Download PDF
Am J Perinatol 2015; 32(03): 283-288
DOI: 10.1055/s-0034-1384638
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Antepartum Anemia on the Development of Chorioamnionitis at Term

Karen Archabald
1   Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
,
Vrishali Lopes
2   Division of Research, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
,
Brenna Anderson
3   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
› Author Affiliations
Further Information

Publication History

15 September 2013

01 June 2014

Publication Date:
31 July 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Objective The aim of this study is to assess the association of antepartum anemia with chorioamnionitis at term.

Study Design This is a case control study of women with and without chorioamnionitis who delivered following spontaneous or induced labor at ≥ 37 weeks' gestation. Cases had both intrapartum fever ≥ 38°C and histologic chorioamnionitis. Controls were afebrile and matched by physician practice group. Anemia was defined by CDC guidelines as hemoglobin < 10.5 g/dL (second trimester) or < 11.0 g/dL (third trimester).

Results A total of 101 cases and 197 controls were identified. The prevalence of anemia at the second and third trimester complete blood count (CBC) was significantly higher in the chorioamnionitis group (p = 0.02). This association persisted after multiple logistic regression controlling for known clinical risk factors (adjusted odds ratios, 2.47; range, 1.24–4.94).

Conclusion Anemia at the time of the second and third trimester CBC was more prevalent among women who developed chorioamnionitis at term. Antepartum anemia may be a modifiable risk factor in the prevention of chorioamnionitis at term.

