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The Relationship of Longitudinal Inflammatory and Oxidative Stress Biomarkers During Pregnancy and Labor Epidural Associated Temperature Elevation
Abstract Number: SAT-27
Abstract Type: Original Research
Labor epidural associated fever (LEAF) is the leading cause of non-infectious intrapartum fever. Although the associated risk factors overlap with intraamniotic infection, (1) LEAF appears to be independent and the consequence of an inflammatory reaction.(2-4) Differences in pro-inflammatory cytokines at the time of labor admission, specifically IL-6, have been identified in patients who go on to develop LEAF. (5) How and when cytokine profiles are altered is unknown; we hypothesized that such changes, as well as increased markers of oxidative stress, could be detected earlier in pregnancy.(6)
This study is a secondary analysis of prospectively collected data from a nested case control study that consisted of 130 women who delivered prior to 37 weeks and 352 randomly selected women who delivered at or after 37 weeks.(7) Maternal plasma and urine samples were obtained at 4 visits (median 9.7, 17.9, 26.0 and 35.1 weeks gestation). Multivariable logistic regression models were fit to assess the association between biomarker (IL-1b, IL-6, IL-10, TNF-a, CRP, 8-OHdG, 8-Isoprostane) levels and the development of clinical fever (≥38°C) or a temperature increase of ≥1°C above baseline during labor epidural analgesia. Appropriate exclusion criteria were used.
Patients who developed a fever were more likely to be younger and primiparous with longer labors, longer duration of membrane rupture and had more cervical exams. After controlling for maternal age, primiparity, length of epidural, number of cervical exams, we found no significant difference between individual biomarkers averaged over visits 1-3 and the risk of temperature elevation or clinical fever. During visit 4, a significant association with IL-1b (OR 0.64, 95% CI (0.44, 0.92) and associations approaching significance with IL-6 (OR 0.62, 95% CI (0.37, 1.01) and 8-Isoprostane (OR 0.67, 95% CI (0.45, 1.00) were found with temperature elevation. No significant associations were found for clinical fever (≥ 38°C) at visit 4.
Elevated levels of maternal plasma inflammatory biomarkers and markers of oxidative stress measured longitudinally throughout pregnancy do not appear to be associated with LEAF. In contrast, higher levels of maternal plasma inflammatory biomarkers appeared in adjusted models to be protective against LEAF. Although the nested case-control study was not designed to investigate our specific outcome, the absence of observed differences in early gestational inflammatory and oxidative stress markers may indicate that LEAF is the result of alterations in late pregnancy or during labor.
1.Obstet Gynecol 1995;86:790–4
2.Clinics in perinatology, 40(3), pp.385-398.
3.Journal of Perinatology, 35(6), pp.396-400.
4.Obstet Gynecol 2011;117:588–95.
5.American journal of obstetrics and gynecology 187.4 (2002): 834-838.
6.BioMed research international 2015 (2015).
7.American journal of reproductive immunology 72.3 (2014):