Source:
Investigators from multiple institutions conducted a retrospective study to assess the association between maternal sexually transmitted infections (STI) during pregnancy and premature birth. For the study, they reviewed data on birth certificates of children born by singleton birth between 2016 and 2019 in all 50 states and the District of Columbia. Data abstracted from birth certificates included demographic information, maternal pregnancy history, and estimated gestational age at birth. Also included on the birth certificates was a history of maternal infection with chlamydia, gonorrhea, and/or syphilis at the time of the diagnosis of pregnancy or during pregnancy. The primary study outcome was premature birth, defined as gestational age <37 weeks. Secondary outcomes included extremely premature birth (<28 weeks), very preterm birth (28-31 weeks), and moderately preterm birth (32-36 weeks). The association between maternal STI and these outcomes were assessed with logistic and multinomial regression, after adjustment for multiple confounders. Models that included any of the assessed STIs, and specific STIs were conducted. In addition, analyses stratified by maternal age or race/ethnicity were performed.
Data on 14,373,023 singleton births were included in the analyses. The mean age of the mothers of these infants was 29 ± 5.8 years. A total 267,260 (1.9%) mothers had chlamydia, 43,147 (0.3%) had gonorrhea, and 16,321 (0.1%) had syphilis. Among the study newborns, 1,146,800 (8.0%) were born prematurely. In the multivariate model, any maternal STI was associated with an increased risk of premature birth (OR, 1.06; 95% CI, 1.05, 1.07); infection with chlamydia (OR, 1.03; 95% CI, 1.02, 1.04), gonorrhea (OR, 1.11; 95% CI, 1.08, 1.15), and syphilis (OR, 1.17; 95% CI, 1.11, 1.22) were each individually associated with an increased risk of premature birth. Maternal STI was associated with an increased risk of very premature birth (OR, 1.07; 95% CI, 1.03, 1.12), and moderately preterm birth (OR, 1.06; 95% CI, 1.05, 1.08), but not extremely premature birth (OR, 1.00; 95% CI, 0.95, 1.05). There was a small but statistically significant (P <0.001) increase in the risk of premature birth associated with maternal STI among women ≥35 years old (OR, 1.09), and those 25-34 years old (OR, 1.08), compared to those <25 years old (OR, 1.06). There was a statistically significant increased risk of premature birth associated with maternal STI among women who were white (OR, 1.10; 95% CI, 1.08, 1.13), Black (1.04; 95% CI, 1.02, 1.06) and Hispanic (OR, 1.06; 95% CI, 1.03, 1.09), but not Asian (OR, 1.01; 95% CI, 0.90, 1.13).
The authors conclude that maternal infection with chlamydia, gonorrhea, or syphilis is associated with an increased risk of premature birth.
Dr Von Kohorn has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device....
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