The relation between pre-eclampsia at term and neonatal encephalopathy
- aDepartment of Obstetrics and Gynaecology, The Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK, bNational Maternity Hospital, Holles St, Dublin 2, Ireland, cNuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital
- Mr Impey, Level 4, The Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UKLawrence.Impey{at}orh.nhs.uk
- Accepted 21 June 2001
Abstract
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.
DESIGN Prospective cohort study.
SETTING A Dublin teaching hospital.
PARTICIPANTS 6163 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.
RESULTS Pre-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 (7.20v 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).
CONCLUSIONS The 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.
