1
|
Jelliffe-Pawlowski LL, Baer RJ, Oltman S, McKenzie-Sampson S, Afulani P, Amsalu R, Bell AJ, Blebu B, Blackman KC, Chambers CD, Costello J, Fuchs J, Garay O, Karvonen KL, Kuppermann M, Lyndon A, McCulloch CE, Ong G, Ponting C, Rand L, Rogers EE, Ryckman KK, Spellen S, Subramaniam A, Swander L, Taylor KD, Williams S, Tabb KM. Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California. JAMA Netw Open 2024; 7:e2435887. [PMID: 39331393 PMCID: PMC11437386 DOI: 10.1001/jamanetworkopen.2024.35887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/26/2024] [Indexed: 09/28/2024] Open
Abstract
Importance Preterm birth (PTB) (gestational age <37 weeks) is a major cause of infant mortality and morbidity in the US and is marked by racial and ethnic and socioeconomic inequities. Further research is needed to elucidate the association of risk and protective factors with trends in PTB rates and with related inequities. Objective To describe the association of PTB rates with inequities as well as related risk and protective factors over the past decade in a US population-based cohort. Design, Setting, and Participants This retrospective cohort study of singleton live births in California from January 1, 2011, to December 31, 2022, was conducted using vital statistics records and hospital records. The cohort included births with a gestational age of 22 to 44 weeks. Main Outcomes and Measures Preterm birth rates by racial and ethnic group and by public and nonpublic insurance (considered as a proxy for socioeconomic status) were studied across years. Log-linear regression (relative risks with 95% CIs) was used to evaluate risk and protective factors within groups. Associations of PTB rates with risk and protective factors were assessed. Results This study included 5 431 018 singleton live births to individuals who identified as American Indian or Alaska Native (0.3%), Asian (14.2%), Black (4.9%), Hispanic (47.8%), or White (27.0%). A total of 43.1% of births were to individuals with public health insurance. From 2011 to 2022, the overall PTB rate increased from 6.8% to 7.5% (change [SE], 10.6% [0.6%]; z score of 18.5; P < .001). Differences in PTB rates and associated changes were observed for racial and ethnic groups and insurance groups. For example, 2022 PTB rates ranged from 5.8% among White individuals with nonpublic insurance to 11.3% among Black individuals with public health insurance. From 2011 to 2022, PTB rates decreased from 9.1% to 8.8% (change [SE], -3.5% [4.2]; z score of -0.8; P = .42) among Black individuals with nonpublic insurance, whereas they increased from 6.4% to 9.5% (change [SE], 49.8% [16.0%]; z score of 3.1; P = .002) among American Indian or Alaska Native individuals with nonpublic insurance. Increases in some risk factors (eg, preexisting diabetes, sexually transmitted infections, mental health conditions) were observed in most groups, and decreases in some protective factors (eg, participation in the California Women, Infants, and Children program) (P for trend < .001 from 2011 to 2021) were observed mostly in low-income groups. Conclusions and Relevance In this cohort study of singleton live births in California, PTB rates increased in many groups. Persistent racial and ethnic and socioeconomic inequities were also observed. Changes in risk and protective factors provided clues to patterns of PTB. These data point to an urgent need to address factors associated with PTB at both the individual and population levels.
