Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana.
INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Cayenne, French Guiana.
PLoS Negl Trop Dis. 2023 Oct 24;17(10):e0011721. doi: 10.1371/journal.pntd.0011721. eCollection 2023 Oct.
The aim of this study was to describe different causes and consequences of fever during pregnancy in Western French Guiana and along the Maroni River.
A retrospective single-center study including all patients with a history of documented fever ≥ 38°C during pregnancy at the West French Guiana Hospital for 9 years. Postpartum fever and nosocomial infections were excluded. We focused on medical history and on clinical and biological findings. Causes were characterized as confirmed or uncertain and then classified as preventable or non-preventable.
A total of 940 pregnant women who experienced at least one episode of fever were included and compared to 23,811 deliveries who occurred during the same period without documented fever. Among them, 43.7% (411/940) were in labor. About 3.7% (35/940) of febrile pregnant women had at least two episodes of fever, while 0.3% (3/940) had a coinfection at the time of diagnosis, resulting in a total of 978 febrile episodes. Among them, causes remained unknown or uncertain in 7.6% (75/978) and 0.9% (9/978) of cases, respectively. Among confirmed causes of fever throughout pregnancy (n = 483), the most common known cause was arbovirus infection (146/483, 30.2%), followed by urinary tract infection (134/483, 27.7%), chickenpox (27/483, 5.6%), and gastrointestinal (14/483, 2.9%) and pulmonary infections (10/483, 2%). Mothers with fever had a higher risk of cesarean section (19.8% vs 15.5%, aOR 1.3 [95% CI 1.14-1.6], stillbirth (5.5% versus 1.9%, aOR 2.7 [95% CI 2-3.7]), and preterm delivery < 34 weeks of gestation (7.2% vs 4.7%, aOR 1.5 [95% CI 1.2-2].
In the Amazon region, causes of fever are diverse and often associated with epidemic waves, notably arboviruses. This must be considered when exploring possible causes of fever during pregnancy in these localities, including fetal anomalies and/or fetal loss. Physicians should consider the epidemiological context and avoid generalizations. Given the impact of emergent agents such as arboviruses on pregnancy, particular attention must be paid to the epidemiological context. This study can also help clinicians when managing fever in pregnant travelers or in their partner after having visited exposed areas. In this context, fetal abnormalities and adverse obstetric outcomes should be explored accordingly.
本研究旨在描述法属圭亚那西部和马罗尼河沿岸妊娠期间发热的不同原因和后果。
这是一项回顾性单中心研究，纳入了 9 年来在法属圭亚那西部医院有记录的发热≥38°C 的所有妊娠患者。排除了产后发热和医院获得性感染。我们重点关注了病史以及临床和生物学发现。病因被描述为确定或不确定，并随后分为可预防或不可预防。
共纳入 940 名至少经历过一次发热的孕妇，并与同期无发热记录的 23811 次分娩进行了比较。其中，43.7%（411/940）在分娩中。约 3.7%（35/940）的发热孕妇有至少两次发热，而 0.3%（3/940）在诊断时合并感染，总共有 978 例发热。其中，7.6%（75/978）和 0.9%（9/978）的病因仍不清楚或不确定。在整个孕期发热的确诊病因中（n=483），最常见的已知病因是虫媒病毒感染（146/483，30.2%），其次是尿路感染（134/483，27.7%）、水痘（27/483，5.6%）、胃肠道（14/483，2.9%）和肺部感染（10/483，2%）。发热的母亲剖宫产的风险更高（19.8% vs 15.5%，aOR 1.3[95%CI 1.14-1.6]），死胎（5.5% vs 1.9%，aOR 2.7[95%CI 2-3.7]）和早产<34 周（7.2% vs 4.7%，aOR 1.5[95%CI 1.2-2]）。
在亚马逊地区，发热的原因多种多样，通常与疫情有关，尤其是虫媒病毒。在这些地区探索发热的可能原因时，包括胎儿异常和/或胎儿丢失，必须考虑到这一点。医生应考虑到流行病学背景，避免一概而论。鉴于虫媒病毒等新发病原体对妊娠的影响，必须特别注意流行病学背景。本研究还可以帮助临床医生在管理发热的孕妇或在这些地区旅行后的孕妇的伴侣时提供参考。在这种情况下，应相应探讨胎儿异常和不良产科结局。
