title: Prenatal inflammation is associated with adverse neonatal outcomes.
abstract: OBJECTIVE
  The purpose of this study was to determine whether prenatal inflammation (as assessed by clinical chorioamnionitis, maternal temperature >38°C, or histologic chorioamnionitis) is associated with a composite adverse neonatal outcome.
  
  
  METHODS
  We performed a prospective cohort study of women at 22 weeks to 33 weeks 6 days' gestation with symptoms of labor (April 2009 to March 2012). Relevant maternal and neonatal exposures and outcomes were recorded. Multivariable logistic regression was performed to determine the association between prenatal inflammation and neonatal outcomes that were controlled for potential confounders.
  
  
  RESULTS
  We analyzed 871 mother-infant pairs. The preterm birth rate was 42.0%. When we controlled for infant sex and modified the data by gestational age at delivery, prenatal inflammation remains a significant risk factor for adverse neonatal outcomes, despite advancing gestational age: clinical chorioamnionitis at 32 weeks' gestation (odds ratio [OR], 3.12; 95% confidence interval [CI], 1.02-9.52], at 36 weeks' gestation (OR, 8.88; 95% CI, 4.32-18.25), and at 40 weeks' gestation (OR, 25.30; 95% CI, 9.25-69.19); maternal temperature >38°C at 32 weeks' gestation (OR, 3.18; 95% CI, 0.66-15.42), at 36 weeks gestation (OR, 8.40; 95% CI, 3.60-19.61), and at 40 weeks gestation (OR, 22.19; 95% CI, 8.15-60.44); histologic chorioamnionitis at 32 weeks gestation (OR, 1.25; 95% CI, 0.64-2.46), at 36 weeks gestation (OR, 2.56; 95% CI, 1.54-4.23), and at 40 weeks gestation (OR, 5.23; 95% CI, 1.95-13.99).
  
  
  CONCLUSIONS
  The protective association with advancing gestational age is diminished when prenatal inflammation is present.
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: jbastek@obgyn.upenn.edu.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Bastek
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Anita L
authors.initials: AL
authors.lastname: Weber
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: McShea
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Ryan
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Michal A
authors.initials: MA
authors.lastname: Elovitz
mesh_terms: D000328:Adult; D019540:Area Under Curve; D002821:Chorioamnionitis / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007249:Inflammation / Q000453:epidemiology*; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: adverse neonatal outcome; chorioamnionitis; placenta; prenatal inflammation; preterm birth