Jun 01, 1999
The Foundation has reported previously that vaginal infection in the pregnant woman is an important factor that can lead to intrauterine infection. Also, that intrauterine infection may be important as a cause of premature labor. Finally, premature labor resulting in low birth weight infants is associated with the occurrence of cerebral palsy. Thus, vaginal infection might be a significant factor in the development of cerebral palsy.
Two studies have recently been published that address these issues:
Treatment of Vaginal Infection to Prevent Premature Delivery Dr. M. Klebanoff and his colleagues have published the results of a nationwide study  to learn whether treatment of a bacterial vaginal infection in pregnant women with no symptoms of illness, prevents premature delivery. The reason for the study is the belief that bacterial infection of the vagina is an important “risk factor” for premature delivery. Thus, would treatment of the infection prevent premature delivery? The answer from this study is “no”, it does not. Although the treatment (an antibiotic) did eliminate the vaginal infection, it did not prevent premature delivery. It was an excellent study. The only meaningful criticism is whether the treatment was started early enough in pregnancy to prevent the effects of infection as a contributor to premature labor.
There is evidence of an association between the presence of non-symptomatic maternal vaginal infection and the occurrence of premature labor. However, is this a cause and effect relationship? Or are they unrelated? Or are both due to another factor common to both? One way of learning about this is to treat the infection and see if it has an effect on the occurrence of premature labor. These investigators did that and found it did not have an effect. This result raises the question does non-symptomatic infection of the vagina become important only when it is present with some other factor also present in pregnant women? To answer this question will take a study of a very large group of pregnant women. Research to answer that question is now being planned in Scandinavia.
Evidence of Intrauterine Infection Associated with Cerebral Palsy A second study addresses the question: is the presence of signs of inflammation in amniotic fluid (the fluid surrounding the fetus) associated with the occurrence of cerebral palsy? Dr. B.H. Yoon and his colleagues report in a study of 104 newborns followed to the age of 3 that the evidence of signs of inflammation in the amniotic fluid is a significant finding in cerebral palsy. Comment: The results of this study are important in two ways: it helps identify an important process in pregnancy that is related to cerebral palsy (signs of inflammation found in the amniotic fluid); it also indicates that a method is available prior to delivery for evaluating the risk of the fetus developing cerebral palsy. It also raises the possibility of detecting inflammation early enough to treat the cause of the inflammation and prevent cerebral palsy. The practical problem is: whom to test? The testing procedure carries a small, but present risk. Testing every pregnant woman routinely would be impractical. Thus, the approach will probably be the identification of pregnant women at risk of having signs of inflammation in the amniotic fluid and testing those women. If the test is positive, then a detailed examination would be initiated to find the site and source of the inflammation and treat it. The objective of the treatment is both the health of the mother and the prevention of brain damage to the fetus. Remember, 70% of cerebral palsy is due to threats to the fetal brain prior to delivery. Early removal of the cause of inflammation should significantly lessen the probability of fetal brain damage. We now need to develop the criteria for periodic testing of high-risk pregnant women and learn whether early treatment of inflammation prevents developmental brain damage.
American Journal of Obstetrics and Gynecology 1999; 180:S2
American Journal of Obstetrics and Gynecology 1998:177:19