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Pradhan J, Mallick S, Mishra N, Tiwari A, Negi VD. Pregnancy, infection, and epigenetic regulation: A complex scenario. Biochim Biophys Acta Mol Basis Dis 2023:166768. [PMID: 37269984 DOI: 10.1016/j.bbadis.2023.166768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 06/05/2023]
Abstract
A unique immunological condition, pregnancy ensures fetus from maternal rejection, allows adequate fetal development, and protects against microorganisms. Infections during pregnancy may lead to devastating consequences for pregnant women and fetuses, resulting in the mother's death, miscarriage, premature childbirth, or neonate with congenital infection and severe diseases and defects. Epigenetic (heritable changes in gene expression) mechanisms like DNA methylation, chromatin modification, and gene expression modulation during gestation are linked with the number of defects in the fetus and adolescents. The feto-maternal crosstalk for fetal survival during the entire gestational stages are tightly regulated by various cellular pathways, including epigenetic mechanisms that respond to both internal as well outer environmental factors, which can influence the fetal development across the gestational stages. Due to the intense physiological, endocrinological, and immunological changes, pregnant women are more susceptible to bacterial, viral, parasitic, and fungal infections than the general population. Microbial infections with viruses (LCMV, SARS-CoV, MERS-CoV, and SARS-CoV-2) and bacteria (Clostridium perfringens, Coxiella burnetii, Listeria monocytogenes, Salmonella enteritidis) further increase the risk to maternal and fetal life and developmental outcome. If the infections remain untreated, the possibility of maternal and fetal death exists. This article focused on the severity and susceptibility to infections caused by Salmonella, Listeria, LCMV, and SARS-CoV-2 during pregnancy and their impact on maternal health and the fetus. How epigenetic regulation during pregnancy plays a vital role in deciding the fetus's developmental outcome under various conditions, including infection and other stress. A better understanding of the host-pathogen interaction, the characterization of the maternal immune system, and the epigenetic regulations during pregnancy may help protect the mother and fetus from infection-mediated outcomes.
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Affiliation(s)
- Jasmin Pradhan
- Laboratory of Infection Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India.
| | - Swarupa Mallick
- Laboratory of Infection Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India.
| | - Neha Mishra
- Laboratory of Infection Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India.
| | - Aman Tiwari
- Vidya Devi Negi, Infection Immunology Laboratory (2i-Lab), Department of Biological Sciences, Indian Institute of Science Education and Research (IISER) Mohali, Knowledge City, Sector 81, SAS Nagar, Punjab 140306, India
| | - Vidya Devi Negi
- Vidya Devi Negi, Infection Immunology Laboratory (2i-Lab), Department of Biological Sciences, Indian Institute of Science Education and Research (IISER) Mohali, Knowledge City, Sector 81, SAS Nagar, Punjab 140306, India.
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Taylor BD, Adekanmbi V, Zhang Y, Berenson A. The Impact of Neisseria gonorrhoeae Mono- and Coinfection on Adverse Pregnancy Outcomes. Open Forum Infect Dis 2023; 10:ofad220. [PMID: 37250177 PMCID: PMC10220503 DOI: 10.1093/ofid/ofad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Background Sexually transmitted infections (STIs) have recently been linked to hypertensive disorders of pregnancy (HDP). However, the impact of Neisseria gonorrhoeae on risk of HDP is not well understood. This study determined the impact of gonorrhea and gonorrhea coinfection on HDP and other adverse pregnancy outcomes in a population with a high screening rate and presumed treatment. Methods This retrospective study included 29 821 singleton births between 2016 and 2021. The STI testing results, demographic variables, and pregnancy outcomes were identified from electronic health records. The HDP were primary outcomes of interest including gestational hypertension, preeclampsia, and superimposed preeclampsia. We further examined preeclampsia subtypes defined by severe features and gestational age of delivery (term and preterm preeclampsia). Secondary outcomes included preterm premature rupture of membranes, chorioamnionitis, and preterm delivery. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Models were adjusted for maternal age, maternal race/ethnicity, and smoking. Results Gonorrhea screening occurred in 95% of the population. Gonorrhea increased the odds of preterm preeclampsia (adjusted OR [ORadj.], 1.95; 95% CI, 1.02-3.73) and preterm birth (ORadj., 1.78; 95% CI, 1.22-2.60). Furthermore, gonorrhea-chlamydia coinfection was associated with preterm birth (ORadj., 1.77; 95% CI, 1.03-3.04). However, results were similar when we examined gonorrhea monoinfection (ORadj., 1.76; 95% CI, 1.04-2.97). Conclusions Among a diverse population of pregnant individuals, gonorrhea increased odds of preterm preeclampsia and preterm delivery Further research is needed to determine the burden of STIs on HDP, including investigations into biological effects during pregnancy.
