Journal Article

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

McElrath, Thomas F., Tsen, Lawrence C., Napoli, Olivia J., Bellavia, Andrea, Arce, Dominique Y., Meeker, John D., Cantonwine, David E., James-Todd, Tamarra

2019

Overview

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

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Analgesia / Analgesia, Epidural - adverse effects / Analgesia, Obstetrical - adverse effects / Anesthesiology / Biological markers / Biology and Life Sciences / Biomarkers / Biomarkers - blood / Blood / C-reactive protein / Childbirth & labor / Cohort Studies / Colonization / Cytokines / Delivery (Childbirth) / Development and progression / Environmental health / Enzymes / Female / Fever / Fever - blood / Fever - etiology / Gene expression / Gynecology / Health aspects / Hospitals / Humans / IL-1β / Immunology / Inflammation / Inflammation Mediators - blood / Interleukin 10 / Interleukin 6 / Interleukins / Labor / Leaves / Leukocytes / Logistic Models / Longitudinal Studies / Medical records / Medical schools / Medicine / Medicine and Health Sciences / Membranes / Multivariate Analysis / Necrosis / Obstetric Labor Complications - blood / Obstetric Labor Complications - etiology / Obstetrics / Pain perception / Physiology / Pregnancy / Pregnant women / Premature birth / Premature infants / Prospective Studies / Public health / Regression analysis / Regression models / Risk Factors / Secondary analysis / Studies / Temperature / Tumor necrosis factor / Tumor necrosis factor-TNF / Tumor necrosis factor-α / Tumors / Urine / White blood cell count / Womens health / Young Adult