Women laboring with epidural analgesia experience fever much more frequently than do women who chose other forms of analgesia, and maternal intrapartum fever is associated with numerous adverse consequences, including brain injury in the fetus. We developed a model of noninfectious inflammatory fever in the near-term pregnant rat to simulate the pathophysiology of epidural-associated fever and hypothesized that it would produce fetal brain inflammation.
Twenty-four pregnant Sprague-Dawley rats were studied at 20 days gestation (term: 22 days). Dams were treated by injection of rat recombinant interleukin (IL)-6 or vehicle at 90-minute intervals, and temperature was monitored every 30 minutes. Eight hours after the first treatment, dams were delivered of fetuses and then killed. Maternal IL-6 was measured at delivery. Fetal brains (n = 24) were processed and stained for ED-1/CD68, a marker for activated microglia, and cell counts in the lateral septal and hippocampal brain regions were measured. Fetal brains were also stained for cyclooxygenase-2 (COX-2), a downstream marker of neuroinflammation. Eight fetal brains were further analyzed for quantitative forebrain COX-2 by Western blotting compared to a β-actin standard. Maternal temperature and IL-6 levels were compared between treatments, as were cell counts, COX-2 staining, and COX-2 levels by Mann-Whitney U test, repeated-measures analysis of variance, or Fisher exact test, as appropriate.
Injection of rat IL-6 at 90-minute intervals produced an elevation of maternal temperature compared to vehicle (P < .0001). IL-6 levels were elevated to clinically relevant levels at delivery in IL-6 compared to vehicle-treated animals (mean ± standard deviation: 923 ± 97 vs 143 ± 94 pg/mL, P = .0006). ED-1–stained cells were present in significantly higher numbers in fetal brains from IL-6 compared to saline-treated dams (median [interquartile range]: caudal hippocampus, 99 [94–104] and 64 [57–68], respectively, P = .002; lateral septum, 102 [96–111] and 68 [65–69], respectively, P = .002), as well as COX-2 immunostaining (lateral septum, 22 [20–26] and 17 [15–18], respectively, P = .005; dorsal hippocampus, 27 [22–32] and 16 [14–19], respectively, P = .013) and quantitative COX-2 Western blotting activity (mean ± standard error of the mean: vehicle, 0% of β-actin intensity versus IL-6, 41.5% ± 24%, P < .001).
Noninfectious inflammatory fever is inducible in the near-term pregnant rat by injection of IL-6 at levels comparable to those observed during human epidural labor analgesia. Maternal IL-6 injection causes neuroinflammation in the fetus.
From the *Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina; †Department of Anesthesiology, Division of Obstetric Anesthesiology, University of Michigan Health Systems, Ann Arbor, Michigan; and ‡Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts.
Accepted for publication August 11, 2017.
Funding: This study was supported by departmental sources (Tufts University School of Medicine and University of Michigan) and by a Society of Obstetric Anesthesiology and Perinatology Gertie Marx research grant (to C.P.).
The authors declare no conflicts of interest.
Reprints will not be available from the authors.
Address correspondence to Scott Segal, MD, MHCM, Department of Anesthesiology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157. Address e-mail to firstname.lastname@example.org.