Maternal genitourinary infections and poor nutritional status increase risk of preterm birth in Gasabo District, Rwanda: a prospective, longitudinal, cohort study

Abstract

Background: Preterm birth (PTB) is a leading cause of early childhood mortality and morbidity, including long-term physical and mental impairment. The risk factors for PTB are complex and include maternal nutritional status and infections. This study aimed to identify potentially modifiable risk factors for targeted interventions to reduce the occurrence of PTB in Rwanda. Methods: We conducted a prospective, longitudinal cohort study of healthy pregnant women aged 18 to 49 years. Women at 9-15 gestational weeks were recruited from 10 health centers in Gasabo District, Kigali Province between September and October 2017. Pregnancy age was estimated using ultrasonography and date of last menstruation. Anthropometric and laboratory measurements were performed using standard procedures for both mothers and newborns. Surveys were administered to assess demographic and health histories. Categorical and continuous variables were depicted as proportions and means, respectively. Variables with p < 0.25 in bivariate analyses were included in multivariable logistic regression models to determine independent predictors of PTB. The results were reported as odds ratios (ORs) and 95% confidence intervals (CI), with statistical significance set at p < 0.05. Results: Among 367 participants who delivered at a mean of 38.0 ± 2.2 gestational weeks, the overall PTB rate was 10.1%. After adjusting for potential confounders, we identified the following independent risk factors for PTB: anemia (hemoglobin < 11 g/dl) (OR: 4.27; 95%CI: 1.85-9.85), urinary tract infection (UTI) (OR:9.82; 95%CI: 3.88-24.83), chlamydia infection (OR: 2.79; 95%CI: 1.17-6.63), inadequate minimum dietary diversity for women (MDD-W) score (OR:3.94; CI: 1.57-9.91) and low mid-upper arm circumference (MUAC) < 23 cm (OR: 3.12, 95%CI; 1.31-7.43). indicators of nutritional inadequacy (low MDD-W and MUAC) predicted risk for low birth weight (LBW) but only UTI was associated with LBW in contrast with PTB.

Association between micronutrients and maternal leukocyte telomere length in early pregnancy in Rwanda

“…In Rwanda, anemia and low hemoglobin levels are present in 19% women of childbearing age, of which 7% are underweight [13,14]. In a recent study, during early pregnancy, anemia was found to be present in 33% participants; in addition, participants showed deficiencies in iron levels as measured by ferritin and soluble transferrin receptors (sTfRs) (19.1%) [15]. In the same study, 27.3% and 7.9% participants showed high levels of inflammatory markers; C reactive protein (CRP) and alpha A glycoprotein (AGP) suggestive of infection or other inflammatory processes [15].…”

“…We assessed leukocyte telomere length in healthy pregnant women aged 18-45 years as part of a prospective, cohort study of pregnant women from 10 health centers in Gasabo District, Kigali Province [15]. Participants were enrolled from September to October 2017 as previously described [15] and were in early pregnancy (gestational age 9-15 weeks, as confirmed by ultrasound and self-reported last menstrual period). Inclusion criteria included testing negative for HIV and syphilis, singleton pregnancy, speaking Kinrywanda or English and providing written consent for participation.…”

“…Pregnant women were approached by community health workers in charge of maternal and child healthcare in the catchment area under their responsibilities as previously described in detail [15]. Eligible candidates reported to the nearest health center for preliminary screening, and trained enumerators obtained verbal and written informed consent from participants prior to their inclusion in the study.…”

“…Cultures were grown and biochemical identification was performed, according to standard procedures [28]. As previously described [15], Trichomonas vaginalis presence was determined using wet mount microscopy [29], while Candida albicans presence was determined by cultures, followed by the germ tube test [30]. Chlamydia trachomatis was detected using CORTEZ One-Step Chlamydia Rapicard™ [31].…”

Maternal Urinary Tract Infection: Is It Associated With Neonatal Urinary Tract Infection?

“…In a recent study, the effect of maternal urinary tract infection was investigated. Maternal urinary tract infection was found to be associated with prematurity ( 12 ). Howley et al examined the effect of maternal urinary tract infection on birth defects ( 13 ).…”