Consequences of sepsis in pregnancy and other infections

Serious infections during pregnancy may have direct implications in terms of complications that can arise during childbirth. This can be inferred from a recent study carried out by investigators at the University of San Francisco, USA.

The researchers investigated pregnant women who had been hospitalised with sepsis prior to giving birth. They found that these women faced an increased incidence of caesarean delivery, postpartum haemorrhage and preterm delivery during childbirth¹.

Sepsis is a major threat to pregnant women

Sepsis is the second highest cause of maternal mortality in the US according to the CDC². However, this study is the first time that an attempt has been made to quantify the consequential downstream risk of serious infections to pregnant women.

Professor Stephanie Gaw, Senior Author of the paper that appeared in JAMA Network Open said, “If pregnant women were admitted for severe infection, even after they’re discharged and they recover from that infection, there was an increased risk of complications related to pregnancy that are associated with core placental dysfunction.”

Timing of infection

The team also found that the timing of infection impacts outcomes for mother and baby:

• Patients with sepsis before delivery were twice as likely to have placental dysfunction compared to pregnant patients without sepsis
• Early infection (< 24 weeks of gestation) was associated with the greatest risk of placental dysfunction, maternal hypertensive disorder, and newborns who were undersized.

Professor Gaw believes the findings are an important reflection of the potential long-term consequences of any serious acute infection during pregnancy.

She said, “Even after you’ve recovered from COVID, or any other infection, there may be downstream consequences that we should pay attention to. Having a baby that was small for gestational age was more common if you had sepsis during pregnancy than if you didn’t, even after controlling for other risk factors. One thing that could be changed in current prenatal care practice would be to add another ultrasound to monitor the baby’s growth. In the third trimester, that was not routinely done for all of these patients and isn’t routinely done in clinical practice right now.”

Pregnant sepsis patients should receive increased surveillance

She thinks that women with septic infections during pregnancy should receive increased surveillance for the remainder of their pregnancy.

The study observed 14,565 patients who delivered babies at University California San Francisco Medical Center over a six-year period from 2012 to 2018. In the sepsis group (59 patients), the most common infections were urinary tract infections (41%) and respiratory infections (37%).

In a subgroup analysis, earlier gestational age at the time of infection (< 24 weeks) was associated with higher odds of placental dysfunction (46% of patients), hypertensive disorders of pregnancy (31% of patients) and undersize neonates (23%).

All in all, after adjusting the sepsis group and non-sepsis for confounders, the study found patients in the sepsis group to have a twofold higher odds of perinatal complications. The team hopes the study will lead to more research about the mother’s response to infection in pregnancy and treatments to improve outcomes for mother and baby.

Professor Gaw concluded, “We need more data to identify potential interventions, whether a woman gets malaria, COVID, or another type of infection to slow the inflammatory process, so that these long term, permanent changes to the placenta don’t happen.”