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Affiliation(s)
- Brandie DePaoli Taylor
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Population Health and Health Disparities, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Victor Adekanmbi
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yuanyi Zhang
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, Texas, USA
| | - Abbey Berenson
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, USA
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Young MR, Broadwell C, Kacanek D, Chadwick EG, Jao J, Moscicki AB, Powis K, Tassiopoulos K, Yee LM, Haddad LB. Sexually Transmitted Infections in Pregnant People With Human Immunodeficiency Virus: Temporal Trends, Demographic Correlates, and Association With Preterm Birth. Clin Infect Dis 2022; 75:2211-2218. [PMID: 35486952 PMCID: PMC10200300 DOI: 10.1093/cid/ciac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We describe trends in prevalence and identify factors associated with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, and Trichomonas vaginalis (TV) diagnosed in pregnancy among US people with human immunodeficiency virus (PWH) and evaluate associations of sexually transmitted infections (STIs) with preterm birth (PTB). METHODS We included pregnant PWH enrolled in the Surveillance Monitoring for ART Toxicities dynamic cohort of the Pediatric HIV/AIDS Cohort Study network who delivered between 2010 and 2019. Multivariable log-binomial or Poisson generalized estimating equation models were used to estimate the association of calendar year with each STI, controlling for confounders; the association of demographic and clinical factors with each STI; and the association of each STI with PTB. RESULTS The sample included 2241 pregnancies among 1821 PWH. Median age at delivery was 29.2 years; 71% of participants identified as Black or African American. STI prevalence was: CT 7.7%, NG 2.3%, syphilis 2.4%, and TV 14.5%; 30% had unknown TV status. There were no temporal changes in STI prevalence. Younger age and initial HIV viral load ≥400 copies/mL were associated with increased risk of CT, NG, and TV. Recreational substance use was a risk factor for NG, syphilis, and TV. No STI was associated with PTB. CONCLUSIONS Unlike nationwide trends, no changes in STI prevalence during the study period were observed. The large proportion with unknown TV status underscores the need for increased adherence to screening guidelines. STIs diagnosed during pregnancy in PWH were not associated with risk of PTB.
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Affiliation(s)
- Marisa R Young
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carly Broadwell
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, USA
| | - Kathleen Powis
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Population Council, Center for Biomedical Research, New York, New York, USA
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Detección de infección por Chlamydia trachomatis en mujeres sexualmente activas en Venezuela. BIOMÉDICA 2022; 42:522-530. [PMID: 36122291 PMCID: PMC9558775 DOI: 10.7705/biomedica.6246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Indexed: 11/25/2022]
Abstract
Introducción. La infección genital por Chlamydia trachomatis es una de las más frecuentes en el mundo. Cada año se registran cerca de 85 millones de nuevos casos de esta enfermedad, que cursa con graves complicaciones en la mujer y recién nacido. Objetivo. Determinar las características clínico-epidemiológicas de la infección por C. trachomatis en mujeres venezolanas sexualmente activas. Materiales y métodos. Es un estudio descriptivo, transversal y de campo, sustentado en la historia clínica y el examen físico, la detección de infección con la prueba inmunoenzimática con anticuerpos policlonales anti-LPS y la confirmación de los resultados con la de biología molecular. La muestra estuvo conformada por 100 mujeres sexualmente activas mayores de 12 años de edad, del estado Carabobo, Venezuela. Resultados. La mayoría de las mujeres se encontraba entre los 20 y los 45 años de edad. En el 25 % de las mismas, se detectaron anticuerpos IgG anti-C. trachomatis y, en el 84 % de estas, se confirmó la infección mediante PCR; en ninguna de las mujeres se hallaron anticuerpos IgM anti-C. trachomatis. Conclusión. La infección crónica predomina en las mujeres entre los 20 y los 45 años de edad; la prueba inmunoenzimática arrojó falsos positivos corroborados por PCR.
