Multifactorial Colonization of the Pregnant Woman’s Reproductive Tract: Implications for Early Postnatal Adaptation in Full-Term Newborns
Abstract
:1. Introduction
1.1. Background
- Premature rupture of membranes (especially before 37 weeks of gestation),
- Drainage of amniotic fluid for more than 18 h,
- Maternal fever,
- Chorioamnionitis,
- Birth of a child with a history of GBS infection,
- Colonization of GBS during pregnancy, especially urinary tract infection,
- Maternal diabetes,
- Prematurity,
- Low birth weight.
1.2. Objectives
2. Methods
2.1. Study Design and Data Sources
2.2. Settings and Participants
2.3. Statistics Methods
3. Results
4. Discussion
5. Conclusions
- The number of pathogens colonizing the reproductive tract affects the early adaptation period in newborns.
- Polymicrobial colonization of the reproductive tract increases the incidence of acid–base balance disorders in newborns.
- Multifactorial colonization of the reproductive tract increases the number of infections in newborns. However, it does not affect the incidence of early-onset sepsis or pneumonia in full-term newborns.
6. Implications
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Witkowska, K.; Głowacka, M.; Słodki, M.; Wierzba, W.; Piórkowska, K. Intensifying transition states in newborns depending on the gender and mode of delivery—A prospective, comparative analysis. Med. Ogólna I Nauk. O Zdrowiu 2020, 26, 134–138. [Google Scholar] [CrossRef]
- Kumar, M.; Saadaoui, M.; Al Khodor, S. Infections and Pregnancy: Effects on Maternal and Child Health. Front. Cell. Infect. Microbiol. 2022, 12, 873253. [Google Scholar] [CrossRef] [PubMed]
- Megli, C.J.; Coyne, C.B. Infections at the maternal–fetal interface: An overview of pathogenesis and defence. Nat. Rev. Microbiol. 2022, 20, 67–82. [Google Scholar] [CrossRef]
- Yancey, M.K.; Duff, P.A. An analysis of cost-effectivenes of selected protocols for the prevention of neonatal group B streptococcal infection. Obstet. Gynecol. 1994, 83, 367–371. [Google Scholar] [PubMed]
- Verani, J.R.; McGee, L.; Schrag, S.J. Prevention of perinatal group B streptococcal disease—Revised guidelines from CDC. MMWR Recomm. Rep. 2010, 59, 1–36. [Google Scholar]
- O’Sullivan, C.P.; Lamagni, T.; Patel, D.; Efstratiou, A.; Cunney, R.; Meehan, M.; Ladhani, S.; Reynolds, A.J.; Campbell, R.; Doherty, L.; et al. Group B streptococcal disease in UK and Irish infants younger than 90 days, 2014–2015: A prospective surveillance study. Lancet Infect Dis. 2019, 19, 83–90. [Google Scholar] [CrossRef]
- Esper, F. Postnatal bacterial infections. In Fanaroff & Martin’s Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant, 11th ed.; Martin, R.J., Fanaroff, A.A., Walsh, M., Eds.; Elsevier Saunders: Philadelphia, PA, USA, 2020. [Google Scholar]
- Glaser, M.A.; Hughes, L.M.; Jnah, A.; Newberry, D. Neonatal Sepsis: A Review of Pathophysiology and Current Management Strategies. Adv. Neonatal. Care 2021, 21, 49–60. [Google Scholar] [CrossRef]
- Birhane Fiseha, S.; Mulatu Jara, G.; Azerefegn Woldetsadik, E.; Belayneh Bekele, F.; Mohammed Ali, M. Colonization Rate of Potential Neonatal Disease-Causing Bacteria, Associated Factors, and Antimicrobial Susceptibility Profile Among Pregnant Women Attending Government Hospitals in Hawassa, Ethiopia. Infect. Drug Resist. 2021, 14, 3159–3168. [Google Scholar] [CrossRef]
