Fever during pregnancy may harm offspring health, according to a study
published online February 24 in
Pediatrics.
Studies in several mammalian models have associated
first trimester exposure to elevated maternal temperature with damage
to the extra embryonic membranes, placenta, and
maternal–fetal circulation, resulting in growth retardation,
malformations,
and fetal demise, and in the longer-term, to impaired
cognitive function. The extent to which these experimental conditions
mimic human prenatal exposures was not clear.
One in 5 women reports fever during pregnancy, but few
investigations have systematically examined the outcomes on child
health.
Therefore, Julie Werenberg Dreier, MSPH, doctoral candidate
at the Institute of Public Health, University of Southern Denmark,
Esbjerg, and colleagues reviewed evidence from epidemiologic
studies to assess the relationship between fetal exposure to
maternal fever and health outcomes.
They reviewed 46 cohort or case-control investigations reported in PubMed, Web of Science, and the Cochrane Library that mentioned maternal fever in general populations during the first trimester or preconceptually. They also included some studies referenced within the initially examined ones.
The analysis revealed elevated risk for poor health outcomes among children exposed to maternal fever in utero for 3 common classes of problems: neural tube defects, congenital heart defects, and oral clefts. The researchers identified a 1.5- to nearly 3-fold increased risk with exposure during the first trimester for 9 case-control studies of neural tube defects, 5 case-control studies of oral clefts, and 7 fixed-effects meta analyses of congenital heart defects.
Neural tube defects had the strongest relationship to temperature exposure (odds ratio [OR] pooled, 2.90; 95% confidence interval [CI], 2.22 - 3.79) compared with oral clefts (OR pooled, 1.94; 95% CI, 1.35 - 2.79) and congenital heart defects (OR
Other outcomes included limb deficiencies, renal defects, anorectal malformation, ear defects, cataracts, and allergic diseases, but few studies were available. The analysis did not find an association between exposure to elevated maternal temperature in utero with spontaneous abortion, stillbirth, or preterm delivery.
Only some studies investigated correlations between magnitude of elevated temperature and outcomes; they did not find any. Some studies showed lowered risk with use of antipyretic medication.
The researchers conclude that they "found substantial evidence to support an adverse impact of maternal fever during pregnancy." They suggest that future studies be conducted prospectively, assess longer-term health outcomes, and consider timing, duration, and extent of fever.
Limitations of the study include the consideration of elevated maternal temperature and not the underlying cause of it (type of infection). The review might also reflect publication bias and heterogeneity among the considered studies (such as prospective vs retrospective).
They reviewed 46 cohort or case-control investigations reported in PubMed, Web of Science, and the Cochrane Library that mentioned maternal fever in general populations during the first trimester or preconceptually. They also included some studies referenced within the initially examined ones.
The analysis revealed elevated risk for poor health outcomes among children exposed to maternal fever in utero for 3 common classes of problems: neural tube defects, congenital heart defects, and oral clefts. The researchers identified a 1.5- to nearly 3-fold increased risk with exposure during the first trimester for 9 case-control studies of neural tube defects, 5 case-control studies of oral clefts, and 7 fixed-effects meta analyses of congenital heart defects.
Neural tube defects had the strongest relationship to temperature exposure (odds ratio [OR] pooled, 2.90; 95% confidence interval [CI], 2.22 - 3.79) compared with oral clefts (OR pooled, 1.94; 95% CI, 1.35 - 2.79) and congenital heart defects (OR
Other outcomes included limb deficiencies, renal defects, anorectal malformation, ear defects, cataracts, and allergic diseases, but few studies were available. The analysis did not find an association between exposure to elevated maternal temperature in utero with spontaneous abortion, stillbirth, or preterm delivery.
Only some studies investigated correlations between magnitude of elevated temperature and outcomes; they did not find any. Some studies showed lowered risk with use of antipyretic medication.
The researchers conclude that they "found substantial evidence to support an adverse impact of maternal fever during pregnancy." They suggest that future studies be conducted prospectively, assess longer-term health outcomes, and consider timing, duration, and extent of fever.
Limitations of the study include the consideration of elevated maternal temperature and not the underlying cause of it (type of infection). The review might also reflect publication bias and heterogeneity among the considered studies (such as prospective vs retrospective).
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