Celeste A Green1, Daniel Westreich2, Matthew M Laughon3, David M Stamilio4, Robert A Strauss1, Jeff Reese5, Elaine L Shelton5, Kartik K Venkatesh6. 1. Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA. 2. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA. 3. Division of Neonatal Perinatal Medicine, Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA. 4. Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC, USA. 5. Department of Pediatrics, Vanderbilt University, Nashville, TN, USA. 6. Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA. kartik.venkatesh@osumc.edu.
Abstract
OBJECTIVE: To estimate the effect of clinical chorioamnionitis on the risk of patent ductus arteriosus (PDA). STUDY DESIGN: A secondary analysis of all deliveries >23 gestational weeks from the U.S. Consortium on Safe Labor (CSL) study. The primary exposure was a clinical diagnosis of chorioamnionitis, and the outcome was a diagnosis of PDA. Generalized estimating equations with estimated error variance for women with multiple deliveries were utilized. Models adjusted for age, race, region, delivery year, body mass index, infant sex, multiple gestation, mode of delivery, and antenatal corticosteroid exposure. RESULTS: Among 228,438 deliveries, a diagnosis of PDA was more frequent with chorioamnionitis exposure versus without (9.2% vs. 3.0%; OR: 3.25; 95% CI: 2.92-3.62). Chorioamnionitis was associated with higher adjusted odds of PDA (AOR: 2.18; 95% CI: 1.93-2.45). In sensitivity analyses, the association between chorioamnionitis and PDA held after adjustment for gestational age at delivery (AOR: 1.28; 95% CI: 1.13-1.44). CONCLUSIONS: Chorioamnionitis was associated with increased odds of PDA. Robust exposure and outcome ascertainment with careful assessment of confounding is needed to further investigate this epidemiologic association.
OBJECTIVE: To estimate the effect of clinical chorioamnionitis on the risk of patent ductus arteriosus (PDA). STUDY DESIGN: A secondary analysis of all deliveries >23 gestational weeks from the U.S. Consortium on Safe Labor (CSL) study. The primary exposure was a clinical diagnosis of chorioamnionitis, and the outcome was a diagnosis of PDA. Generalized estimating equations with estimated error variance for women with multiple deliveries were utilized. Models adjusted for age, race, region, delivery year, body mass index, infant sex, multiple gestation, mode of delivery, and antenatal corticosteroid exposure. RESULTS: Among 228,438 deliveries, a diagnosis of PDA was more frequent with chorioamnionitis exposure versus without (9.2% vs. 3.0%; OR: 3.25; 95% CI: 2.92-3.62). Chorioamnionitis was associated with higher adjusted odds of PDA (AOR: 2.18; 95% CI: 1.93-2.45). In sensitivity analyses, the association between chorioamnionitis and PDA held after adjustment for gestational age at delivery (AOR: 1.28; 95% CI: 1.13-1.44). CONCLUSIONS: Chorioamnionitis was associated with increased odds of PDA. Robust exposure and outcome ascertainment with careful assessment of confounding is needed to further investigate this epidemiologic association.
Authors: Jun Zhang; James Troendle; Uma M Reddy; S Katherine Laughon; D Ware Branch; Ronald Burkman; Helain J Landy; Judith U Hibbard; Shoshana Haberman; Mildred M Ramirez; Jennifer L Bailit; Matthew K Hoffman; Kimberly D Gregory; Victor H Gonzalez-Quintero; Michelle Kominiarek; Lee A Learman; Christos G Hatjis; Paul van Veldhuisen Journal: Am J Obstet Gynecol Date: 2010-08-12 Impact factor: 8.661