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Groene EA, Boraas CM, Smith MK, Lofgren SM, Rothenberger MK, Enns EA. A Statewide Mixed-Methods Study of Provider Knowledge and Behavior Administering Expedited Partner Therapy for Chlamydia and Gonorrhea. Sex Transm Dis 2022; 49:601-609. [PMID: 35796238 PMCID: PMC9378509 DOI: 10.1097/olq.0000000000001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expedited partner therapy (EPT) refers to the practice of having patients diagnosed with chlamydia or gonorrhea deliver medication directly to their partner(s) to treat them presumptively for infection. Although EPT facilitates timely treatment and prevents reinfection, it remains underused. We used findings from key informant interviews to design and implement a statewide survey to estimate knowledge and utilization of EPT and to identify barriers and facilitators to EPT among Minnesota providers. METHODS From November to December 2020, we carried out 15 interviews with health providers who currently provide EPT and coded interviews by recurring themes. We then conducted a statewide online survey on sexually transmitted infection treatment and barriers to EPT, from December 2020 to March 2021. We disseminated the survey to all licensed Minnesota health providers, and those who reported treating bacterial sexually transmitted infections in the past year were included in the study. RESULTS Interview themes included the importance of direct provision of partner medication, administrative/pharmacy barriers to treatment, inclusive EPT eligibility, and patient counseling. Of the 623 health providers who completed the online survey, only 70% thought EPT was legal and only 37% currently offer EPT. Of those who did not provide EPT, 78% said they would under certain circumstances. Barriers included concerns about safety/liability of prescribing without a medical examination, administrative concerns about prescriptions, and patient acceptance. CONCLUSIONS Given that over a quarter of respondents did not know expedited partner therapy (EPT)'s legal status, improving provider education may increase EPT provision. More research is needed on system-level barriers and patient acceptance of solutions identified in this study.
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Affiliation(s)
- Emily A Groene
- From the Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Christy M Boraas
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School
| | - M Kumi Smith
- From the Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Sarah M Lofgren
- Division of Infectious Disease and International Medicine, University of Minnesota Medical School
| | - Meghan K Rothenberger
- Division of Infectious Disease and International Medicine, University of Minnesota Medical School
| | - Eva A Enns
- School of Public Health, Division of Health Policy and Management, Minneapolis, MN
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DePaoli Taylor B, Hill AV, Perez-Patron MJ, Haggerty CL, Schisterman EF, Naimi AI, Noah A, Comeaux CR. Sexually transmitted infections and risk of hypertensive disorders of pregnancy. Sci Rep 2022; 12:13904. [PMID: 35974035 PMCID: PMC9381495 DOI: 10.1038/s41598-022-17989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022] Open
Abstract
Hypertensive disorders of pregnancy (HDP) result in maternal morbidity and mortality but are rarely examined in perinatal studies of sexually transmitted infections. We examined associations between common sexually transmitted infections and HDP among 38,026 singleton pregnancies. Log-binomial regression calculated relative risk (RRs) and 95% confidence intervals (CIs) for associations with gestational hypertension, preeclampsia with severe features, mild preeclampsia, and superimposed preeclampsia. All models were adjusted for insurance type, maternal age, race/ethnicity, and education. Additional adjustments resulted in similar effect estimates. Chlamydia was associated with preeclampsia with severe features (RRadj. 1.4, 95% CI 1.1, 1.9). Effect estimates differed when we examined first prenatal visit diagnosis only (RRadj. 1.3, 95% CI 0.9, 1.9) and persistent or recurrent infection (RRadj. 2.0, 95% CI 1.1, 3.4). For chlamydia (RRadj. 2.0, 95% CI 1.3, 2.9) and gonorrhea (RRadj. 3.0, 95% CI 1.1, 12.2), women without a documented treatment were more likely to have preeclampsia with severe features. Among a diverse perinatal population, sexually transmitted infections may be associated with preeclampsia with severe features. With the striking increasing rates of sexually transmitted infections, there is a need to revisit the burden in pregnant women and determine if there is a link between infections and hypertensive disorders of pregnancy.
