The relation between pre-eclampsia at term and neonatal encephalopathy
L Impeya, C Greenwooda, O Sheilb, K MacQuillanb, M Reynoldsb, C Redmanc
a Department of
Obstetrics and Gynaecology, The Women's Centre, John Radcliffe
Hospital, Headley Way, Headington, Oxford OX3 9DU, UK, b National Maternity
Hospital, Holles St, Dublin 2, Ireland, c Nuffield
Department of Obstetrics and Gynaecology, University of Oxford, John
Radcliffe Hospital
Correspondence to: Mr Impey, Level 4, The Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK Lawrence.Impey{at}orh.nhs.uk
Accepted 21 June 2001
OBJECTIVES
To
determine whether pre-eclampsia, hypothesised to be an inflammatory
condition, is associated with fever in term labour, and confirm and
examine the reported association of pre-eclampsia at term with neonatal encephalopathy.
DESIGNProspective
cohort study.
SETTINGA Dublin
teaching hospital.
PARTICIPANTS6163
women in labour with singleton pregnancies at term at low risk for
intrapartum hypoxia, recruited to a randomised trial examining the
effect of admission cardiotocography on neonatal outcome.
RESULTSPre-eclampsia
was associated with maternal fever > 37.5° in labour (odds ratio
(OR) 3.39, 95% confidence interval (CI) 2.1 to 5.4); this was
independent of obstetric intervention (adjusted OR 2.07, 95% CI 1.24 to 3.47). Pre-eclampsia was associated with neonatal encephalopathy (OR
25.5, 95% CI 8.4 to 74.7); this too was independent of obstetric
intervention (adjusted OR 18.5, 95% CI 5.9 to 58.1). Cord arterial pH
values were significantly lower in pre-eclamptics (7.20 v 7.24), although severe cord acidaemia was
not significantly more common (OR 2.91, 95% CI 0.7 to 9.9). The
association of pre-eclampsia with encephalopathy was independent of
maternal fever (adjusted OR 16.5, 95% CI 5.1 to 54) and cord acidaemia
(adjusted OR 13.5, 95% CI 3.2 to 56.7).
CONCLUSIONSThe
association of pre-eclampsia with maternal fever at term supports the
hypothesis that pre-eclampsia is an inflammatory condition. The
association of pre-eclampsia with neonatal encephalopathy is
independent of obstetric intervention and cannot be explained by either
acidaemia or maternal fever. A systemic inflammatory response in the
fetus, perhaps secondary to oxidative stress, could explain the link
between maternal pre-eclampsia and neonatal encephalopathy, and this
may occur through cerebral vasoconstriction.
Keywords: pre-eclampsia; encephalopathy; fever; labour
© 2001 by Archives of Disease in Childhood
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