Influence of Sexually Transmitted Infections in Pregnant Adolescents on Preterm Birth and Chorioamnionitis

Abstract

Background. Adolescents have an increased risk of preterm birth (PTB) and sexually transmitted infections (STIs). We examined the prevalence and impact of STIs (gonorrhea, chlamydia, and trichomonas) on PTB and chorioamnionitis in pregnant adolescents. Methods. This retrospective cohort study utilized the first pregnancy delivered at an urban hospital among patients≤19 years old over a 5-year period. Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of the association between STIs and PTB (<37 weeks) and chorioamnionitis identified by clinical or placental pathology criteria. Results. 739 deliveries were included. 18.8% (n=139) of births were preterm. The overall prevalence of STIs during pregnancy was 16.5% (Chlamydia trachomatis: 13.1%, n=97; Trichomonas vaginalis: 3.7%, n=27; and Neisseria gonorrheae: 3.1%, n=23). Detection of C. trachomatis, T. vaginalis, or N. gonorrheae was not associated with increased PTB. While infection with N. gonorrheae and C. trachomatis did not increase the likelihood of any chorioamnionitis, infection with T. vaginalis significantly increased the likelihood of any chorioamnionitis diagnosis (aPR 2.19, 95% CI 1.26-3.83). Conclusion. In this adolescent population with a high rate of PTB, in whom most received appropriate STI treatment, we did not find an association between STI during pregnancy and an increased rate of PTB. However, an infection with T. vaginalis was associated with an increased likelihood of chorioamnionitis. Early detection of STIs may prevent adverse pregnancy outcomes. Continued vigilance in STI screening during pregnancy, including consideration of universal Trichomonas vaginalis screening, is merited in this high-risk population.

Relationship between vaginal group B streptococcus colonization in the early stage of pregnancy and preterm birth: a retrospective cohort study

“…But our study has several limitations. First, the lack of data about sexually transmitted infections (STIs), which is reported to be a risk factor for PTB in the context of vaginal microbiota [ 21 ]. Second, the lack of performing GBS serotyping.…”

Sexually transmitted infections in pregnant women from sub-Saharan Africa

“…25,47 Similarly, Mullick et al 97 demonstrated a higher incidence of low birth weight and preterm delivery in pregnant women infected with T. vaginalis. In a recent study by Fuchs et al, 84 it was reported that adolescents diagnosed with T. vaginalis during pregnancy had more than a twofold increased likelihood of chorioamnionitis compared to those not diagnosed with T. vaginalis.The C. trachomatis infection in the third trimester of pregnancy was associated with more than a twofold increased likelihood of preterm birth when compared to participants without C. trachomatis during pregnancy. 84 A 2015 meta-analysis of M. genitalium infection in pregnant women reported an approximately twofold increase in the odds of preterm delivery or spontaneous abortion in women with this STI.…”

“…In a recent study by Fuchs et al, 84 it was reported that adolescents diagnosed with T. vaginalis during pregnancy had more than a twofold increased likelihood of chorioamnionitis compared to those not diagnosed with T. vaginalis.The C. trachomatis infection in the third trimester of pregnancy was associated with more than a twofold increased likelihood of preterm birth when compared to participants without C. trachomatis during pregnancy. 84 A 2015 meta-analysis of M. genitalium infection in pregnant women reported an approximately twofold increase in the odds of preterm delivery or spontaneous abortion in women with this STI. 98 Furthermore, a recent study conducted by Smullin et al 60 in South Africa reported an association between M. genitalium and adverse pregnancy outcomes in HIV-infected pregnant women.…”

“… 71 Several studies have reported that risk factors associated with STIs include younger age, condomless sex, being single or unmarried, having more than one sexual partner, unemployment, low level education attainment, frequent alcohol use, frequent tobacco use, illegal substance use and a history of previous STIs. 29 , 30 , 31 , 60 , 67 , 73 , 82 , 83 , 84 Furthermore, a recent study had reported that having oral, anal or vaginal intercourse having multiple partners, having anonymous partners, using alcohol or drugs and not wearing condoms increases the risk for HIV and other STIs. 85 Several studies have reported that the prevalence of STI in pregnant women younger than 25 years of age is significantly higher when compared to pregnant women aged 25–35 years, but the risk in pregnant women > 35 years of age is declining.…”

Genital Tract Infection during Pregnancy and its Association with Preterm Delivery

“…46 Another retrospective cohort study also failed to demonstrate a relationship between preterm delivery and gonorrhea despite finding a trend toward chorioamnionitis during the third trimester of pregnancy with gonorrhea. 47 These findings suggest that gonorrhea's role in inducing chorioamnionitis is time-specific.…”