Collapse
Affiliation(s)
- Laura L. Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Diego Study of Outcomes in Mothers and Infants, University of California San Diego, La Jolla
- EGG Healthy Pregnancy, San Francisco, California
| | - Rebecca J. Baer
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Diego Study of Outcomes in Mothers and Infants, University of California San Diego, La Jolla
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Scott Oltman
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Patience Afulani
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
| | - Ribka Amsalu
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - April J. Bell
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Family Community Medicine, University of California, San Francisco
| | - Bridgette Blebu
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Kacie C.A. Blackman
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Health Sciences, California State University, Northridge
| | - Christina D. Chambers
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Diego Study of Outcomes in Mothers and Infants, University of California San Diego, La Jolla
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Jean Costello
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Francisco Department of Public Health, San Francisco, California
| | - Jonathan Fuchs
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Francisco Department of Public Health, San Francisco, California
| | - Odessa Garay
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Biology, San Francisco State University, San Francisco, California
| | - Kayla L. Karvonen
- California Preterm Birth Initiative, University of California, San Francisco
- Department of Pediatrics, University of California, San Francisco
| | - Miriam Kuppermann
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Audrey Lyndon
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Rory School of Nursing, New York University, New York, New York
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
| | - Giannina Ong
- California Preterm Birth Initiative, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Carolyn Ponting
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Psychiatry, University of California, San Francisco
| | - Larry Rand
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Elizabeth E. Rogers
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Health Sciences, California State University, Northridge
| | - Kelli K. Ryckman
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| | - Solaire Spellen
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Akila Subramaniam
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Departmment of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Louie Swander
- Department of Health Sciences, California State University, Northridge
| | - Kelly D. Taylor
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
| | - Schyneida Williams
- Department of Pediatrics, University of California, San Francisco
- Black Women’s Health and Livelihood Initiative, University of California, San Francisco
| | - Karen M. Tabb
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- School of Social Work, University of Illinois Urbana-Champaign, Urbana
| |
Collapse
|
2
|
Masson L, Wilson J, Amir Hamzah AS, Tachedjian G, Payne M. Advances in mass spectrometry technologies to characterize cervicovaginal microbiome functions that impact spontaneous preterm birth. Am J Reprod Immunol 2023; 90:e13750. [PMID: 37491925 DOI: 10.1111/aji.13750] [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: 04/03/2023] [Revised: 06/12/2023] [Accepted: 07/01/2023] [Indexed: 07/27/2023] Open
Abstract
Preterm birth (PTB) is a leading cause of morbidity and mortality in young children. Infection is a major cause of this adverse outcome, particularly in PTBs characterised by spontaneous rupture of membranes, referred to as spontaneous (s)PTB. However, the aetiology of sPTB is not well defined and specific bacteria associated with sPTB differ between studies and at the individual level. This may be due to many factors including a lack of understanding of strain-level differences in bacteria that influence how they function and interact with each other and the host. Metaproteomics and metabolomics are mass spectrometry-based methods that enable the collection of detailed microbial and host functional information. Technological advances in this field have dramatically increased the resolution of these approaches, enabling the simultaneous detection of thousands of proteins or metabolites. These data can be used for taxonomic analysis of vaginal bacteria and other microbes, to understand microbiome-host interactions, and identify diagnostic biomarkers or therapeutic targets. Although these methods have been used to assess host proteins and metabolites, few have characterized the microbial compartment in the context of pregnancy. The utilisation of metaproteomic and metabolomic-based approaches has the potential to vastly improve our understanding of the mechanisms leading to sPTB.
Collapse
Affiliation(s)
- Lindi Masson
- Disease Elimination Program, Life Sciences Discipline, Burnet Institute, Melbourne, Australia
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Central Clinical School, Monash University, Melbourne, Australia
| | - Jenna Wilson
- Disease Elimination Program, Life Sciences Discipline, Burnet Institute, Melbourne, Australia
| | - Aleya Sarah Amir Hamzah
- Disease Elimination Program, Life Sciences Discipline, Burnet Institute, Melbourne, Australia
| | - Gilda Tachedjian
- Disease Elimination Program, Life Sciences Discipline, Burnet Institute, Melbourne, Australia
- Department of Microbiology, Monash University, Clayton, Australia
- Department of Microbiology and Immunology, at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Payne
- Division of Obstetrics and Gynaecology, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
