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Association of common maternal infections with birth outcomes: a multinational cohort study

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It is unclear whether common maternal infections during pregnancy are risk factors for adverse birth outcomes. We assessed the association between self-reported infections during pregnancy with preterm birth and small-for-gestational-age (SGA) in an international cohort consortium.


Data on 120,507 pregnant women were obtained from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA. Self-reported common infections during pregnancy included influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections, cystitis, urinary tract infection, and the symptoms fever and diarrhoea. Birth outcomes included preterm birth, low birth weight and SGA. Associations between maternal infections and birth outcomes were first assessed using Poisson regression in each cohort and then pooled using random-effect meta-analysis. Risk ratios (RR) and 95% confidence intervals (CI) were calculated, adjusted for potential confounders.


Vaginal infections (pooled RR, 1.10; 95% CI, 1.02–1.20) and urinary tract infections (pooled RR, 1.17; 95% CI, 1.09–1.26) during pregnancy were associated with higher risk of preterm birth. Similar associations with low birth weight were also observed for these two infections. Fever during pregnancy was associated with higher risk of SGA (pooled RR, 1.07; 95% CI, 1.02–1.12). No other significant associations were observed between maternal infections/symptoms and birth outcomes.


Vaginal infections and urinary infections during pregnancy were associated with a small increased risk of preterm birth and low birth weight, whereas fever was associated with SGA. These findings require confirmation in future studies with laboratory-confirmed infection diagnosis.

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Data availability

The data underlying this article were provided by the original cohorts in I4C by permission. Please contact Prof Terence Dwyer regarding data access to I4C data (


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We would like to thank all cohorts from the I4C that participated in our study.


Jian-Rong He was supported by funding from the Ministry of Science and Technology of the People’s Republic of China (2022YFC2704601) and China Scholarship Council-University of Oxford Joint Scholarship. Per Magnus is supported by the Research Council of Norway through its Centres of Excellence funding scheme (project number 262700) and by the Norwegian Institute of Public Health.

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Authors and Affiliations



Jian-Rong He conceived the study, formulated the clinical question and finalise the protocol, accessed the data, did the statistical analyses and wrote the report. Jane E Hirst and Terrence Dwyer conceived the study, formulated the clinical question, reviewed and revised the manuscript. All authors critically reviewed the report, interpreted the data and revised the manuscript. Jian-Rong He and Terrence Dwyer is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version of the manuscript.

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Correspondence to Jian-Rong He.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study and data use were approved by the I4C Steering Committee and the Ethics Committees from the participating cohorts.

Additional information

Jane E. Hirst and Terence Dwyer Joint senior authors.

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He, JR., Tikellis, G., Paltiel, O. et al. Association of common maternal infections with birth outcomes: a multinational cohort study. Infection (2024).

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