title: Association of maternal hypertension and chorioamnionitis with preterm outcomes.
abstract: OBJECTIVE
  We compared the relative effect of hypertensive disorders of pregnancy and chorioamnionitis on adverse neonatal outcomes in very preterm neonates, and studied whether gestational age (GA) modulates these effects.
  
  
  METHODS
  A cohort of neonates 23 to 30 weeks' GA, born in 2008 to 2011 in 82 hospitals adhering to the Italian Neonatal Network, was analyzed. Infants born from mothers who had hypertensive disorders (N = 2096) were compared with those born after chorioamnionitis (N = 1510). Statistical analysis employed logistic models, adjusting for GA, hospital, and potential confounders.
  
  
  RESULTS
  Overall mortality was higher after hypertension than after chorioamnionitis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.80), but this relationship changed across GA weeks; the OR for hypertension was highest at low GA, whereas from 28 weeks' GA onward, mortality was higher for chorioamnionitis. For other outcomes, the relative risks were constant across GA; infants born after hypertension had an increased risk for bronchopulmonary dysplasia (OR, 2.20; 95% CI, 1.68-2.88) and severe retinopathy of prematurity (OR, 1.48; 95% CI, 1.02-2.15), whereas there was a lower risk for early-onset sepsis (OR, 0.25; 95% CI, 0.19-0.34), severe intraventricular hemorrhage (OR, 0.65; 95% CI, 0.48-0.88), periventricular leukomalacia (OR, 0.70; 95% CI, 0.48-1.01), and surgical necrotizing enterocolitis or gastrointestinal perforation (OR, 0.47; 95% CI, 0.31-0.72).
  
  
  CONCLUSIONS
  Mortality and other adverse outcomes in very preterm infants depend on antecedents of preterm birth. Hypertension and chorioamnionitis are associated with different patterns of outcomes; for mortality, the effect changes across GA weeks.
authors.affiliation: Department of Woman and Child Health, Ospedale Versilia, Viareggio, Italy; l.gagliardi@neonatalnet.org.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gagliardi
authors.affiliation: Unit of Epidemiology, A Meyer Children's University Hospital, Florence, Italy; and.
authors.forename: Franca
authors.initials: F
authors.lastname: Rusconi
authors.affiliation: Neonatal ICU, Ospedale Alessandro Manzoni, Lecco, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellù
authors.affiliation: Neonatal ICU, Ospedale Alessandro Manzoni, Lecco, Italy.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Zanini
mesh_terms: D002821:Chorioamnionitis; D005260:Female; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies
keywords: logistic models; mortality; outcomes; pregnancy complications; preterm infants; risks