Meconium‐stained amniotic fluid exposure is associated with a lower incidence of offspring long‐term infectious morbidity

Abstract

Objective Meconium‐stained amniotic fluid (MSAF) is a well‐established risk factor for immediate adverse neonatal outcomes and was recently suggested to be associated with microbial invasion of the amniotic cavity. We aimed to determine whether MSAF exposure during labor carries a longer lasting impact on pediatric infectious morbidity. Study design A population‐based cohort analysis was performed including all singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Exposure was defined as the presence of MSAF during labor. Hospitalizations of the offspring up to the age of 18 years involving infectious diseases were evaluated. A Kaplan‐Meier survival curve was used to compare cumulative morbidity and a Cox regression model to control for confounders. Results During the study period, 243 725 deliveries met the inclusion criteria. Of them, 35 897 (14.7%) involved MSAF. Rate of infectious‐related hospitalizations of the offspring was significantly lower in children exposed to MSAF as compared with the unexposed group (10.8% vs 11.1%, P < 0.05). Specifically, hospitalizations involving respiratory infections were significantly less common among the MSAF group (5.1% vs 5.6%, P < 0.001). The survival curve demonstrated significantly lower cumulative total infectious morbidity rates in the MSAF‐exposed group (log rank P < 0.001). In the Cox model, controlled for maternal age, diabetes, hypertension, mode of delivery, and gestational age, exposed children exhibited lower rates of long‐term childhood infectious morbidity (adjusted HR 0.96, 95% CI 0.92‐0.99, P < 0.001). Conclusion Fetal exposure to MSAF during labor and delivery appears to be associated with lower rates of long‐term infectious‐related hospitalizations in the offspring.

Maternal hepatitis B or C status and the long‐term risk of gastrointestinal morbidity for offspring: A population‐based cohort study

“…The simple theory of microorganism contamination leading to GE has been recently transformed. Recent studies have shown that GE develops as a result of a combination of complex interactions between the individual's genetic background, alterations in the composition of the intestinal microbiota, a dysregulated innate and adaptive immune system, environmental factors and microorganism contamination …”

Outcomes of endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid: a systematic review and meta-analysis

“…Meconium-stained amniotic fluid (MSAF) is a condition in which infants have passed meconium in amniotic fluid. The incidence of MSAF is generally about 5%-20% of all births [1][2][3] and increases with advanced gestational age. 4 5 MSAF can be a sign of fetal maturity or of a pathological condition, such as an infant with hypoxia.…”

Perinatal Outcome and Long-Term Infectious Morbidity of Offspring Born to Women with Known Tuberculosis

“…Previous studies associated maternal inflammatory statuses with offspring with long-term alterations of immune responses that result in childhood infectious morbidity. These maternal conditions were pure infectious diseases [19,30,31], but were also attributed to conditions such as obesity and smoking that may involve maternal subclinical inflammation [20,21,[32][33][34]. This association between intrauterine inflammation and childhood morbidity, however, showed mixed trends in different studies.…”

“…Melville et al demonstrated that infants exposed to intrauterine inflammation show increased immune maturation and require less intensive and respiratory care after birth [20]. Likewise, exposure to meconium-stained amniotic fluid was associated with lower incidence of long-term infectious morbidity of the offspring [21]. In contrast, other studies showed increased risk of short and long-term infectious morbidity in children born to mothers with an augmented inflammatory state during pregnancy.…”

“…The association between infectious processes (chorioamnionitis, neonatal sepsis) and meconium-stained amniotic fluid has raised a question regarding the presence of bacterial content in the meconium [19]. Nevertheless, some studies demonstrated lower rates of long-term infectious morbidity in offspring exposed to meconium-stained amniotic fluid and other intra-uterine inflammatory conditions [20,21].…”