3
|
Das A, Trivedi MM, Bellingham-Young DA. Food environment index and preterm birth rate in the counties of the United States. J Neonatal Perinatal Med 2023; 16:491-500. [PMID: 37718862 DOI: 10.3233/npm-221180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To determine the relationship between Food Environment Index (FEI) and Preterm Birth (PTB) rate at the county level of the United States of America (USA) (primary), while evaluating the interaction of multiple factors within a framework of sociodemographic, maternal health, maternal behavioral, and environmental factors. METHODS This is a population-based retrospective cohort ecological study from 2015-2018. The study compares the characteristics of the population of the counties of the USA. All counties with complete data on their PTB rate and the independent variables were included in the study. Independent variables with greater than 20% missing data were excluded from the study. Purposive sampling technique was applied. A total of 2983/3142 counties were included in the study. RESULTS The median PTB rate of all counties was 9.90%. The highest PTB rate (23.3%) was in Tallapoosa County, Alabama and the lowest (3.4%) in San Juan County, Washington State. After adjusting for variables, PTB rate had a significant association with FEI (coefficient of correlation - 0.36, p < 0.01, 95% CI - 0.19 to - 0.04). Increase in the rate of unemployment, African American race, adult smoking, obesity, uninsured rate, sexually transmitted diseases (STD), high school education and air pollution was associated with an increase in PTB rate, while an increase in FEI and alcohol abuse rates was associated with a decrease in PTB rate. CONCLUSIONS FEI can predict the PTB rate in USA counties after adjusting for sociodemographic, health, behavioral and environmental factors. Future studies are needed to confirm these associations and consider them when making policies to reduce PTBs.
Collapse
Affiliation(s)
- A Das
- Department of Neonatology, Cleveland Clinic, Cleveland, OH, USA
| | - M M Trivedi
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | |
Collapse
|
4
|
Zhu B, Tao Z, Edupuganti L, Serrano MG, Buck GA. Roles of the Microbiota of the Female Reproductive Tract in Gynecological and Reproductive Health. Microbiol Mol Biol Rev 2022; 86:e0018121. [PMID: 36222685 PMCID: PMC9769908 DOI: 10.1128/mmbr.00181-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The microbiome of the female reproductive tract defies the convention that high biodiversity is a hallmark of an optimal ecosystem. Although not universally true, a homogeneous vaginal microbiome composed of species of Lactobacillus is generally associated with health, whereas vaginal microbiomes consisting of other taxa are generally associated with dysbiosis and a higher risk of disease. The past decade has seen a rapid advancement in our understanding of these unique biosystems. Of particular interest, substantial effort has been devoted to deciphering how members of the microbiome of the female reproductive tract impact pregnancy, with a focus on adverse outcomes, including but not limited to preterm birth. Herein, we review recent research efforts that are revealing the mechanisms by which these microorganisms of the female reproductive tract influence gynecologic and reproductive health of the female reproductive tract.
Collapse
Affiliation(s)
- Bin Zhu
- Microbiology & Immunology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zhi Tao
- Microbiology & Immunology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Laahirie Edupuganti
- Microbiology & Immunology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Myrna G. Serrano
- Microbiology & Immunology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gregory A. Buck
- Microbiology & Immunology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for Microbiome Engineering and Data Analysis, Virginia Commonwealth University, Richmond, Virginia, USA
- Computer Science, School of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Wood SK, Ford K, Madden HCE, Sharp CA, Hughes KE, Bellis MA. Adverse Childhood Experiences and Their Relationship with Poor Sexual Health Outcomes: Results from Four Cross-Sectional Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8869. [PMID: 35886718 PMCID: PMC9316235 DOI: 10.3390/ijerph19148869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. Exposure to adverse childhood experiences (ACEs) can increase the risk of poor sexual health outcomes, but most research is US-based. This study explored associations between ACEs and poor sexual health outcomes in the UK. Data from four cross-sectional ACE surveys with adult general populations in different regions of the UK from 2013−2015 (n = 12,788) were analysed. Data included participants’ demographics, ACE exposure, and four sexual health outcomes: having early sex (<16 years), having an accidental teenage pregnancy, becoming a teenage parent, or having a lifetime diagnosis of a sexually transmitted infection. ACE count was a consistent and significant predictor of all four sexual health outcomes for both males and females, with odds of these outcomes between three and seven times higher for those with 4+ ACEs compared to those with no ACEs. Increased risks of some, but not all, sexual health outcomes were also found with higher residential deprivation, younger age, being of white ethnicity, and being born to a teenage mother. Findings highlight the need for effective interventions to prevent and ameliorate the lifelong effects of ACEs. Trauma-informed relationships and sex education, sexual health services, and antenatal/postnatal services, particularly for teenagers and young parents, could provide opportunities to prevent ACEs and support those affected. Ensuring that those living in deprived areas have access to services and that barriers to uptake are addressed is also key.
