Management of Infection for the Obstetrician/Gynecologist

Maternal Infection in Pregnancy and Childhood Leukemia: A Systematic Review and Meta-analysis

OBJECTIVE

To summarize the published evidence regarding the association between maternal infection during pregnancy and childhood leukemia.

STUDY DESIGN

In this systematic review and meta-analysis (PROSPERO number, CRD42018087289), we searched PubMed and Embase to identify relevant studies. We included human studies that reported associations of at least one measure of maternal infection during pregnancy with acute lymphoblastic leukemia (ALL) or all childhood leukemias in the offspring. One reviewer extracted the data first using a standardized form, and the second reviewer independently checked the data for accuracy. Two reviewers used the Newcastle-Ottawa Scale to assess the quality of included studies. We conducted random effects meta-analyses to pool the ORs of specific type of infection on ALL and childhood leukemia.

RESULTS

This review included 20 studies (ALL, n = 15; childhood leukemia, n = 14) reported in 32 articles. Most (>65%) included studies reported a positive association between infection variables and ALL or childhood leukemia. Among specific types of infection, we found that influenza during pregnancy was associated with higher risk of ALL (pooled OR, 3.64; 95% CI, 1.34-9.90) and childhood leukemia (pooled OR, 1.77; 95% CI, 1.01-3.11). Varicella (pooled OR, 10.19; 95% CI, 1.98-52.39) and rubella (pooled OR, 2.79; 95% CI, 1.16-6.71) infections were also associated with higher childhood leukemia risk.

CONCLUSIONS

Our findings suggest that maternal infection during pregnancy may be associated with a higher risk of childhood leukemia.

Trend and spatial distribution of infectious diseases in pregnant women in the state of Paraná-Brazil

Objective

to analyze the trend and spatial distribution of some diseases that require compulsory notification in pregnant women.

Method

ecological study, with data from the National Notifiable Diseases Surveillance System, of the incidence of the six most frequent diseases that, require compulsory notification, in pregnant women. The Prais-Winsten model was used to analyze the trend classified as stable, decreasing and increasing, according to macro-regions. For the spatial analysis, the incidences distributed in percentiles, in choropleth maps, by Health Regions were calculated.

Results

the most frequent infections were syphilis, dengue, Human Immunodeficiency Virus, influenza, hepatitis and toxoplasmosis. Incidence increased by 30.8%, 30.4%, 15.4% and 2.6%, on average, for syphilis, toxoplasmosis, dengue and Human Immunodeficiency Virus, respectively. On average, the incidence of syphilis increased by 40.5% in Macro-regional North and 38% in Macro-regional Northwest. The spatial analysis showed, in the last four years, high incidence of dengue, syphilis and infection by Human Immunodeficiency Virus, which reached 180.2, 141.7 and 100.8 cases per 10,000 live births, respectively.

Conclusion

there were increased incidences of infection in pregnant women due to syphilis, toxoplasmosis and Human Immunodeficiency Virus, with differences in their spatial distribution, indicating that these diseases should be a priority in the care of pregnant women in more affected regions.

Infections and Risk of Peripartum Stroke During Delivery Admissions

BACKGROUND AND PURPOSE

Peripartum strokes during delivery admissions are rare but have high maternal morbidity. Infections have been proposed as a possible stroke trigger. We hypothesized that women who had infections diagnosed at the time of delivery admission would have higher risk of stroke during their delivery hospitalization.

METHODS

We conducted a case-control study using state inpatient administrative databases for California (2007-2011), Florida (2009-2011), and New York (2009-2011). Women whose admission included a vaginal or cesarean delivery, with a new diagnosis of stroke during the admission, were considered cases and were randomly matched to 3 in-state controls by age/admission year and presence and severity of hypertensive disorders of pregnancy. The primary exposure of interest was infection of any type present on admission. Secondary exposures included race/ethnicity, payer status, delivery method, and known vascular risk factors such as chronic hypertension, diabetes mellitus, smoking, alcohol abuse, hypercoagulable states, coagulopathies, and renal disease. We used multivariable conditional logistic regression to estimate the odds ratios and 95% confidence intervals for the association of infections and known vascular risk factors with stroke risk.

RESULTS

A total of 455 cases (mean age, 29.8), of whom 195 (42.9%) had hypertensive disorders of pregnancy, were matched with 1365 controls. Infection of any type present on admission increased the odds of stroke diagnosis during the admission (adjusted odds ratio, 1.74; 95% confidence interval, 1.29-2.35). Risk was higher for genitourinary infections (adjusted odds ratio, 2.56; 95% confidence interval, 1.25-5.24) and sepsis (adjusted odds ratio, 10.4; 95% confidence interval, 2.15-20.0). The association between infection and stroke during delivery admission did not differ by the presence of hypertensive disorders of pregnancy.

CONCLUSIONS

Infections present on admission increased stroke risk during delivery admissions in women with and without hypertensive disorders of pregnancy. The results were driven by genitourinary infections and sepsis. Infections may be an underrecognized precipitant of peripartum stroke.