Keywords

anemia - chorioamnionitis - term - infection
 

  • References

  • 1 Alexander JM, McIntire DM, Leveno KJ. Chorioamnionitis and the prognosis for term infants. Obstet Gynecol 1999; 94 (2) 274-278
    CrossrefPubMedGoogle Scholar
  • 2 Bailit JL, Gregory KD, Reddy UM , et al. Maternal and neonatal outcomes by labor onset type and gestational age. Am J Obstet Gynecol 2010; 202 (3) e1 , e12
    PubMedGoogle Scholar
  • 3 Newton E. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol 1993; 36 (4) 795-808
    CrossrefPubMedGoogle Scholar
  • 4 Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB. Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA 2003; 290 (20) 2677-2684
    CrossrefPubMedGoogle Scholar
  • 5 Wu YW, Colford Jr JM. Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis. JAMA 2000; 284 (11) 1417-1424
    CrossrefPubMedGoogle Scholar
  • 6 Grether JK, Cummins SK, Nelson KB. The california cerebral palsy project. Paediatr Perinat Epidemiol 1992; 6 (3) 339-351
    CrossrefPubMedGoogle Scholar
  • 7 Mark S, Groughan-Minihane M, Kilpatrick S. Chorioamnionitis and uterine function. Obstet Gynecol 2000; 95 (6) 909-912
    CrossrefPubMedGoogle Scholar
  • 8 Rouse DJ, Landon M, Leveno KJ , et al; National Institute of Child Health And Human Development, Maternal-Fetal Medicine Units Network. The Maternal-Fetal Medicine Units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes. Am J Obstet Gynecol 2004; 191 (1) 211-216
    CrossrefPubMedGoogle Scholar
  • 9 Newton ER. Preterm labor, preterm premature rupture of membranes, and chorioamnionitis. Clin Perinatol 2005; 32 (3) 571-600
    CrossrefPubMedGoogle Scholar
  • 10 Tran SH, Cheng YW, Kaimal AJ, Caughey AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol 2008; 198 (6) e1-e5
    PubMedGoogle Scholar
  • 11 Seaward PG, Hannah ME, Myhr TL , et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol 1997; 177 (5) 1024-1029
    CrossrefPubMedGoogle Scholar
  • 12 Stürchler D, Menegoz F, Daling J. Reproductive history and intrapartum fever. Gynecol Obstet Invest 1986; 21 (4) 182-186
    CrossrefPubMedGoogle Scholar
  • 13 Fiscella K. Race, perinatal outcome, and amniotic infection. Obstet Gynecol Surv 1996; 51 (1) 60-66
    CrossrefPubMedGoogle Scholar
  • 14 Centers for Disease Control. Pregnancy and pediatric surveillance system. 2011. Table 2-D. Available at: http://www.cdc.gov/pednss/pnss_tables/pdf/national_table2.pdf . Accessed October 9, 2013
    PubMedGoogle Scholar
  • 15 Rasmussen K. Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality?. J Nutr 2001; 131 (2S-2): 590S-601S , discussion 601S–603S
    PubMedGoogle Scholar
  • 16 Scholl TO, Hediger ML. Anemia and iron-deficiency anemia: compilation of data on pregnancy outcome. Am J Clin Nutr 1994; 59 (2, Suppl): 492S-500S , discussion 500S–501S
    PubMedGoogle Scholar
  • 17 Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr 1992; 55 (5) 985-988
    CrossrefPubMedGoogle Scholar
  • 18 Aly H, Alhabashi G, Hammad TA, Owusu-Ansah S, Bathgate S, Mohamed M. ABO phenotype and other risk factors associated with chorioamnionitis. J Pediatr 2008; 153 (1) 16-18
    CrossrefPubMedGoogle Scholar
  • 19 Allen LH. Biological mechanisms that might underlie iron's effects on fetal growth and preterm birth. J Nutr 2001; 131 (2S-2): 581S-589S
    PubMedGoogle Scholar
  • 20 Oppenheimer SJ. Iron and its relation to immunity and infectious disease. J Nutr 2001; 131 (2S-2): 616S-633S , discussion 633S–635S
    CrossrefPubMedGoogle Scholar
  • 21 Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr 2000; 72 (1, Suppl): 257S-264S
    CrossrefPubMedGoogle Scholar
  • 22 Casanueva E, Pfeffer F, Drijanski A, Fernández-Gaxiola AC, Gutiérrez-Valenzuela V, Rothenberg SJ. Iron and folate status before pregnancy and anemia during pregnancy. Ann Nutr Metab 2003; 47 (2) 60-63
    CrossrefPubMedGoogle Scholar
  • 23 Smulian JC, Shen-Schwarz S, Vintzileos AM, Lake MF, Ananth CV. Clinical chorioamnionitis and histologic placental inflammation. Obstet Gynecol 1999; 94 (6) 1000-1005
    CrossrefPubMedGoogle Scholar
  • 24 Heller DS, Rimpel LH, Skurnick JH. Does histologic chorioamnionitis correspond to clinical chorioamnionitis?. J Reprod Med 2008; 53 (1) 25-28
    PubMedGoogle Scholar
  • 25 Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep 1998; 47 (RR-3) 1-29
    PubMedGoogle Scholar
  • 26 Redline RW. Severe fetal placental vascular lesions in term infants with neurologic impairment. Am J Obstet Gynecol 2005; 192 (2) 452-457
    CrossrefPubMedGoogle Scholar
  • 27 Scanlon KS, Yip R, Schieve LA, Cogswell ME. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol 2000; 96 (5 Pt 1) 741-748
    CrossrefPubMedGoogle Scholar
  • 28 Ren A, Wang J, Ye RW, Li S, Liu JM, Li Z. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. Int J Gynaecol Obstet 2007; 98 (2) 124-128
    CrossrefPubMedGoogle Scholar
  • 29 Zhang Q, Ananth CV, Li Z, Smulian JC. Maternal anaemia and preterm birth: a prospective cohort study. Int J Epidemiol 2009; 38 (5) 1380-1389
    CrossrefPubMedGoogle Scholar
  • 30 Xiong X, Buekens P, Alexander S, Demianczuk N, Wollast E. Anemia during pregnancy and birth outcome: a meta-analysis. Am J Perinatol 2000; 17 (3) 137-146
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 95: Anemia in pregnancy. Obstet Gynecol 2008; 112 (1) 201-207
    CrossrefPubMedGoogle Scholar
  • 32 Reveiz L, Gyte GM, Cuervo LG, Casasbuenas A. Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database Syst Rev 2011; (10) CD003094-CD003094
    PubMedGoogle Scholar