Sexually transmitted infections and risk of hypertensive disorders of pregnancy

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.

The Impact of Neisseria gonorrhoeae Mono- and Coinfection on Adverse Pregnancy Outcomes

“…In our study, we were unable to distinguish the use of vaginal versus urine for STI diagnosis. It is possible that our study underestimated rates of gonorrhea, but prevalence is consistent with national data in similar populations [ 12 , 15 ]. We were unable to find detailed data on treatments, adherence, partner treatment, and recurrence of infection.…”

“…Similarly, 15% of individuals who tested positive for gonorrhea had a preterm delivery. Our study, in addition to recent work by others, has shown a potential link between gonorrhea and HDP as well as preterm birth [ 14 , 15 , 38 ], within populations that are presumed treated after screening. It may be time for a fresh examination of the impact of STIs on pregnancy health and a new focus on alternative prevention strategies.…”

“…Thus, lack of consideration of subtypes often limits the ability to identify risk and predictive factors [ 42 ]. In a recent study of 38 000 prenatal records, researchers examined preeclampsia subtypes defined by severity [ 15 ] but found no association between gonorrhea and gestational hypertension, mild preeclampsia, or preeclampsia with severe features. They did find that those with gonorrhea, but without a documented CDC-recommended treatment, had an increased risk of preeclampsia with severe features.…”

“…Thus, residual confounding cannot be completely ruled out. We did not have extensive data on adequacy of prenatal care or timing of infection, but others have shown that associations between STIs and adverse pregnancy outcomes are consistent when stratified by these factors [ 15 , 38 ]. Our population is different than the general US population.…”

“…Chlamydia has been associated with superimposed preeclampsia and preeclampsia with severe features, whereas syphilis has been associated with gestational hypertension [ 14–17 ]. Studies of gonorrhea and HDP are rare [ 14 , 15 ], and it remains unknown whether gonorrhea has any impact on various HDP.…”