Chlamydia, Gonorrhea, and Incident HIV Infection During Pregnancy Predict Preterm Birth Despite Treatment.
Child
Chlamydia
/ isolation & purification
Chlamydia Infections
/ complications
Female
Gonorrhea
/ complications
HIV Infections
/ complications
Humans
Infant
Infant, Newborn
Inflammation
/ etiology
Longitudinal Studies
Neisseria gonorrhoeae
/ isolation & purification
Parturition
Pregnancy
Pregnancy Complications, Infectious
/ epidemiology
Pregnancy Outcome
/ epidemiology
Pregnant Women
Premature Birth
/ epidemiology
Prevalence
Sexually Transmitted Diseases
Trichomonas Infections
/ complications
Trichomonas vaginalis
/ isolation & purification
Young Adult
HIV
STI
chlamydia
gonorrhea
preterm birth
sexually transmitted infections
Journal
The Journal of infectious diseases
ISSN: 1537-6613
Titre abrégé: J Infect Dis
Pays: United States
ID NLM: 0413675
Informations de publication
Date de publication:
15 12 2021
15 12 2021
Historique:
received:
11
02
2021
accepted:
19
05
2021
pubmed:
24
5
2021
medline:
27
1
2022
entrez:
23
5
2021
Statut:
ppublish
Résumé
Identifying predictors of preterm birth (PTB) in high-burden regions is important as PTB is the leading cause of global child mortality. This analysis was nested in a longitudinal study of human immunodeficiency virus (HIV) incidence in Kenya. HIV-seronegative women enrolled in pregnancy had nucleic acid amplification tests (chlamydia and gonorrhea), rapid plasma reagin (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. Among 1244 mothers of liveborn infants, 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 = .006), gonorrhea a 1.62-fold (P = .04), and incident HIV a 2.08-fold (P = .02) increased PTB prevalence. Vaginal discharge and cervical inflammation were associated with PTB, as were age ≤21 (prevalence ratio [PR] = 1.39, P = .001) and any STI (PR = 1.47, P = .001). Associations with chlamydia and incident HIV remained in multivariable models. STIs and incident HIV in pregnancy predicted PTB despite treatment, suggesting the need for earlier treatment and interventions to decrease genital inflammation.
Sections du résumé
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 human immunodeficiency virus (HIV) incidence in Kenya. HIV-seronegative women enrolled in pregnancy had nucleic acid amplification tests (chlamydia and gonorrhea), rapid plasma reagin (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.
RESULTS
Among 1244 mothers of liveborn infants, 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 = .006), gonorrhea a 1.62-fold (P = .04), and incident HIV a 2.08-fold (P = .02) increased PTB prevalence. Vaginal discharge and cervical inflammation were associated with PTB, as were age ≤21 (prevalence ratio [PR] = 1.39, P = .001) and any STI (PR = 1.47, P = .001). Associations with chlamydia and incident HIV remained in multivariable models.
CONCLUSIONS
STIs and incident HIV in pregnancy predicted PTB despite treatment, suggesting the need for earlier treatment and interventions to decrease genital inflammation.
Identifiants
pubmed: 34023871
pii: 6282455
doi: 10.1093/infdis/jiab277
pmc: PMC8672741
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2085-2093Subventions
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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