The relation between pre-eclampsia at term and neonatal encephalopathy.
OBJECTIVE
To determine whether pre-eclampsia, hypothesised to be an inflammatory condition, is associated with fever in term labour, and confirm and examine the reported association of pre-eclampsia at term with neonatal encephalopathy.


METHODS
Prospective cohort study.


METHODS
A Dublin teaching hospital.


METHODS
6163 women in labour with singleton pregnancies at term at low risk for intrapartum hypoxia, recruited to a randomised trial examining the effect of admission cardiotocography on neonatal outcome.


RESULTS
Pre-eclampsia was associated with maternal fever > 37.5 degrees in labour (odds ratio (OR) 3.39, 95% confidence interval (CI) 2.1 to 5.4); this was independent of obstetric intervention (adjusted OR 2.07, 95% CI 1.24 to 3.47). Pre-eclampsia was associated with neonatal encephalopathy (OR 25.5, 95% CI 8.4 to 74.7); this too was independent of obstetric intervention (adjusted OR 18.5, 95% CI 5.9 to 58.1). Cord arterial pH values were significantly lower in pre-eclamptics (7.20 v 7.24), although severe cord acidaemia was not significantly more common (OR 2.91, 95% CI 0.7 to 9.9). The association of pre-eclampsia with encephalopathy was independent of maternal fever (adjusted OR 16.5, 95% CI 5.1 to 54) and cord acidaemia (adjusted OR 13.5, 95% CI 3.2 to 56.7).


CONCLUSIONS
The association of pre-eclampsia with maternal fever at term supports the hypothesis that pre-eclampsia is an inflammatory condition. The association of pre-eclampsia with neonatal encephalopathy is independent of obstetric intervention and cannot be explained by either acidaemia or maternal fever. A systemic inflammatory response in the fetus, perhaps secondary to oxidative stress, could explain the link between maternal pre-eclampsia and neonatal encephalopathy, and this may occur through cerebral vasoconstriction.
Impey
L
L
Department of Obstetrics and Gynaecology, The Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. Lawrence.Impey@orh.nhs.uk
Greenwood
C
C
Sheil
O
O
MacQuillan
K
K
Reynolds
M
M
Redman
C
C
D001784:Blood Gas Analysis; D001927:Brain Diseases / Q000097:blood / Q000196:embryology*; D002097:C-Reactive Protein / Q000032:analysis; D015148:Cardiotocography; D016001:Confidence Intervals; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005334:Fever / Q000196:embryology*; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D011225:Pre-Eclampsia; D011247:Pregnancy; D011446:Prospective Studies
D002097:C-Reactive Protein