Collapse
Affiliation(s)
- Sara K. Wood
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK; (K.E.H.); (M.A.B.)
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK;
| | - Hannah C. E. Madden
- School of Social Sciences, Liverpool Hope University, Hope Park, Liverpool L6 1HP, UK;
| | - Catherine A. Sharp
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK;
| | - Karen E. Hughes
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK; (K.E.H.); (M.A.B.)
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK;
| | - Mark A. Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK; (K.E.H.); (M.A.B.)
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK;
| |
Collapse
|
7
|
Janssen LE, Verduin RJT, de Groot CJM, Oudijk MA, de Boer MA. The association between vaginal hygiene practices and spontaneous preterm birth: A case-control study. PLoS One 2022; 17:e0268248. [PMID: 35771798 PMCID: PMC9246112 DOI: 10.1371/journal.pone.0268248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Spontaneous preterm birth (SPTB) is a major cause of neonatal morbidity and mortality worldwide and defining its risk factors is necessary to reduce its prevalence. Recent studies have pointed out that bacterial vaginosis, a disturbance in the vaginal microbiome, is associated with SPTB. It is hypothesized that vaginal hygiene practices can alter the vaginal microbiome and are therefore associated with SPTB, but there are no studies investigating this matter. METHODS AND FINDINGS A case-control study was conducted between August 2018 and July 2021 in two affiliated university medical centers in Amsterdam, the Netherlands. We included a total of 79 women with a SPTB and compared them with 156 women with a term birth. Women with uterine anomalies, a history of cervical surgery or major congenital anomalies of the fetus were excluded. All participants filled in a questionnaire about vaginal washing with water, soap or gel, the use of intravaginal douches and vaginal steaming, both before and during pregnancy. Most women washed vaginally with water, 144 (61.3%) women before pregnancy and 135 (57.4%) women during pregnancy. A total of 43 (18.3%) washed with soap before and 36 (15.3%) during pregnancy. Before pregnancy, 40 (17.0%) women washed with vaginal gel and 27 (11.5%) during pregnancy. We found that the use of vaginal gel before pregnancy (aOR 2.29, 95% CI: 1.08-4.84) and even more during pregnancy, was associated with SPTB (aOR 3.45, 95% CI: 1.37-8.67). No association was found between washing with water or soap, intravaginal douching, or vaginal steaming and SPTB. CONCLUSIONS Our findings suggest that the use of vaginal gel is associated with SPTB. Women should be informed that vaginal use of gels might not be safe.
