Umbilical Cord and Maternal Oxidative Stress and Inflammatory Cytokine Levels in Intrapartum Maternal Fever

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

1-29-2021

DOI

10.1016/j.ajog.2020.12.554

Journal Title

American Journal of Obstetrics and Gynecology

Department

Obstetrics and Gynecology

Abstract

Objective

The objective of this study was to compare intrapartum maternal and umbilical cord serum levels of oxidative stress (Glutathione ratio), RANTES, IFN-γ, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, and TNF-α between nonfebrile patients, febrile patients without clinical chorioamnionitis (CC), and febrile patient with CC.

Study Design

We recruited 30 nonfebrile patients (≥36weeks) in active labor and collected maternal intrapartum and umbilical cord samples to evaluate for oxidative stress and cytokine levels. Placentas were collected for pathological review. These results were compared to 121 patients ( ≥36weeks) who developed a fever of >100.4º F in active labor; they were further divided to 46 patients with CC and 75 patients without CC. A p value of <0.05 was considered statistically significant.

Results

Patient demographics including age, BMI, and epidural use were similar between groups. Compared to nonfebrile patients, cord levels of Glutathione ratio, IFN-γ, IL-1ß, IL-6, IL-8, RANTES, and TNF-α were similarly elevated in the presence of maternal hyperthermia regardless of the diagnosis of CC (Table 1). IL-6 cord level was the only cytokine that was significantly elevated in febrile patients with CC compared to febrile patients without CC. When comparing maternal serum, we found significant elevation in glutathione ratio, IL-10, RANTES, TNF-γ levels in the febrile group regardless of the presence of CC compared to the nonfebrile group (Table 2). Only one of the 30 non-febrile patients had histological chorioamnionitis. Additionally, histological chorioamnionitis was found in 28.4% of febrile patients without CC and 67.4% with CC while funisitis was detected in 4.1% and 15.2%, respectively.

Conclusion

Maternal hyperthermia, even in the absence of CC, induced elevations in fetal oxidative stress and proinflammatory cytokines. IL-6 cord level was the only cytokine that was significantly elevated between febrile patients with and without CC. In the setting of intrapartum fever, maternal intrapartum cytokines were similar irrespective of the diagnosis of CC.

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