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Affiliation(s)
- Brandie DePaoli Taylor
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA. .,Department of Preventive Medicine and Population Health, University of Texas Medical Branch-Galveston, Galveston, TX, USA.
| | - Ashley V Hill
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria J Perez-Patron
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Catherine L Haggerty
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Enrique F Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley I Naimi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Akaninyene Noah
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Camillia R Comeaux
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
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Niles JK, Kaufman HW, Peterman TA, Tao G, Gift TL, Alagia DP. Chlamydia trachomatis and Neisseria gonorrhoeae in Pregnancy: Trends in United States, 2010 to 2018. Sex Transm Dis 2021; 48:932-938. [PMID: 34192725 PMCID: PMC8594523 DOI: 10.1097/olq.0000000000001504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) case surveillance relies on reported positive laboratory results. Changes in reported cases may represent changes in testing practice or infection prevalence. This study evaluated changes over time for CT and NG positivity and testing rates of pregnant persons. METHODS Prenatal testing results from persons aged 16 to 40 years tested by a national reference clinical laboratory were analyzed for CT and NG testing and positivity from 2010 to 2018 (n = 3,270,610). RESULTS Testing rates increased among pregnant persons for CT (from 56.3% in 2010 to 64.1% in 2018, P < 0.001) and NG (from 55.6% to 63.2%, P < 0.001). Higher CT testing rates were found in Black non-Hispanic (adjusted odds ratio [AOR], 1.58; 95% confidence interval [CI], 1.57-1.60) and Hispanic (AOR, 1.19; 95% CI, 1.18-1.20) persons. NG and CT testing rates were virtually identical. Significant increasing trends in CT positivity were observed for each age group studied (P < 0.001 for all): 16-19 (from 11.7% to 13.0%), 20-24 (from 6.4% to 6.7%), 25-30 (from 1.9% to 2.4%), and 31-40 years (from 0.76% to 0.92%). Black non-Hispanic persons had the highest positivity for CT (AOR, 2.52; 95% CI, 2.46-2.57) and NG (AOR, 5.42; 95% CI, 5.05-5.82). CONCLUSIONS Testing and adjusted positivity for both CT and NG among pregnant persons increased from 2010 to 2018. Higher testing rates were observed in Black non-Hispanic and Hispanic persons (even in persons younger than 25 years), suggesting some testing decisions may have been based on perceived risk, in contrast to many guidelines recommending screening all pregnant persons younger than 25 years.
