The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review

Abstract

Adverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality, including long-term physical and psychological sequelae. These events are common in low- and middle-income countries, particularly in Sub Saharan Africa, despite national efforts. Maternal infections can cause complications at any stage of pregnancy and contribute to adverse outcomes. Among infections, those of the genital tract are a major public health concern worldwide, due to limited availability of prevention, diagnosis and treatment approaches. This applies even to treatable infections and holds true especially in Sub-Saharan Africa. As late as 2017, the region accounted for 40% of all reported treatable non-viral genital pathogens worldwide, many of which have been independently associated with various adverse pregnancy outcomes, and that include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum. Two databases (PubMed and Embase) were examined to identify eligible studies published up to October 2022. This study reviewed findings on the association between infections by treatable non-viral genital pathogens during pregnancy and adverse pregnancy outcomes among women living in Sub-Saharan Africa. Articles' title and abstract were screened at first using keywords as “sexually transmitted infections”, “non-viral”, “adverse pregnancy outcome”, “Africa”, “sub-Saharan Africa”, “pregnant women”, “pregnancy”, and “pregnancy outcome”. Subsequently, according to the eligibility criteria, potential articles were read in full. Results showed that higher risk of preterm birth is associated with Treponema pallidum, Chlamydia trachomatis and Candida albicans infections. Additionally, rates of stillbirth, neonatal death, low birth weight and intrauterine growth restriction are also associated with Treponema pallidum infection. A better insight on the burden of non-viral genital pathogens and their effect on pregnancy is needed to inform antenatal care guidelines and screening programs, to guide the development of innovative diagnostic tools and other strategies to minimize transmission, and to prevent short- and long-term complications for mothers and children.

Análise epidemiológica dos óbitos por doença inflamatória dos órgãos pélvicos femininos no Brasil entre 2013 e 2022

“…Também foi relatado que Streptococcus pyogenes causa salpingite em alguns estudos (Gamberini et al, 2023).…”

“…Muitas mulheres que recebem um diagnóstico de DIP não apresentam evidências de infecção do trato genital, enquanto outras mulheres obtêm diagnóstico de DIP apenas quando descobrem que têm infertilidade por fator tubário. O diagnóstico de DIP é complicado porque: pode ser uma sequela de patógenos sexualmente transmissíveis, incluindo Neisseria gonorrhoeae ou Chlamydia trachomatis; pode ocorrer quando patógenos respiratórios ou entéricos infectam o trato genital feminino, ou quando bactérias e micoplasmas que fazem parte do microbioma vaginal ascendem para o trato genital superior e causam inflamação (Gamberini et al, 2023).…”

Intermittent preventive treatment with sulphadoxine-pyrimethamine but not dihydroartemisinin-piperaquine modulates the relationship between inflammatory markers and adverse pregnancy outcomes in Malawi

“…In 2019 in Africa, malaria in pregnancy resulted in an estimated 900,000 LBW deliveries due to a mix of SGA and PTB [5,6]. In LMICs, sexually transmitted infections, HIV, and reproductive tract infections also contribute to adverse pregnancy outcomes [7][8][9].…”