Maternal Hyperthermia
For the critical outcome of mortality, we identified low-quality evidence from 2 nonrandomized clinical trials (downgraded for risk of bias) showing an increased risk with maternal hyperthermia.(Alexander 1999, 274; Petrova 2001, 20)
For the important outcome of neonatal seizures, we identified low-quality evidence from 7 nonrandomized clinical trials (downgraded for risk of bias) showing an increased risk with maternal hyperthermia. (Alexander 1999, 274; Lieberman 2000, 983; Lieberman 2000, 8; Petrova 2001, 20; Glass 2009, 24; Goetzl 2010, 363; Greenwell 2012, e447)
For the important outcome of adverse neurologic states (encephalopathy), we identified low-quality evidence from 4 nonrandomized clinical trials (downgraded for risk of bias) showing an increased risk with maternal hyperthermia.(Badawi 1998, 1554; Impey 2001, 59; Impey 2008, 49; Linder 2013, 207)
Maternal Hypothermia
For the critical outcome of mortality and the important outcomes of seizures or adverse neurologic states (encephalopathy), we identified very-low-quality evidence from 5 randomized clinical trials (downgraded for very serious indirectness) that showed no significant risk of these outcomes with maternal hypothermia. (Horn 2002, 409; Fallis 2006, 324; Butwick 2007, 1413; Woolnough 2009, 346; Yokoyama 2009, 242) However, the above studies did not specifically examine these outcomes.
There are no studies of neonatal outcomes after interventions to keep mothers normothermic.
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Although maternal hyperthermia is associated with adverse neonatal outcomes, there is insufficient evidence to make a recommendation regarding the management of maternal hyperthermia.
There is insufficient evidence to make a treatment recommendation about maternal hypothermia.
Values, Preferences, and Task Force Insights
There was discussion as to whether this is a prognostic versus a therapeutic question. The worksheet authors used observational studies, because the randomized clinical trials did not focus on the outcomes targeted. There was discussion as to whether it was possible to separate hypothermia from the cause of hypothermia.
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