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Affiliation(s)
| | | | - Thomas A. Peterman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Guoyu Tao
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thomas L. Gift
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Burdette ER, Young MR, Dude CM, Wall KM, Haddad LB. Association of Delayed Treatment of Chlamydial Infection and Gonorrhea in Pregnancy and Preterm Birth. Sex Transm Dis 2021; 48:925-931. [PMID: 34091583 DOI: 10.1097/olq.0000000000001490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treating chlamydia and gonorrhea in pregnancy has been shown to decrease the associated risk of preterm birth in some studies. Delayed treatment of these infections among nonpregnant patients carries known consequences. It is unclear whether delayed treatment in pregnancy similarly increases adverse outcomes. METHODS We conducted a retrospective cohort study of women who delivered at a safety-net hospital from July 2016 to June 2018. Women with at least one visit who were tested for chlamydia and gonorrhea were included. Women diagnosed after 36 weeks (preterm analysis) or 31 weeks (early preterm analysis) were excluded. We used multivariable logistic regression to examine the association between no infection, timely treatment (<1 week), and delayed treatment (>1 week, not treated) with preterm (<37 weeks) and early preterm (<32 weeks) birth. RESULTS Among 3154 deliveries, 389 (12%) were preterm. Among 3107 deliveries, 74 (2%) were early preterm. In adjusted models, women with timely (adjusted odds ratio [aOR]; 1.7, 95% confidence interval [CI], 1.0-2.7) and delayed (aOR, 1.7; 95% CI, 1.1-2.5) treatments had increased odds of preterm birth. Similarly, women with timely (aOR, 2.5; 95% CI, 1.0-6.2) and delayed (aOR, 2.4; 95% CI, 1.2-4.9) treatments had increased odds of early preterm birth. Among women who tested positive, multiple infections were not associated with an increase in preterm birth (preterm: 17% vs. 20%, P = 0.53; early preterm: 5% vs. 6%, P = 0.74). CONCLUSIONS Chlamydia and gonorrhea are associated with preterm and early preterm births, regardless of time to treatment. Creative solutions are needed to improve the prevention of these infections in pregnancy.
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Affiliation(s)
- Emily R Burdette
- From the Department of Gynecology and Obstetrics, Emory University School of Medicine
| | - Marisa R Young
- From the Department of Gynecology and Obstetrics, Emory University School of Medicine
| | - Carolynn M Dude
- From the Department of Gynecology and Obstetrics, Emory University School of Medicine
| | - Kristin M Wall
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA
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Lazenby GB, Savage AH, Horner G, Richmond J, Peterman TA. Declining Chlamydia and Gonorrhea Diagnoses Among Pregnant Women in South Carolina, 2008 to 2018. Sex Transm Dis 2021; 48:141-144. [PMID: 32956241 DOI: 10.1097/olq.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reported US cases of chlamydia and gonorrhea have increased since 2000, whereas studies in select populations suggest that the prevalence of these diseases has decreased. We sought to determine if these diagnoses are increasing among pregnant women delivering at our center. METHODS This is a retrospective study of women delivering at least 1 infant >18 weeks of gestation at the Medical University of South Carolina for 11 years (2008-2018). Using the perinatal information system, we collected maternal race, age, insurer, and chlamydia and gonorrhea screening results during the pregnancy of record. Cochran-Armitage trend analyses were performed to evaluate trends in these diagnoses by delivery year for all women and for age/race subgroups. RESULTS During the study period, there were 24,807 deliveries. The median age of women was 28 years (interquartile range, 23-32 years). Five percent (5.0%) of women were diagnosed with chlamydia and 1.2% with gonorrhea. The percent of women diagnosed decreased for both chlamydia (9.6%-3.4%) and gonorrhea (2.5%-1.1%; P < 0.001, trend analyses for both). A higher percentage of Black women had chlamydia and gonorrhea, and both diagnoses declined over time: 17.4% to 6.9% (P < 0.0001) for chlamydia and 5.8% to 2.1% (P < 0.0001) for gonorrhea. In a subanalysis of race and age, Black women younger than 25 years experienced the most significant decline in chlamydia diagnoses (P < 0.0001). CONCLUSIONS We observed declining diagnoses of chlamydia and gonorrhea among pregnant women in our center. Although Black women delivering were more likely to have either diagnoses, they experienced a significant decline in both chlamydia and gonorrhea over time.
