Maternal intestinal, genitourinary infections raise risk for biliary atresia in offspring
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Key takeaways:
- Compared with other maternal infections, intestinal infection and genitourinary tract infection increased the risk for biliary atresia.
- Antepartum viral enterocolitis also increased risk.
Offspring born to mothers with prenatal or third trimester intestinal infection or genitourinary tract infection experienced a significantly higher risk for biliary atresia, according to a study in JAMA Network Open.
“Biliary atresia (BA) is a rare yet devastating hepatobiliary disease that is the primary cause for pediatric liver transplant,” Wei-Hao Wang, MD, MSc, of the Graduate Institute of Biomedical Informatics at Taipei Medical University, and colleagues wrote. “Although substantial research has been conducted, the underlying etiology of BA remains elusive. ... The association of maternal infections during pregnancy with development of BA in offspring is less understood.”
Using data from the Taiwan National Health Insurance Research Database and the Taiwan Maternal and Child Health Database, Wang and colleagues conducted a population-based, case control study to assess the association between prenatal infections in mothers and development of BA in their offspring.
Of more than 2.9 million singleton live births among mother-infant pairs from 2004 to 2020, researchers included 447 infants with BA (51.9% girls) and 2,912 without BA as controls (48% girls). The mean birth weight was 3,078 g, the male-to-female ratio was 1.06 and the mean maternal age at childbirth was 30.7 years. The annual prevalence of BA was 1.54 per 100,000 live births.
During the study period, researchers reported 3,803 episodes of prenatal maternal infection. The most common infection in both the case and control groups was upper airway infection (72.7% and 71.5%, respectively), followed by genitourinary tract infection, intestinal infection, influenza, soft-tissue infection and pneumonia.
Among all infectious diseases diagnosed before conceiving or during pregnancy, intestinal infections (weighted OR = 1.46; 95% CI, 1.17-1.82) and genitourinary tract infections (wOR = 1.22; 95% CI, 1.05-1.41) were associated with a significantly higher risk for BA among offspring. Offspring born to mothers with prenatal viral enterocolitis also were at significantly higher risk for BA (wOR = 2.18; 95% CI, 1.19-4).
While prenatal maternal intestinal infection correlated with an increased risk for BA in offspring, regardless of inpatient (wOR = 1.48; 95% CI, 1.02-2.14) or outpatient treatment (wOR = 1.45; 95% CI, 1.11-1.9), only severe cases of genitourinary tract infection in which hospitalization was required were associated with increased risk for BA (wOR = 1.81; 95% CI, 1.46-2.25).
Risk for BA increased further when maternal intestinal infection (wOR = 6.05; 95% CI, 3.8-9.63) and genitourinary tract infection (wOR = 1.55; 95% CI, 1.13-2.11) occurred during the third trimester.
“This case-control study observed an association between prenatal intestinal infection and genitourinary tract infection in mothers and BA occurrence in their offspring, the exact underlying mechanism for which warrants further exploration,” Wang and colleagues concluded. “The findings also indicate the importance of additional BA surveillance in offspring of pregnant women with these diseases.”
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