Pneumonia as a complication of pregnancy

OBJECTIVE: Previous reports on the effect of pneumonia on pregnancy have been limited by small numbers of study subjects and lack of control groups for comparison. As a result, there is no clear consensus regarding the effects of pneumonia on pregnancy outcome. The purpose of this retrospective, case-control study was to review the maternal and perinatal outcome of 53 women diagnosed with antepartum pneumonia. STUDY DESIGN: Between January 1, 1988 and December 31, 1995, there were 27,772 women who delivered at the University of South Alabama Medical Center and 53 (1.9 per 1000) of these women had pneumonia in the antepartum period. A diagnosis of pneumonia was made in women with lower respiratory tract symptoms, no other source of infection, radiographie findings consistent with pneumonia, and at least two of the following criteria: oral temperature 38° C; white blood cell count 15,000/ml; productive cough, and/or positive sputum cultures. The control group consisted of 106 mothers who delivered immediately before and after the index study subject. Outcome variables analyzed included maternal demographic characteristics, anemia (hematocrit 25%), tobacco and substance abuse, chronic lung disease (i.e., asthma, tuberculosis), and perinatal outcome. Data were analyzed using the t-test and x an(l a p-value < .05 was considered significant. RESULTS: Five (9.4%) women in the study group required intubation and ventilator}' support and there was one maternal death (mortality rate of 1887/100,000). There was no significant difference between the study and control groups in maternal age, race, or proportion of primiparous patients. Significantly more women in the study group had anemia [10(18.9% ) vs. 2 (1.9%), x2 = IS.2, p < .001]. Mothers in the study group were more likely to receive an intravenous tocolytic agent [13 (24.5%) vs. 5 (4.7%), x = 16.2, p < .001] and betamethasone to enhance fetal lung maturity [10 (18.9%) vs. 3 (2.8%), x2 = 28.1, p < .001] than women in the control group. When compared to the control group, women in the study group delivered at an earlier gestational age [36.0 ±4.4 wk vs. 38.0 ±3.4 wk, t = -3.0, p = .003] and had infants who weighed significantly less [2768 ± 930gvs. 3163 ±714g, t = -3,0, p = .003]. The prevalence of asthma was greater in the study group [8 (15%) vs. 3 (2.8%), x = 8.4, p = .015], but there was no difference in the prevalence of tobacco or substance abuse. CONCLUSION: Women with community-acquired pneumonia during pregnancy were- significantly more likely to deliver prematurely and receive tocolytic treatment than control subjects. Maternal risk factors identified in this study for the subsequent development of antepartum pneumonia were anemia and asthma.