Perinatal outcomes among births to women with infection during pregnancy

• Published in: Archives of disease in childhood 2021-10, Vol.106 (10), p.946-953
• Main Authors: Cecatti, José Guilherme, Curteanu, Ala, Minkauskiene, Meile, Jayaratne, Kapila, Ribeiro-do-Valle, Carolina Carvalho, Budianu, Mihaela-Alexandra, Souza, João Paulo, Kouanda, Séni, Aman, Mohammad Iqbal, Noormal, Bashir, Espinoza, Marisa, Pasquale, Julia, Vandenberghe, Griet, Aguemon, Christiane Tshabu, Altamirano, Víctor Conde, Muñoz, Rosalinda Hernández, Ouedraogo, Henri Gautier, Simo, Elie, Tebeu, Pierre-Marie, Escobar, María Fernanda, Fernández, Paula, Colmorn, Lotte Berdiin, Langhoff-Roos, Jens, Vélez, Paola, Kassa, Dawit Worku, Govule, Philip, Romero, William Enrique, Castro, Rigoberto, Lara, Bredy, Kumar, Vijay, Suri, Vanita, Trikha, Sonia, Donati, Serena, Kabylova, Saule, Gwako, George, Osoti, Alfred, Qureshi, Zahida, Boobekova, Aigul, Kak, Faysal El, Chikhwaza, Owen, Gadama, Luis, Malunga, Eddie, Zerbo, Fanta Eliane, Castañeda, Juan Ismael, Khishgee, Seded, Lkhagvasuren, Bat-Erdene, Assarag, Bouchra, Essolbi, Amina, Moulki, Rachid, Osman, Nafissa Bique, Jaze, Zara, Maung, Thae Maung, Gurung, Tara, Shrestha, Amir Babu, Shrestha, Sangeeta, Rijken, Marcus J, Akker, Thomas Van, Estrada, María Esther, Gómez, Néstor Pavón, Adesina, Olubukola, Fawole, Bukola, Chaudhri, Rizwana, Hamid, Saima, Adnan Khan, M, Pimentel, Nelly Zavaleta, Andal, Maria Lu, Recidoro, Zenaida Dy, Pușcașiu, Lucian, Moreira, Philippe Marc, Borovsky, Miroslav, Kristufkova, Alexandra, López, Marta, Benedé, María José, Jayakody, Hemali, Nabag, Wisal, Omer, Sara, Tsoy, Victoria, Uzakova, Urunbish, Yunusova, Dilrabo, Siriwachirachai, Thitiporn, Tangsiriwatthana, Thumwadee, Dunlop, Catherine, Knight, Marian, Lissauer, David, Pérez, Aquilino M, Roman, Jhon, Vitureira, Gerardo, Tuan, Dinh Anh, Truong, Luong Ngoc, Hanh, Nghiem Thi, Madziyire, Mugove, Magwali, Thulani, Munjanja, Stephen, Nabhan, Ashraf, Nadisauskiene, Ruta, Jacob, Shevin T, Gamerro, Hugo, Althabe, Fernando, Brizuela, Vanessa
• Format: Article
• Language: English
• Subjects: Adult; Attrition (Research Studies); Birth; Births; Childbirth & labor; Clinical outcomes; Comorbidity; Death; Developing Countries - statistics & numerical data; Epidemiology; Fatalities; Female; Females; Gestational Age; Global Child Health; Health facilities; Hospitals; Humans; Infant mortality; Infant, Newborn; Infections; Live Birth - epidemiology; Low Income; Low income groups; Mortality; Near Miss, Healthcare - statistics & numerical data; Neonates; neonatology; Obstetrics; Parturition; Pediatrics; Perinatal Death - etiology; Perinatal Mortality; Pragmatics; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - epidemiology; Prospective Studies; Risk Factors; Semiotics; Sepsis; Stillbirth; Stillbirth - epidemiology; Vagina; Womens health; Young Adult; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-321865

ObjectiveThis study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC).DesignWe conducted a 1-week inception hospital-based cohort study.SettingThe study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017.PatientsWe included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up.Main outcome measuresPerinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death).Results1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother’s infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death.ConclusionsOverall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.