Collapse
Affiliation(s)
- Laura E. Janssen
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Rubin J. T. Verduin
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Martijn A. Oudijk
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Marjon A. de Boer
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Jiang W, Ronen K, Osborn L, Drake AL, Unger JA, Matemo D, Enquobahrie DA, Kinuthia J, John-Stewart G. Predictors of adverse pregnancy outcomes among Kenyan women with HIV on antiretroviral treatment in pregnancy. AIDS 2022; 36:1007-1019. [PMID: 35652673 PMCID: PMC9178912 DOI: 10.1097/qad.0000000000003215] [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
OBJECTIVE The aim of this study was to understand predictors of adverse pregnancy outcomes (APOs) among women on antiretroviral treatment (ART). DESIGN A longitudinal cohort. METHODS Participants from the Mobile WAChX trial were evaluated for APOs, including stillbirth (fetal death at ≥20 weeks' gestation), preterm birth (PTB, livebirth at <37 weeks' gestation,) and neonatal death (NND, ≤28 days after live birth). Predictors were determined by univariable and multivariable Cox proportional hazards and log-binomial models. RESULTS Among 774 women included, median age was 27 years and 29.0% had unsuppressed HIV viral load (>1000 copies/ml) at enrollment. Half (55.1%) started ART prepregnancy, 89.1% on tenofovir-based regimens. Women with depression had a higher risk of stillbirth (adjusted hazard ratio [aHR] 2.93, 95% confidence interval (95% CI) 1.04-8.23), and women with lower social support score had higher risk of late stillbirth (aHR 11.74, 2.47-55.86). Among 740 livebirths, 201 (27.2%) were preterm and 22 (3.0%) experienced NND. PTB was associated with unsuppressed maternal viral load (adjusted prevalence ratio [aPR] 1.28, 95% CI 1.02-1.61), intimate partner violence (IPV) in pregnancy (aPR 1.94, 95% CI 1.28-2.94), and history of any sexually transmitted infection (STI) (aPR 1.63, 95% CI 1.06-2.51). NND was associated with PTB (aPR 2.53, 95% CI 1.10-5.78) and STI history (aPR 4.25, 95% CI 1.39-13.06). Most associations retained significance in the subgroup of women with viral suppression. CONCLUSION Maternal viremia during pregnancy predicted PTB as did IPV, lower education, and STI history, while psychosocial stressors predicted stillbirth. Implementing mental health services, ART adherence, partner support, and routine STI screening and treatment could reduce APOs among women with HIV in sub-Saharan Africa settings.
Collapse
Affiliation(s)
- Wenwen Jiang
- University of Washington, Seattle, Washington, USA
| | - Keshet Ronen
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Miller FA, Marphatia AA, Wells JC, Cortina-Borja M, Manandhar DS, Saville NM. Associations between early marriage and preterm delivery: Evidence from lowland Nepal. Am J Hum Biol 2021; 34:e23709. [PMID: 34862821 DOI: 10.1002/ajhb.23709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Preterm delivery (<37 weeks gestation) is the largest cause of child mortality worldwide. Marriage and pregnancy during adolescence have been associated with an increased risk of preterm delivery. We investigate independent associations of age at marriage and age at first pregnancy with preterm delivery in a cohort of women from rural lowland Nepal. METHODS We analyzed data from 17 974 women in the Low Birth Weight South Asia Trial. Logistic regression models tested associations of age at marriage and age at first pregnancy with preterm delivery, for primigravida (n = 6 243) and multigravida (n = 11 731) women. Models were adjusted for maternal education, maternal caste, and household asset score. RESULTS Ninety percent of participants had married at <18 years and 58% had their first pregnancy at <18 years. 20% of participants delivered preterm. Primigravida participants married at ≤14 years had higher odds of preterm delivery than those married ≥18 years, when adjusting for study design (adjusted odds ratio (aOR) 1.45, 95% CI: 1.15-1.83), confounders (aOR 1.28: 1.01-1.62) and confounders + age at pregnancy (aOR 1.29: 1.00-1.68). Associations were insignificant for multigravida women. No significant associations were observed between age at first pregnancy and preterm delivery. DISCUSSION In this population, early marriage, rather than pregnancy, is a risk factor for preterm delivery. We hypothesize that psychological stress, a driver of preterm delivery which is increased among those marrying young, rather than physiological immaturity, drives this association. Further research into the psychological consequences of child marriage in Nepal is needed.
