Pregnancy outcomes in women infected with Chlamydia trachomatis: a population-based cohort study in Washington State

Abstract

Objectives: To measure the risk of preterm delivery, premature rupture of membranes, infant low birth weight and infant mortality, by a population-based retrospective cohort study using Washington State birth certificate data. Methods: All women diagnosed with Chlamydia trachomatis infection (n = 851), noted with a check box on the birth certificate from 2003, and a randomly selected sample of women not diagnosed with C trachomatis (n = 3404) were identified. To assess the RR between chlamydia infection and pregnancy outcomes, multivariable logistic regression analysis was used. Results: Women with chlamydia infection were younger, more likely to be non-white and had less years of education compared with women without chlamydia. Additionally, they were more likely to have inadequate prenatal care and coinfections with other sexually transmitted infections. After adjusting for age and education, chlamydia-infected women were at an increased risk of preterm delivery (RR 1.46, 95% CI 1.08 to 1.99) and premature rupture of membranes (RR 1.50, 95% CI 1.03 to 2.17) compared with non-infected women. However, no increased risk of infant death (RR 1.02, 95% CI 0.37 to 2.80) or low birth weight (RR 1.12, 95% CI 0.74 to 1.68) associated with chlamydia infection was observed. Conclusion: This study suggests that C trachomatis is associated with an increased risk of preterm delivery and premature rupture of membranes, but not with infant death and low birth weight. Routine screening and opportune treatment for C trachomatis should be considered a necessary part of prenatal care to reduce these adverse pregnancy outcomes. G enital chlamydial infection is recognised as one of the most common sexually transmitted infections (STIs) worldwide. In 1999, 92 of the 340 million new STI cases reported by the World Health Organization were due to this infection.1 Chlamydia trachomatis is also the most commonly reported notifiable disease in the US, and the leading cause of bacterial STI in industrialised countries.2 3 In the US, there are approximately four million new chlamydia infections per year. It is estimated that ,10% of these cases are diagnosed, resulting in an adverse impact, especially in women not treated for this infection. Infection with C trachomatis can lead to severe complications of the reproductive tract and adverse pregnancy outcomes. The common clinical manifestations of this infection include cervicitis, pelvic inflammatory disease and tubal factor infertility. [5][6][7] In pregnant women, chlamydia infection has been associated with an increased risk of ectopic pregnancy, preterm delivery, spontaneous abortions, low birth weight, premature rupture of membranes, perinatal mortality and postpartum endometritis.5 8-14 Because of these risks, screening of pregnant women at the first prenatal visit is recommended by the Centers for Disease Control and Prevention and US Preventive Services Task Force. Additionally, both organisations suggest testing pregnant women at increased risk a second time during the third trimes...

The management of sexually transmitted infections in pregnancy

“…The largest study 4 shows an association between antenatal chlamydia and preterm rupture of membranes and low birthweight, but only in women with evidence of primary infection. However, culture was used to detect chlamydia and this is now known to have only 60-70% sensitivity, being better at detecting infections More recent studies using newer diagnostic techniques show associations between chlamydia and preterm birth 5,6 and low birthweight; 7 they also suggest an increased risk of complications the earlier in the pregnancy the infection occurs. 8 There is some evidence that treatment of chlamydia in pregnancy reduces complications.…”

2010 European guideline for the management of Chlamydia trachomatis infections

“…Infection is associated with premature labour, preterm birth and neonatal conjunctivitis and pneumonitis. 60,61 The positive effect of treatment on pregnancy outcome suggests screening and treatment of all pregnant women. 62 Preferably all pregnant women, but at least pregnant women from high prevalence populations (e.g.…”

Chlamydia trachomatis Infections in Neonates

“…A suspected choriodecidual inflammation and histological chorioamnionitis can give a possible explanation for the mechanism that may lead to the premature rupture of amniotic membranes. Chorioamnionitis is frequently seen in the case of premature babies, but the role of chlamydial infection in subsequent respiratory insufficiency is yet to be determined (Blas et al, 2007;Givner et al, 1981;Mårdh, 2002;Numazaki, 2004;Rastogi et al, 1999Rastogi et al, , 2003Yoshida et al, 2000).…”

“…The unfavourable consequences of placental inflammation are not yet completely understood, but direct impact of pathogens or organ damage due to inflammatory cytokines and proteolytic enzymes may both serve as an explanation. Several surveys indicate that among other bacteria deriving from urogenital reservoir C. trachomatis carriage also increases the risk of the premature rupture of membranes (PROM), as well as that of preterm uterine activity in infected women, which may contribute to fetal morbidity and mortality (Blas et al, 2007;Mårdh, 2002, Yu et al;. Much of the harmful complications of C. trachomatis infection are supposed to occur via immunopathological damage (Baud et al, 2008).…”