Am J Perinatol 2009; 26(9): 667-672
DOI: 10.1055/s-0029-1220792
© Thieme Medical Publishers

Maternal Genitourinary Infection and Small for Gestational Age

Joshua R. Mann1 , Suzanne McDermott1 , Anthony Gregg2 , Tariq Jamil Gill1
  • 1Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
  • 2Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, South Carolina
Further Information

Publication History

Publication Date:
18 May 2009 (online)

ABSTRACT

Children who are born small for gestational age (SGA) are at increased risk of adverse neurological outcomes, and there is limited evidence that maternal genitourinary (GU) infections may be associated with SGA. Our objective was to explore the possible relationship between maternal GU infection during pregnancy and SGA. We modeled the association between maternal GU infections and SGA using linked South Carolina Medicaid billing data and birth certificate records for 141,035 women and infants born from 1996 through 2002. Controlling for demographic covariates and maternal medical conditions, GU infection was not significantly associated with SGA (odds ratio = 1.03, p = 0.143). When categorizing GU infections by trimester, second-trimester infection had a statistically significant but weak association with SGA (odds ratio = 1.08, p = 0.005). Young and old maternal age, female sex, maternal alcohol and tobacco use, preeclampsia/eclampsia, and hypertension were significantly associated with increased risk of SGA. White race, maternal education, diabetes mellitus, and more recent year of birth were associated with lower risk. Maternal GU infection generally was not associated with SGA, though there may be an association for second-trimester infections only. Even this association was modest and may not be clinically significant.

REFERENCES

  • 1 Lundgren E M, Tuvemo T. Effects of being born small for gestational age on long-term intellectual performance.  Best Pract Res Clin Endocrinol Metab. 2008;  22 477-478
  • 2 Bhutta A T, Cleves M A, Casey P H, Cradock M M, Anand K J. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.  JAMA. 2002;  288 728-737
  • 3 Wood N S, Marlow N, Costeloe K, Gibson A T, Wilkinson A R. for the EPICure Study Group . Neurologic and developmental disability after extremely preterm birth.  N Engl J Med. 2000;  343 378-384
  • 4 Roussounis S H, Hubley P A, Dear P R. Five-year follow-up of very low birthweight infants: neurological and psychological outcome.  Child Care Health Dev. 1993;  19 45-59
  • 5 Hack M, Taylor H G, Klein N, Eiben R, Schatschneider C, Mercuri-Minich N. School-age outcomes in children with birth weights under 750 g.  N Engl J Med. 1994;  331 753-759
  • 6 Rosenberg A. The IUGR newborn.  Semin Perinatol. 2008;  32 219-224
  • 7 Walker D M, Marlow N. Neurocognitive outcome following fetal growth restriction.  Arch Dis Child Fetal Neonatal Ed. 2008;  93 F322-F325
  • 8 Strauss R S. Adult functional outcome of those born small for gestational age: twenty-six-year follow-up of the 1970 British Birth Cohort.  JAMA. 2000;  283 625-632
  • 9 Stein Z, Susser M, Rush D. Prenatal nutrition and birthweight: experiments and quasiexperiments in the past decade.  J Reprod Med. 1978;  21 287-299
  • 10 Macara L, Kingdom J C, Kaufmann P et al.. Structural analysis of placental terminal villi from growth-restricted pregnancies with abnormal umbilical artery Doppler wave forms.  Placenta. 1996;  17 37-48
  • 11 Klebanoff M A, Meirik O, Berendes H W. Second-generation consequences of small for dates birth.  Pediatrics. 1989;  84 343-347
  • 12 Lieberman E, Gremy I, Lang J M, Cohen A P. Low birthweight at term and the timing of fetal exposure to maternal smoking.  Am J Public Health. 1994;  84 1127-1131
  • 13 Das U G, Sysyn G D. Abnormal fetal growth: intrauterine growth retardation, small for gestational age, large for gestational age.  Pediatr Clin North Am. 2004;  51 639-654
  • 14 Maulik D. Fetal growth restriction: the etiology.  Clin Obstet Gynecol. 2006;  49 228-235
  • 15 Saenger P, Czernichow P, Hughes I, Reiter E O. Small for gestational age: short stature and beyond.  Endocr Rev. 2007;  28 219-251
  • 16 Henriksen T. The macrosomic fetus: a challenge in current obstetrics.  Acta Obstet Gynecol Scand. 2008;  87 134-145
  • 17 Romero R, Ozyarzum E, Mazur M et al.. Meta-analysis of the relationship between asymptomatic baceriuria and preterm delivery/low birth weight.  Obstet Gynecol. 1989;  73 576-582
  • 18 Mittendorf R, Williams M A, Kass E H. Prevention of preterm delivery and low birth weight associated with asymptomatic baceriuria.  Clin Infect Dis. 1992;  14 927-932
  • 19 Meis P J, Michielute R, Peters T H et al.. Factors associated with preterm birth in Cardiff, Wales: II. Indicated and spontaneous preterm birth.  Am J Obstet Gynecol. 1995;  173 597-602
  • 20 Klein L L, Gibbs R S. Use of microbial cultures and antibiotics in the prevention of infection-associated preterm birth.  Am J Obstet Gynecol. 2004;  190 1493-1502
  • 21 Blas M M, Canchihuaman F A, Alva I E, Hawes S E. Pregnancy outcomes in women infected with Chlamydia trachomatis: a population-based cohort study in Washington State.  Sex Transm Infect. 2007;  83 314-318
  • 22 Goldenberg R L, Culhane J F, Diams J, Romero R. Epidemiology and causes of preterm birth.  Lancet. 2008;  371 75-84
  • 23 Goldenberg R L, Hauth J C, Andrews W W. Intrauterine infection and preterm delivery.  N Engl J Med. 2000;  342 1500-1507
  • 24 Association of Chlamydia trachomatis and Mycoplasma hominis with intrauterine growth retardation and preterm delivery. The John Hopkins Study of Cervicitis and Adverse Pregnancy Outcome.  Am J Epidemiol. 1989;  129 1247-1257
  • 25 Germain M, Krohn M A, Hillier S L, Eschenbach D A. Genital flora in pregnancy and its association with intrauterine growth retardation.  J Clin Microbiol. 1994;  32 2162-2168
  • 26 Cunningham F G, Leveno K L, Bloom S L, Hauth J C, Gilstrap III L C, Wenstrom K D. Chapter 38. Fetal growth disorders. In: Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC III, Wenstrom KD Williams Obstetrics, 22nd Ed. New York; McGraw Hill 2005
  • 27 Rahimian J, Varner M W. Disproportionate fetal growth. In: De Cherney AH, Nathan L CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10th Ed. New York; McGraw Hill 2007
  • 28 Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;  87 163-168
  • 29 Gonçalves L F, Chaiworapongsa T, Romero R. Intrauterine infection and prematurity.  Ment Retard Dev Disabil Res Rev. 2002;  8 3-13

Joshua R MannM.D. M.P.H. 

Department of Family and Preventive Medicine, University of South Carolina School of Medicine

3209 Colonial Drive, Columbia, SC 29203

Email: joshua.mann@uscmed.sc.edu