Trichomoniasis and adverse birth outcomes: a systematic review and meta‐analysis

Abstract

Background Trichomoniasis commonly affects women of childbearing age and has been linked to several adverse birth outcomes.Objective To elucidate the association between trichomoniasis in pregnant women and adverse birth outcomes, including preterm delivery, prelabour rupture of membranes and low birthweight.Search strategy MEDLINE, EMBASE and ClinicalTrials.gov were systematically searched in December 2020 without time or language restrictions.Selection criteria Original research studies were included if they assessed at least one of the specified adverse birth outcomes in pregnant women with laboratory-diagnosed trichomoniasis.Data collection and analysis Estimates from included articles were either extracted or calculated and then pooled to produce a combined estimate of the association of trichomoniasis with each adverse birth outcome using the random effects model. Heterogeneity was assessed using the I 2 statistic and Cochran's Q test.Main results Literature search produced 1658 publications after removal of duplicates (n = 770), with five additional publications identified by hand search. After screening titles and abstracts for relevance, full text of 84 studies was reviewed and 19 met inclusion criteria for meta-analysis. Significant associations were found between trichomoniasis and preterm delivery (OR 1.27; 95% CI 1.08-1.50), prelabour rupture of membranes (OR 1.87; 95% CI 1.53-2.29) and low birthweight (OR 2.12; 95% CI 1.15-3.91).Conclusions Trichomoniasis in pregnant women is associated with preterm delivery, prelabour rupture of membranes and low birthweight. Rigorous studies are needed to determine the impact of universal trichomoniasis screening and treatment during pregnancy on reducing perinatal morbidity.

Trichomonas vaginalis and Spontaneous Preterm Birth in a High-Risk Obstetric Cohort in Atlanta, GA

“…A 2014 meta-analysis found that TV infection was associated with an increased risk of PTB (RR, 1.34; 95% CI, 1.19–1.51; P < 0.001) 7 in 6 studies of more than 20,000 participants and controlling for STI coinfection. More recently, a 2021 meta-analysis found a similar magnitude of the effect of TV on PTB (OR, 1.27; 95% CI, 1.08–1.50), analyzing 11 studies including >80,000 participants 6 . Our study may have been underpowered to detect an effect, given a potentially small effect size, as suggested by the meta-analyses.…”

“…More recently, a 2021 meta-analysis found a similar magnitude of the effect of TV on PTB (OR, 1.27; 95% CI, 1.08-1.50), analyzing 11 studies including >80,000 participants. 6 Our study may have been underpowered to detect an effect, given a potentially small effect size, as suggested by the meta-analyses. Lack of association between TV and PTB was seen in 3 recent studies in underserved populations: adolescents in Illinois 21 (adjusted prevalence ratio, 1.19; 95% CI, 0.58-2.43), South African women with 37% HIV seroprevalence 22 (aOR, 1.1; 95% CI, 0.7-1.9), and Australian indigenous women 23 (aOR, 0.66; 95% CI, 0.39-1.12).…”

“…A 2014 meta-analysis 7 found an increased risk of PTB with TV infection after adjusting for coinfection with other STIs (relative risk [RR], 1.34; 95% confidence interval [95% CI], 1.19–1.51). An even larger 2021 meta-analysis including >80,000 patients similarly showed increased odds of PTB with TV (odds ratio [OR], 1.27; 95% CI, 1.08–1.50) 6 . Despite this, benefit of the treatment of TV during pregnancy is unclear.…”

“…2 Trichomonas vaginalis causes an inflammatory vaginitis and is associated with adverse reproductive health outcomes, including HIV acquisition and transmission, 3 cervical cancer, 4 infertility, 5 and preterm birth (PTB). 6,7 As with other STIs in the United Stated, systemic racism has resulted in a striking health disparity in infection rates through multiple pathways, including economic injustice, residential segregation, inadequate health care quality/access, and discriminatory incarceration. 8 Drawing from the 2001-2004 National Health and Examination Survey, the estimated prevalence of TV in reproductively aged US women was 3% overall, 13% among non-Hispanic Black women, and 1% among non-Hispanic White women.…”

“…An even larger 2021 meta-analysis including >80,000 patients similarly showed increased odds of PTB with TV (odds ratio [OR], 1.27; 95% CI, 1.08-1.50). 6 Despite this, benefit of the treatment of TV during pregnancy is unclear. A randomized controlled trial of the treatment of asymptomatic TV infection found a higher risk of PTB with metronidazole administration 11 (19% vs.…”