Collapse
Affiliation(s)
- Faith A Miller
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Akanksha A Marphatia
- Department of Geography, University of Cambridge, Cambridge, UK.,Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Jonathan C Wells
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | | | - Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
| |
Collapse
|
10
|
Gao R, Liu B, Yang W, Wu Y, Wang B, Santillan MK, Ryckman K, Santillan DA, Bao W. Association of Maternal Sexually Transmitted Infections With Risk of Preterm Birth in the United States. JAMA Netw Open 2021; 4:e2133413. [PMID: 34842927 PMCID: PMC8630565 DOI: 10.1001/jamanetworkopen.2021.33413] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Maternal infection has been implicated in the pathogenesis of preterm birth through intrauterine inflammatory response. Chlamydia, gonorrhea, and syphilis are among the most common sexually transmitted infections worldwide, but studies on their association with preterm birth are sparse. OBJECTIVE To examine the association between maternal chlamydia, gonorrhea, and syphilis infections in pregnancy and the risk of preterm birth in a large population-based study in the US. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study examined nationwide birth certificate data from the US National Vital Statistics System between 2016 and 2019. All mothers who had a singleton live birth and available data on chlamydia, gonorrhea, or syphilis infection before or during pregnancy and gestational age at birth were included in analysis. EXPOSURES Sexually transmitted infection (chlamydia, gonorrhea, or syphilis) occurring before or during pregnancy. MAIN OUTCOMES AND MEASURES Preterm birth, defined as gestational age less than 37 weeks. RESULTS This study included 14 373 023 mothers (mean [SD] age 29 [5.8] years; Hispanic, 3 435 333 [23.9%]; non-Hispanic Asian, 912 425 [6.3%]; non-Hispanic Black, 2 058 006 [14.3%]; and non-Hispanic White, 7 386 568 [51.4%]). Among the mothers, 267 260 (1.9%) had chlamydia, 43 147 (0.3%) had gonorrhea, and 16 321 (0.1%) had syphilis. Among the newborns, 1 146 800 (8.0%) were preterm births. The rate of preterm birth was 9.9%, 12.2%, and 13.3% among women with chlamydia, gonorrhea, and syphilis infection, respectively. After adjustment for sociodemographic and medical and/or health factors, the adjusted odds ratio of preterm birth was 1.03 (95% CI, 1.02-1.04) for chlamydia, 1.11 (95% CI, 1.08-1.15) for gonorrhea, 1.17 (95% CI, 1.11-1.22) for syphilis, and 1.06 (95% CI, 1.05-1.07) for any of these sexually transmitted infections comparing mothers with these conditions and those without. CONCLUSIONS AND RELEVANCE Maternal sexually transmitted infections (gonorrhea, syphilis, or chlamydia) were associated with an increased risk of preterm birth. Pregnant women with sexually transmitted infections before or during pregnancy might benefit from targeted prevention for preterm birth.
Collapse
Affiliation(s)
- Rui Gao
- Shenzhen Birth Cohort Study Center, Nanshan Maternity and Child Healthcare Hospital of Shenzhen, Shenzhen, China
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Buyun Liu
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Wenhan Yang
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
- Department of Maternal and Child Health, Sun Yat-sen University School of Public Health, Guangzhou, Guangdong Province, China
| | - Yuxiao Wu
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Bo Wang
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Mark K. Santillan
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City
- Center for Hypertension Research, University of Iowa, Iowa City
| | - Kelli Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Donna A. Santillan
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City
- Center for Hypertension Research, University of Iowa, Iowa City
| | - Wei Bao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| |
Collapse
|
11
|
Adhikari EH, Roberts S. Sexually Transmitted Infections and Preterm Birth-Attempting to Pin Down Targets for Intervention From Population-Level Observational Data. JAMA Netw Open 2021; 4:e2134459. [PMID: 34842929 DOI: 10.1001/jamanetworkopen.2021.34459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Scott Roberts
- University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
12
|
Freedman AA, Smart BP, Keenan-Devlin LS, Borders A, Ernst LM, Miller GE. Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery. J Epidemiol Community Health 2021; 76:398-403. [PMID: 34607891 DOI: 10.1136/jech-2020-215377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Housing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes. METHODS We used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups. RESULTS Individuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies. CONCLUSION Our results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.