- Ohlsson, A.; Shah, V. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst. Rev. 2009, 3, CD007467. [Google Scholar]
- Payne, M.S.; Bayatibojakhi, S. Exploring preterm birth as a polymicrobial dis-ease: An overview of the uterine microbiome. Front. Immunol. 2014, 5, 595. [Google Scholar] [CrossRef] [PubMed]
- Brown, R.G.; Al-Memar, M.; Marchesi, J.R.; Lee, Y.S.; Smith, A.; Chan, D.; Lewis, H.; Kindinger, L.; Terzidou, V.; Bourne, T.; et al. Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes. Transl. Res. 2018, 207, 30–43. [Google Scholar] [CrossRef] [PubMed]
- Stinson, L.F.; Boyce, M.C.; Payne, M.S.; Keelan, J.A. The Not-so-Sterile Womb: Evidence That the Human Fetus Is Exposed to Bacteria Prior to Birth. Front. Microbiol. 2019, 10, 1124. [Google Scholar] [CrossRef] [PubMed]
- Mueller, N.T.; Bakacs, E.; Combellick, J.; Grigoryan, Z.; Dominguez-Bello, M.G. The infant microbiome development: Mom matters. Trends Mol. Med. 2015, 21, 109–117. [Google Scholar] [CrossRef] [PubMed]
- Chan, G.J.; Lee, A.C.; Baqui, A.H.; Tan, J.; Black, R.E. Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: A systematic review and meta-analysis. BMC Infect. Dis. 2015, 15, 118. [Google Scholar] [CrossRef] [PubMed]
- Qian, L.-L.; Liu, C.-Q.; Guo, Y.-X.; Jiang, Y.-J.; Ni, L.-M.; Xia, S.-W.; Liu, X.-H.; Zhuang, W.-Z.; Xiao, Z.-H.; Wang, S.-N.; et al. Chinese Collaborative Study Group for Neonatal Respiratory Diseases. Current status of neonatal acute respiratory disorders: A one-year prospective survey from a Chinese neonatal network. Chin. Med. J. 2010, 123, 2769–2775. [Google Scholar] [PubMed]
- Gizzi, C.; Klifa, R.; Pattumelli, M.G.; Massenzi, L.; Taveira, M.; Shankar-Aguilera, S.; De Luca, D. Continuous Positive Airway Pressure and the Burden of Care for Transient Tachypnea of the Neonate: Retrospective Cohort Study. Am. J. Perinatol. 2015, 32, 939–943. [Google Scholar] [CrossRef] [PubMed]
- Edwards, M.O.; Kotecha, S.J.; Kotecha, S. Respiratory distress of the term newborn infant. Paediatr. Respir Rev. 2013, 14, 29–36. [Google Scholar] [CrossRef] [PubMed]
- Alfarwati, T.W.; Alamri, A.A.; Alshahrani, M.A.; Al-Wassia, H. Incidence, Risk factors and Outcome of Respiratory Distress Syndrome in Term Infants at Academic Centre, Jeddah, Saudi Arabia. Med. Arch. 2019, 73, 183–186. [Google Scholar] [CrossRef] [PubMed]
- Consortium on Safe Labor; Hibbard, J.U.; Wilkins, I.; Sun, L.; Gregory, K.; Haberman, S.; Hoffman, M.; Kominiarek, M.A.; Reddy, U.; Bailit, J.; et al. Respiratory morbidity in late preterm births. JAMA 2010, 304, 419–425. [Google Scholar] [CrossRef] [PubMed]
- Frymoyer, A.; Joshi, N.S.; Allan, J.M.; Cohen, R.S.; Aby, J.L.; Kim, J.L.; Benitz, W.E.; Gupta, A. Sustainability of a Clinical Examination-Based Approach for Ascertainment of Early-Onset Sepsis in Late Preterm and Term Neonates. J. Pediatr. 2020, 225, 263–268. [Google Scholar] [CrossRef] [PubMed]
Variable | Group I (N = 637) | Group II (N = 186) | p | Effect Size |
---|---|---|---|---|
Mother’s age | 31.03 (SD ± 4.23) | 32.1 (SD ± 4.52) | 0.54 | 0.244 |
Gestational age (weeks) | 39.4 (SD ± 1.94) | 39.1 (SD ± 1.88) | 0.32 | 0.157 |
Pregnancy | 1.75 (SD ± 0.91) | 1.83 (SD ± 0.89) | 0.08 | 0.089 |
Parity | 1.59 (SD ± 0.80) | 1.45 (SD ± 0.68) | 0.77 | 0.189 |
