(1002) Exposure to maternal vaginal flora during labor and long-term infectious morbidity of the offspring

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Cesarean deliveries (CD) have been associated with an increased risk for offspring long-term infectious morbidity, as suboptimal exposure to maternal vaginal microbiome alters offspring immunologic milieu. We hypothesized that children who had varying exposure level to vaginal microbiome during labor, would differ in their long-term infectious morbidity.

Study Design: A population-based cohort analysis comparing long-term infectious morbidity of children according to mode of delivery and CD indication. We compared children born via CD for non-progressive labor in the first (NPL1), second stage (NPL2) and elective CD (pre-labor) with children born vaginally (VD) as a reference group. Offspring hospitalizations up to 18 years involving infectious morbidities were evaluated. A Kaplan-Meier survival curve was used to compare cumulative hospitalization incidence between groups and a Cox model was used to control for confounders.

Results: 348,332 deliveries were included; 89.2% were VD, 1.4% were CD for NPL1, 0.6% for NPL2 and 8.8% born in an elective CD. Total infectious-related hospitalization rates were significantly higher in children born via CD for NPL1 and in elective CD (26.2% for both vs. 24.3% for NPL2, and 23.8% in VD, p</em> < 0.001). The Kaplan-Meier survival curve demonstrated higher cumulative incidence of infectious-related hospitalizations with a dose-response effect (with relation to exposure to vaginal flora) noted between VD, NPL2, NPL1 and elective CD with the highest incidence (log rank p < 0.001, Figure). In the Cox regression model, controlled for maternal and gestational age, elective CD and NPL1 were associated with an increased risk for offspring long-term infectious morbidity (aHR 1.14 and aHR 1.09, respectively), while NPL2 CD did not differ in risk for the offspring (Table).

Conclusion: The risk for long-term infectious morbidity is increased for offspring with lower exposure to vaginal microbiome (elective CD or NPL1), as compared with NPL2 and VD offspring. The fetal exposure to vaginal microbiome during the second stage of labor may provide immunological benefit to the offspring.

Primary & Presenting Author(s)

Gil Gutvirtz, MD
Soroka University Medical Center
Metar, HaDarom, Israel

Coauthor(s)

Tamar Wainstock, PhD (she/her/hers)
Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev
Beer Sheva, HaDarom, Israel, Israel

Eyal Sheiner, MD,PhD
Head of department of Obstetrics and Gynecology B, Soroka University Medical Center
Soroka Medical Center
Omer, HaDarom, Israel