Collapse
Affiliation(s)
- Alexa A Freedman
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA .,Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Linda M Ernst
- Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Gregory E Miller
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA.,Department of Psychology, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|
13
|
Green J, Petty J, Whiting L, Fowler C. Exploring modifiable risk-factors for premature birth in the context of COVID-19 mitigation measures: A discussion paper. JOURNAL OF NEONATAL NURSING : JNN 2021; 27:172-179. [PMID: 33169065 PMCID: PMC7640921 DOI: 10.1016/j.jnn.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 12/20/2022]
Abstract
During the COVID-19 pandemic, parents with sick or premature babies have faced challenges following admission to a neonatal unit due to the imposed lock-down restrictions on social contact, hospital visitation and the wearing of personal protective equipment. The negative short-term impact on neonatal care in relation to the prevention of close proximity, contact and bonding between parents and babies is potentially significant. However, an interesting finding has been reported of a reduction in premature birth admissions to the neonatal intensive care unit during the pandemic, raising important questions. Why was this? Was it related to the effect of the modifiable risk-factors for premature birth? This discussion paper focuses on an exploration of these factors in the light of the potential impact of COVID-19 restrictions on neonatal care. After contextualising both the effect of premature birth and the pandemic on neonatal and parental short-term outcomes, the discussion turns to the modifiable risk-factors for premature birth and makes recommendations relevant to the education, advice and care given to expectant mothers.
Collapse
Affiliation(s)
- Janet Green
- School of Nursing, College of Health and Medicine, University of Tasmania, Australia
| | - Julia Petty
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Lisa Whiting
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Cathrine Fowler
- Faculty of Health, University of Technology, Sydney, Australia
| |
Collapse
|
14
|
Ravindran J, Richardson B, Kinuthia J, Unger JA, Drake AL, Osborn L, Matemo D, Patterson J, McClelland RS, John-Stewart G. Chlamydia, gonorrhea, and incident HIV infection during pregnancy predict preterm birth despite treatment. J Infect Dis 2021; 224:2085-2093. [PMID: 34023871 DOI: 10.1093/infdis/jiab277] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identifying predictors of preterm birth (PTB) in high burden regions is important as PTB is the leading cause of global child mortality. METHODS This analysis was nested in a longitudinal study of peripartum HIV incidence in Kenya. HIV-seronegative women enrolled in pregnancy were screened with nucleic acid amplification tests (chlamydia and gonorrhea), RPR (syphilis), wet mount microscopy (Trichomonas and yeast), and Gram stain (bacterial vaginosis); sexually transmitted infection (STI) treatment was provided. PTB predictors were determined using log binomial regression. FINDINGS Among 1244 mothers of liveborn infants, median age was 22 years (IQR 19 - 27), median gestational age at enrollment was 26 weeks (IQR 22 - 31) and at delivery was 39.1 weeks (IQR 37.1 - 40.9). PTB occurred in 302 women (24.3%). Chlamydia was associated with a 1.59-fold (p=0.006), gonorrhea a 1.62-fold (p=0.04) and incident HIV a 2.08-fold (p=0.02) increased prevalence of PTB. Vaginal discharge and cervical inflammation were significantly associated with PTB, as were age ≤21 (prevalence ratio [PR] =1.39, p=0.001) and any STI (PR=1.47, p=0.001). Chlamydia and incident HIV remained associated with PTB in multivariable models. INTERPRETATION STIs and incident HIV in pregnancy predicted PTB despite treatment, suggesting need for earlier treatment and interventions to decrease genital inflammation.
