁵ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹⁶ George Institute for Global Health, London, UK.
¹⁷ Clinical Sciences Theme, Heart Group, Murdoch Children's Research Institute, Melbourne, Australia.
¹⁸ Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.

PMID: 38733459
DOI: 10.1007/s15010-024-02291-0

Abstract

Purpose: It is unclear whether common maternal infections during pregnancy are risk factors for adverse birth outcomes. We assessed the association between self-reported infections during pregnancy with preterm birth and small-for-gestational-age (SGA) in an international cohort consortium.

Methods: Data on 120,507 pregnant women were obtained from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA. Self-reported common infections during pregnancy included influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections, cystitis, urinary tract infection, and the symptoms fever and diarrhoea. Birth outcomes included preterm birth, low birth weight and SGA. Associations between maternal infections and birth outcomes were first assessed using Poisson regression in each cohort and then pooled using random-effect meta-analysis. Risk ratios (RR) and 95% confidence intervals (CI) were calculated, adjusted for potential confounders.

Results: Vaginal infections (pooled RR, 1.10; 95% CI, 1.02-1.20) and urinary tract infections (pooled RR, 1.17; 95% CI, 1.09-1.26) during pregnancy were associated with higher risk of preterm birth. Similar associations with low birth weight were also observed for these two infections. Fever during pregnancy was associated with higher risk of SGA (pooled RR, 1.07; 95% CI, 1.02-1.12). No other significant associations were observed between maternal infections/symptoms and birth outcomes.

Conclusion: Vaginal infections and urinary infections during pregnancy were associated with a small increased risk of preterm birth and low birth weight, whereas fever was associated with SGA. These findings require confirmation in future studies with laboratory-confirmed infection diagnosis.

Keywords: Cohort study; Fetal growth; Maternal infection; Preterm birth.

Abstract

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