Chorioamnionitis and risk of long term neurodevelopmental impairment in offspring

American Journal of Obstetrics and Gynecology, 2022 chorioamnionitis is a common complication of pregnancy with approximately 1-3% of pregnancies with intact membranes and 6-10% of those with preterm rupture of membranes. It is associated with potentially serious adverse maternal,fetal,and neonatal outcomes,as well as increased long-term risks of cerebral palsy (CP) and other neuro-developmental disabilities.

This is A retrospective population-based cohort study in Sweden, where researchers examined the link between chorioamnionitis and neurodevelopmental disorders in a total of 22,28,280 singleton live births and stillbirths during a 12-year period. A total of 4,752 (0.21%) cases of CP, 17,897 37 (0.80 %) of epilepsy, 50,570 (2.27 %) of autism, 1,14,087 (5.12%) of attention deficit hyperactivity disorder and 14,574 (0.65%) of intellectual disability.

In the study time, 5,770 (0.26%) offspring were exposed to chorioamnionitis during pregnancy. After adjusting for potential confounders, exposure to chorioamnionitis increased the hazard ratios of all types of neurodevelopmental disorders except for epilepsy in offspring. However, this study raises some important issues which should be addressed.

Theauthors concluded that the associations were mainly mediated through preterm delivery, and increased risk was also observed among term infants, their study lacked some important information.

Amongthe 93 cases of CP with chorioamnionitis, how many were in those of preterm and term deliveries, respectively?

similarly, the question about the 4659 cases of CP without chorioamnionitis is the same. They expected that in both chorioamnionitis and non chorioamnionitis groups, the rate of CP in preterm infants would be remarkably higher than that in term infants, since preterm infants are more likely to develop CP and other adverse outcomes including abnormalities in cognition, language development, and behavior.

It will also be interesting to know whether the above rates are significantly different between the two groups (chorioamnionitis and non chorioamnionitis). In addition to preterm delivery, especially extremely preterm delivery, inflammatory substances induced by fetal infection/inflammation can cause cerebral ischemia and damage, ultimately leading to adverse neurodevelopmental consequences. Although efforts for timely identification and appropriate interventions to treat infections during pregnancy might have benefits in reducing the burden of neurological complications in offspring at the individual level, the efficacy is unclear as chorioamnionitis can only be cured by delivery of the infected products of conception.