Chen San-Nung, Wang Peng-Hui, Hsieh Ming-Fang, Tsai Hsiao-Wen, Lin Li-Te, Tsui Kuan-Hao
Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
Taiwan J Obstet Gynecol. 2019 Mar;58(2):261-265. doi: 10.1016/j.tjog.2019.01.017.
Neonatal candidiasis is a leading infectious cause of significant morbidity and mortality in premature birth mainly due to impaired physical barriers and immature immune system of fetus. Maternal pregnancy-induced hypertension (PIH) has been reported to be able to disturb the neonatal immune system, which could cause the increased possibility of neonatal infection. Therefore, we hypothesized that maternal PIH may increase the risk of neonatal candidiasis. The aim of this study was to evaluate whether PIH increased the risk of neonatal candidiasis and identify the predictive risk factors.
Patients with newly diagnosed PIH between January 1, 2000, and December 31, 2013 were selected from the Taiwan National Health Insurance Research Database (NHIRD). For each patient in the PIH cohort, 4 subjects without PIH, matched for age and year of delivery, were randomly selected as the comparison cohort. A Cox proportional regression model was used to estimate the risks of neonatal candidiasis in both cohorts.
Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. Patients with PIH had a higher incidence of neonatal candidiasis than did those without PIH. According to the multivariate analysis, PIH (odds ratio [OR] = 2.08, 95% confidence interval [CI] = 1.11-3.19, p < 0.0228), single parity (OR = 1.91, 95% CI = 1.00-3.65, p < 0.0499), and preterm birth (OR = 3.57, 95% CI = 1.84-6.93, p = 0.0002) were independent risk factors for the development of neonatal candidiasis.
Patients who had a history of PIH was associated with an increased risk of having infants who develop neonatal candidiasis compared with those without PIH. Additionally, preterm birth was an independent risk factor for the development of neonatal candidiasis.
新生儿念珠菌病是早产中导致显著发病和死亡的主要感染原因，主要归因于胎儿身体屏障受损和免疫系统不成熟。据报道，母亲妊娠高血压（PIH）会干扰新生儿免疫系统，这可能导致新生儿感染的可能性增加。因此，我们推测母亲PIH可能会增加新生儿念珠菌病的风险。本研究的目的是评估PIH是否会增加新生儿念珠菌病的风险，并确定预测风险因素。
从台湾国民健康保险研究数据库（NHIRD）中选取2000年1月1日至2013年12月31日期间新诊断为PIH的患者。对于PIH队列中的每位患者，随机选择4名年龄和分娩年份匹配的无PIH受试者作为对照队列。采用Cox比例回归模型估计两个队列中新生儿念珠菌病的风险。
在NHIRD登记的2330万个体中，确定了29013例PIH患者和116052例匹配对照。PIH患者的新生儿念珠菌病发病率高于无PIH患者。根据多变量分析，PIH（比值比[OR]=2.08，95%置信区间[CI]=1.11-3.19，p<0.0228）、单胎妊娠（OR=1.91，95%CI=1.00-3.65，p<0.0499）和早产（OR=3.57，95%CI=1.84-6.93，p=0.0002）是新生儿念珠菌病发生的独立危险因素。
与无PIH的患者相比，有PIH病史的患者生育患新生儿念珠菌病婴儿的风险增加。此外，早产是新生儿念珠菌病发生的独立危险因素。
