Average and time-specific maternal prenatal inflammatory biomarkers and the risk of labor epidural associated fever


Autoři: Dominique Y. Arce aff001;  Andrea Bellavia aff002;  David E. Cantonwine aff003;  Olivia J. Napoli aff004;  John D. Meeker aff005;  Tamarra James-Todd aff002;  Thomas F. McElrath aff003;  Lawrence C. Tsen aff001
Působiště autorů: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Obstetric Anesthesia, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America aff001;  Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff002;  Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America aff003;  Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, United States of America aff004;  Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222958

Souhrn

Background

The use of labor epidural analgesia has been associated with intrapartum fever, known as labor epidural associated fever (LEAF). LEAF is most commonly non-infectious in origin and associated with elevated inflammatory cytokines.

Methods

The LIFECODES pregnancy cohort was designed to prospectively collect data to evaluate the association of maternal inflammatory biomarkers with preterm birth in women who delivered between 2007 and 2008 at Brigham and Women’s Hospital. Our secondary analysis of the data from the cohort identified 182 women for whom inflammatory biomarkers (i.e. interleukin-10, interleukin-1β, interleukin-6, tumor necrosis factor-α and C-reactive protein) collected longitudinally over four prenatal visits was available. Maternal temperature and other clinical variables were abstracted from medical records. The primary outcome, the presence of LEAF, was defined as oral temperature ≥ 38°C (≥100.4°F) after epidural analgesia initiation. Multivariable logistic regression estimated the association between inflammatory biomarker concentrations and the odds of developing an intrapartum fever after adjusting for a number of potential confounders.

Results

Women who developed LEAF were more likely to have a longer duration of epidural analgesia, whereas women who did not develop LEAF were more likely to have induced labor and positive or unknown Group B Streptococcus colonization status. However, no differences were seen by nulliparity, mode of delivery, white blood cell count at admission, baseline temperature, length of rupture of membranes and number of cervical exams performed during labor. Unadjusted and multivariable logistic regression models did not provide evidence for or exclude an association between individual maternal inflammatory biomarkers and the odds of developing LEAF, regardless of visit time-period.

Conclusion

The predictive value of maternal inflammatory biomarkers measured during early- and mid-pregnancy for the risk of developing LEAF cannot be excluded.

Klíčová slova:

Analgesia – Biomarkers – Cytokines – Epidural block – Fevers – Inflammation – Labor and delivery – Pregnancy


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2019 Číslo 11