Delayed prenatal care, maternal smoking lead to perinatal complications in preterm infants

Infants of mothers who smoke and who delay the initiation of prenatal care have an increased risk of developing perinatal complications.
Infants of mothers who smoke and who delay the initiation of prenatal care have an increased risk of developing perinatal complications.

SAN ANTONIO—Infants who are at an increased gestational age when their mothers initiate prenatal care have dysregulated blood cortisol levels and an increased risk of developing necrotizing enterocolitis, researchers reported at the 2016 annual meeting of the American Academy of PAs (AAPA).

In addition, infants of mothers who smoke more than 10 cigarettes per day have lower salivary cortisol levels and an increased risk of intraventricular hemorrhage, according to Tamara R. Dietze, PA-S, from the University of Nebraska Medical Center in Omaha, and colleagues.

The researchers sought to compare maternal social variables and prenatal care and examined their association with cortisol levels on the first day of life and the development of complications of prematurity in the preterm infant.

The study authors recruited a convenience sample of very preterm infants from a level III neonatal intensive-care unit in a Midwestern U.S. tertiary medical center. All participants were younger than 32 weeks gestational age at birth, and those with major congenital anomalies were excluded. A total of 31 infants were enrolled, and the study was completed with 30 infants.

The investigators measured cortisol levels in cord blood and saliva collected within 24 hours after birth to represent physiologic stress response.  They also obtained data from the infant's medical records, which included a diagnosis of any of the four most common complications of prematurity—necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, or retinopathy of prematurity—by discharge, as well as maternal variables such as marital status, employment status, insurance coverage, smoking habits, and gestational age at the initial prenatal visit.

“The association between maternal social variables, HPA [hypothalamic-pituitary adrenal] axis dysregulation, and increased risk of developing certain complications of prematurity supports the model of physiologic dysregulation and allostatic load as a mechanism for complications in the preterm infant population,” concluded Ms. Dietze's group.

Reference

Dietze TR, Rose, FF, Moore TA. Maternal variables associated with physiologic stress and perinatal complications in preterm infants. ePoster presented at: 2016 meeting of the American Academy of PAs; May 14-18, 2016; San Antonio, TX. 

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