BMI (kg/m2) | 27.1 (SD ± 3.45) | 26.7 (SD ± 2.88) | 0.63 | 0.126 |
Birth weight (g) | 3366 (SD ± 493) | 3402 (SD ± 456) | 0.37 | 0.076 |
Apgar score (1 min) | 8.83 (SD ± 0.57) | 8.33 (SD ± 1.03) | 0.20 | 0.601 |
Apgar score (3 min) | 9.78 (SD ± 0.77) | 9.79 (SD ± 0.92) | 0.83 | 0.012 |
Apgar score (5 min) | 9.37 (SD ± 0.54) | 9.23 (SD ± 0.72) | 0.44 | 0.220 |
Apgar score (10 min) | 9.63 (SD ± 0.80) | 9.67 (SD ± 0.74) | 0.94 | 0.052 |
Lp | Pathogen | Group I (N = 637) | Group II (N = 186) |
---|---|---|---|
1 | Candida albicans | 302 | 156 |
2 | Streptococcus agalactiae | 247 | 148 |
3 | Candida glabrata | 42 | 35 |
4 | Staphylococcus aureus MSSA | 29 | 26 |
5 | Candida tropicalis | 10 | 14 |
6 | Enterococcus faecalis | 2 | 3 |
7 | Trichomonas vaginalis | 1 | 0 |
8 | Klebsiella pneumoniae | 1 | 1 |
9 | Candida krusei | 1 | 1 |
10 | Escherichia coli | 1 | 18 |
11 | Staphylococcus aureus MRSA | 1 | 2 |
Variable | Group I (N = 637) | Group II (N = 186) | p | Effect Size |
---|---|---|---|---|
pH | 7.39 (SD ± 0.02) | 7.31 (SD ± 0.07) | 0.0001 | 1.554 |
BE (mEq/l) | −3.61 (SD ± 2.21) | −6.13 (SD ± 3.72) | 0.06 | 0.824 |
pO2 (mmHg) | 46.21 (SD ± 11.01) | 45.78 (SD ± 13.11) | 0.67 | 0.036 |
pCO2 (mmHg) | 36.75 (SD ± 8.61) | 36.66 (SD ± 7.11) | 0.88 | 0.011 |
HCO3−(mmol/L) | 23.22 (SD ± 2.64) | 19.17 (SD ± 3.23) | 0.0001 | 1.373 |
Saturation (%) | 83.44 (SD ± 6.91) | 78.91 (SD ± 13.1) | 0.03 | 0.433 |
CRP (mg/L) | 7.24 (SD ± 6.12) | 8.52 (SD ± 8.02) | 0.34 | 0.179 |
Procalcitonin (ng/mL) | 0.67 (SD ± 0.52) | 1.74 (SD ± 1.11) | 0.01 | 1.235 |
Bilirubin (mg/dL) | 7.92 (SD ± 3.67) | 8.92 (SD ± 4.05) | 0.03 | 0.259 |
WBC (tys/µL) | 12.51 (SD ± 4.35) | 19.57 (SD ± 7.48) | 0.0001 | 1.154 |
Granulocytes (%) | 54.67 (SD ± 11.39) | 56.42 (SD ± 9.76) | 0.15 | 0.165 |
Variable | Group I (N = 637) | Group II (N = 186) | p | Cramer’s V |
---|---|---|---|---|
Respiratory disorder syndrome | 31 | 85 | 0.001 | 0.491 |
CPAP | 21 | 63 | 0.001 | 0.422 |
Oxygen therapy | 8 | 15 | 0.02 | 0.173 |
Antibiotics | 8 | 13 | 0.01 | 0.152 |
Parenteral nutrition | 7 | 8 | 0.2 | 0.100 |
Jaundice | 122 | 98 | 0.04 | 0.317 |
Type of Infection | Group I (N= 8) | Group II (N = 13) | p | Cramer’s V |
---|---|---|---|---|
Pneumonia | 3 | 3 | 0.27 | 0.155 |
Urinary tract infection | 1 | 2 | 0.14 | 0.040 |
Infection of undetermined origin | 4 | 8 | 0.01 | 0.113 |
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Gibała, P.; Jarosz-Lesz, A.; Sołtysiak-Gibała, Z.; Staniczek, J.; Stojko, R. Multifactorial Colonization of the Pregnant Woman’s Reproductive Tract: Implications for Early Postnatal Adaptation in Full-Term Newborns. J. Clin. Med. 2023, 12, 6852. https://doi.org/10.3390/jcm12216852
Gibała P, Jarosz-Lesz A, Sołtysiak-Gibała Z, Staniczek J, Stojko R. Multifactorial Colonization of the Pregnant Woman’s Reproductive Tract: Implications for Early Postnatal Adaptation in Full-Term Newborns. Journal of Clinical Medicine. 2023; 12(21):6852. https://doi.org/10.3390/jcm12216852
Chicago/Turabian StyleGibała, Piotr, Anna Jarosz-Lesz, Zuzanna Sołtysiak-Gibała, Jakub Staniczek, and Rafał Stojko. 2023. "Multifactorial Colonization of the Pregnant Woman’s Reproductive Tract: Implications for Early Postnatal Adaptation in Full-Term Newborns" Journal of Clinical Medicine 12, no. 21: 6852. https://doi.org/10.3390/jcm12216852