1096. Effect of diarrheal illness during pregnancy on adverse birth outcomes in Nepal
Session: Poster Abstract Session: Enteric Infections
Friday, October 5, 2018
Room: S Poster Hall

Background: Adverse birth outcomes, including low birthweight (LBW), small-for-gestational-age (SGA) and preterm birth, contribute to 60-80% of infant mortality worldwide. Little published data exists on the association between diarrhea during pregnancy and adverse birth outcomes. We sought to identify whether diarrhea during pregnancy was associated with adverse birth outcomes.

Methods: We used data from a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011-2014. Illness episodes were defined as at least three watery bowel movements per day for one or more days with seven diarrhea-free days between episodes. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. The c2 test, two-sample t-test, and log-binomial regression were performed to evaluate baseline characteristics and the association between diarrhea during pregnancy and adverse birth outcomes.

Results: Of 3682 women in the study, 527 (14.3%) experienced one or more episodes of diarrhea during pregnancy. Diarrhea incidence was not seasonal. Women with diarrhea had a median of 1 episode of diarrhea (interquartile range (IQR) 1-2 episodes) and 2 cumulative days of diarrhea (IQR 1-3 days). Of women with diarrhea, 16.1% (85) sought medical care. Mean maternal age, parity, biomass cook stove use, home latrine, water source, caste, and smoking did not differ in pregnant women with and without diarrhea. In crude and adjusted analyses, women with diarrhea during pregnancy were significantly more likely to have SGA infants (42.6% vs. 36.8%; adjusted risk ratio=1.20, 95% CI 1.06-1.36, p=0.005). LBW and preterm birth incidence did not significantly differ between women with diarrhea during pregnancy and those without. There was no significant association between seeking medical care for diarrhea and birth outcomes.

Conclusion: Diarrheal illness during pregnancy was associated with a significantly higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings.

 

Kira Newman, MD, PhD, Internal Medicine, University of Washington, Seattle, WA, Katie Gustafson, n/a, University of Washington, Seattle, WA, Janet Englund, MD, FIDSA, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, Joanne Katz, ScD, Johns Hopkins University, Baltimore, MD, Amalia Magaret, PhD, Department of Biostatistics, University of Washington, Seattle, WA, Subarna Khatry, MBBS, DOMS, NNIPS, Kathmandu, Nepal, Laxman Shreshtha, MD, Institute of Medicine, Tribuvhan University, Kathmandu, Nepal, Steven C Leclerq, MPH, NNIPS, Baltimore, MD, James Tielsch, PhD, MA, George Washington University, Washington, DC, Mark C. Steinhoff, MD, FIDSA, Division of Infectious Diseases, Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH and Helen Chu, MD MPH, Medicine, University of Washington, Seattle, WA

Disclosures:

K. Newman, None

K. Gustafson, None

J. Englund, None

J. Katz, None

A. Magaret, None

S. Khatry, None

L. Shreshtha, None

S. C. Leclerq, None

J. Tielsch, None

M. C. Steinhoff, None

H. Chu, None

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