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Affiliation(s)
- Gweneth B Lazenby
- From the Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Ashlyn H Savage
- From the Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Gwynneth Horner
- From the Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Joshua Richmond
- From the Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Thomas A Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Waltmann A, McKinnish TR, Duncan JA. Nonviral sexually transmitted infections in pregnancy: current controversies and new challenges. Curr Opin Infect Dis 2021; 34:40-49. [PMID: 33337618 PMCID: PMC8634851 DOI: 10.1097/qco.0000000000000702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides an update of nonviral, curable sexually transmitted infections (STIs) in pregnancy and summarizes our understanding of the current issues and controversies surrounding risk factors, screening, and treatment of STIs in pregnancy primarily in high-income countries (using the United States and the United Kingdom as examples). The infections covered in this review are syphilis, gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium infections. RECENT FINDINGS Overall, limited modern data is available to update researchers and clinicians on the epidemiology and care of STIs in pregnancy. Though common risk factors can be identified among these STIs, like socioeconomic status and inadequate antenatal care, specific screening and treatment challenges vary by geography and pathogen. Wherever available, surveillance data and research evidence are often limited to nonpregnant patients, leading to imperfect pregnancy-specific risk estimates and obstetric lags in the development and adoption of new guidelines. We have identified three areas of opportunity that may enhance the effectiveness of current approaches and inform new ones: improved data collection and evidence-based screening practices; prompt and comprehensive therapy, including partner services, and evaluations of new treatment modalities; and equitable antenatal and sexual healthcare for all pregnant persons and their partners. SUMMARY These findings highlight the need to revisit standards of screening and management of STIs in pregnancy in high-income countries.
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Affiliation(s)
- Andreea Waltmann
- Institute for Global Health and Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tyler R McKinnish
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St Louis, Missouri
| | - Joseph A Duncan
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Simons JL, McKenzie JS, Wright NC, Sheikh SA, Subramaniam A, Tita ATN, Dionne-Odom J. Chlamydia Prevalence by Age and Correlates of Infection Among Pregnant Women. Sex Transm Dis 2021; 48:37-41. [PMID: 32932385 PMCID: PMC7737858 DOI: 10.1097/olq.0000000000001261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of population-based data on chlamydia in pregnancy despite rising rates in US women. Our objectives were to assess chlamydia prevalence by age group and to identify factors associated with infection in pregnant women to inform screening guidelines. METHODS This cross-sectional study included pregnant women tested for chlamydia who delivered at the University of Alabama at Birmingham between November 1, 2012, and December 31, 2017. The primary outcome was chlamydia prevalence, defined as a positive urogenital chlamydia nucleic acid amplification test result documented in the electronic medical record. Multivariable logistic regression was used to identify factors associated with infection. RESULTS Among 17,796 women who delivered during the study period, 13,657 (77%) had chlamydia testing performed at the University of Alabama at Birmingham. Chlamydia prevalence (95% confidence interval) was 7.4% (7.0%-7.9%). Age-stratified prevalence rates were 14.6%, 4.3%, and 1.7% for women younger than 25 years, 25 to 29 years, and 30 years or older, respectively. Chlamydia in pregnancy remained strongly associated with age (adjusted odds ratio [95% confidence interval], 7.2 [5.6-9.2] for age <25 years, and 2.3 [1.7-3.0] for ages 25-29 years, when compared with >30 years) after adjustment for race, urban residence, and insurance status. CONCLUSIONS Among pregnant women living in the southeastern United States, chlamydia was detected in 1 of 14 women who were tested. Chlamydia positivity was highest among women younger than 30 years. Study findings support broad screening for chlamydia in pregnancy.
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Affiliation(s)
| | | | | | | | - Akila Subramaniam
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Center for Women’s Reproductive Health
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Center for Women’s Reproductive Health
| | - Jodie Dionne-Odom
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
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