Collapse
Affiliation(s)
| | - Barbra Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Jennifer A Unger
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | | | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Vallely LM, Egli-Gany D, Wand H, Pomat WS, Homer CSE, Guy R, Silver B, Rumbold AR, Kaldor JM, Vallely AJ, Low N. Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae: systematic review and meta-analysis. Sex Transm Infect 2021; 97:104-111. [PMID: 33436505 PMCID: PMC7892372 DOI: 10.1136/sextrans-2020-054653] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/28/2020] [Accepted: 11/28/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To examine associations between Neisseria gonorrhoeae (NG) infection during pregnancy and the risk of preterm birth, spontaneous abortion, premature rupture of membranes, perinatal mortality, low birth weight and ophthalmia neonatorum. Data sources We searched Medline, EMBASE, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature for studies published between 1948 and 14 January 2020. Methods Studies were included if they reported testing for NG during pregnancy and compared pregnancy, perinatal and/or neonatal outcomes between women with and without NG. Two reviewers independently assessed papers for inclusion and extracted data. Risk of bias was assessed using established checklists for each study design. Summary ORs with 95% CIs were generated using random effects models for both crude and, where available, adjusted associations. Results We identified 2593 records and included 30 in meta-analyses. Women with NG were more likely to experience preterm birth (OR 1.55, 95% CI 1.21 to 1.99, n=18 studies); premature rupture of membranes (OR 1.41, 95% CI 1.02 to 1.92, n=9); perinatal mortality (OR 2.16, 95% CI 1.35 to 3.46, n=9); low birth weight (OR 1.66, 95% CI 1.12 to 2.48, n=8) and ophthalmia neonatorum (OR 4.21, 95% CI 1.36 to 13.04, n=6). Summary adjusted ORs were, for preterm birth 1.90 (95% CI 1.14 to 3.19, n=5) and for low birth weight 1.48 (95% CI 0.79 to 2.77, n=4). In studies with a multivariable analysis, age was the variable most commonly adjusted for. NG was more strongly associated with preterm birth in low-income and middle-income countries (OR 2.21, 95% CI 1.40 to 3.48, n=7) than in high-income countries (OR 1.38, 95% CI 1.04 to 1.83, n=11). Conclusions NG is associated with a number of adverse pregnancy and newborn outcomes. Further research should be done to determine the role of NG in different perinatal mortality outcomes because interventions that reduce mortality will have the greatest impact on reducing the burden of disease in low-income and middle-income countries. PROSPERO registration number CRD42016050962.
Collapse
Affiliation(s)
- Lisa M Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Dianne Egli-Gany
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Handan Wand
- Biostatistics and Databases program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Rebecca Guy
- Surveillance and Evaluation Research, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Bronwyn Silver
- Public Health Division, Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - Alice R Rumbold
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - John M Kaldor
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| |
Collapse
|
17
|
Sexually transmitted infections in pregnancy - An update on Chlamydia trachomatis and Neisseria gonorrhoeae. Eur J Obstet Gynecol Reprod Biol 2020; 255:1-12. [PMID: 33059307 DOI: 10.1016/j.ejogrb.2020.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Routine screening for Chlamydia and gonococcal infection in pregnancy is not widespread, especially in low- and middle-income countries (LMICs), despite their potential adverse consequences on pregnancy outcome. We conducted a systematic literature search of three major databases to review current literature surrounding Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnancy. We discuss the epidemiology and burden of both infections, detection methods, potential adverse feto-maternal and infant outcomes and provide an overview of treatment options. A total of 67 articles met the inclusion criteria. The prevalence of C. trachomatis and N. gonorrhoeae across all trimesters ranged between 1.0%-36.8% and 0-14.2% worldwide, respectively. The most common diagnostic method is the Nucleic acid amplification test (NAAT). In pregnancy, chlamydia is associated with preterm birth, spontaneous miscarriage, stillbirth and neonatal conjunctivitis, while gonorrhoea is mainly associated with preterm birth and stillbirth. Amoxicillin, erythromycin and azithromycin showed similar efficacy in the treatment of chlamydia in pregnancy, while ceftriaxone and cefixime were effective in treating gonorrhoea in pregnancy. Being largely asymptomatic infections in women, we opine that detection strategies with locally appropriate tools should be combined with the syndromic approach in LMICs, where there is a high burden of disease.
Collapse
|
18
|
Kowalska JD, Nowicka K, Wroblewska A, Firląg-Burkacka E, Marczyńska M. A current HCV infection may increase the risk of preterm birth among HIV-positive women. Sex Transm Infect 2020; 96:335-336. [PMID: 32071123 DOI: 10.1136/sextrans-2019-054324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warszawa, Poland .,HIV Outpatient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
| | - Karolina Nowicka
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warszawa, Poland
| | - Agnieszka Wroblewska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warszawa, Poland.,HIV Outpatient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
| | | | - Magdalena Marczyńska
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warszawa, Poland
| |
Collapse
|