Systematic review and meta-analyses: Fever in pregnancy and health impacts in the offspring

TY - JOUR

T1 - Systematic review and meta-analyses

T2 - Fever in pregnancy and health impacts in the offspring

AU - Dreier, Julie Werenberg

AU - Andersen, Anne-Marie Nybo

AU - Berg-Beckhoff, Gabriele

PY - 2014/3/1

Y1 - 2014/3/1

N2 - BACKGROUND AND OBJECTIVE: Fever during pregnancy has been suspected to harm the developing fetus. However, until now, no systematic analysis of the available evidence has been undertaken to assess the impact of maternal fever on health outcomes in the child. The goal of this study was to systematically review evidence from epidemiologic studies on adverse health outcomes of the offspring in relation to exposure to maternal fever during pregnancy.METHODS: Systematic searches in PubMed, Web of Science, and the Cochrane Library were performed by using Medical Subject Headings, Boolean operators, and truncation, and references of references were reviewed. Cohort and case-control studies addressing health outcomes of prenatal fever exposure in humans were eligible for inclusion. Studies with no direct reference to fever, studies in selected populations (eg, preterm births), and studies published before 1990 were excluded.RESULTS: The available literature supported an increased risk of adverse offspring health in association with fever during pregnancy. The strongest evidence was available for neural tube defects, congenital heart defects, and oral clefts, in which meta-analyses suggested between a 1.5- and nearly 3-fold increased risk with fever exposure in the first trimester. We did not find strong evidence of a dose-response relationship, but there was some evidence that antipyretic medications may have a protective effect when used in relation to febrile episodes.CONCLUSIONS: We found substantial evidence to support the contention that maternal fever during pregnancy may negatively affect offspring health. The harmful effects seemed to cover both short- and longer-term health outcomes; however, for several outcomes, the evidence was insufficient to judge any association.

AB - BACKGROUND AND OBJECTIVE: Fever during pregnancy has been suspected to harm the developing fetus. However, until now, no systematic analysis of the available evidence has been undertaken to assess the impact of maternal fever on health outcomes in the child. The goal of this study was to systematically review evidence from epidemiologic studies on adverse health outcomes of the offspring in relation to exposure to maternal fever during pregnancy.METHODS: Systematic searches in PubMed, Web of Science, and the Cochrane Library were performed by using Medical Subject Headings, Boolean operators, and truncation, and references of references were reviewed. Cohort and case-control studies addressing health outcomes of prenatal fever exposure in humans were eligible for inclusion. Studies with no direct reference to fever, studies in selected populations (eg, preterm births), and studies published before 1990 were excluded.RESULTS: The available literature supported an increased risk of adverse offspring health in association with fever during pregnancy. The strongest evidence was available for neural tube defects, congenital heart defects, and oral clefts, in which meta-analyses suggested between a 1.5- and nearly 3-fold increased risk with fever exposure in the first trimester. We did not find strong evidence of a dose-response relationship, but there was some evidence that antipyretic medications may have a protective effect when used in relation to febrile episodes.CONCLUSIONS: We found substantial evidence to support the contention that maternal fever during pregnancy may negatively affect offspring health. The harmful effects seemed to cover both short- and longer-term health outcomes; however, for several outcomes, the evidence was insufficient to judge any association.

KW - Case-Control Studies

KW - Cleft Lip

KW - Cohort Studies

KW - Female

KW - Fever

KW - Heart Defects, Congenital

KW - Humans

KW - Infant, Newborn

KW - Neural Tube Defects

KW - Pregnancy

KW - Pregnancy Complications

KW - Prenatal Exposure Delayed Effects

U2 - 10.1542/peds.2013-3205

DO - 10.1542/peds.2013-3205

M3 - Journal article

C2 - 24567014

SN - 0031-4005

VL - 133

SP - e674-88

JO - Pediatrics

JF - Pediatrics

IS - 3

ER -