Comparing adverse neonatal and maternal outcomes of chlamydia, gonorrhoea, and syphilis infections and co‐infections in pregnancy

Abstract

Background While maternal sexually transmitted infections (STIs) during pregnancy have been extensively studied, fewer studies have directly compared the associations of different infections and co‐infections or investigated the association between STIs in pregnancy and maternal outcomes. Objectives We examine associations between STIs and co‐infections in pregnancy on risks of adverse neonatal and maternal outcomes. Methods Data from the 2019 US natality files (n = 3,747,882) were used to assess the associations between STIs in pregnancy on adverse pregnancy outcomes. Five mutually exclusive STI groups were examined: a single chlamydia, syphilis, or gonorrhoeal infection, chlamydia and gonorrhoea co‐infection, and syphilis co‐infection (with chlamydia, gonorrhoea, or both). Demographic and obstetric characteristics among each STI group were compared to those of an uninfected comparison group. Prevalence ratios (PR) of adverse neonatal outcomes (preterm birth, small for gestational age [SGA] births, and 5‐min APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score < 7) and maternal outcomes (gestational hypertension) by STI status were examined using log‐binomial regression. Results Increased prevalence of preterm birth was apparent, especially among those with a syphilis infection (PR 1.19, 95% confidence intreval [CI] 1.10, 1.30 for single infections and PR 1.31, 95% CI 1.10, 1.57 for co‐infections). All STI groups, except gonorrhoea and chlamydia co‐infections, were associated with an increased prevalence of gestational hypertension, with the strongest association among those with syphilis co‐infections (PR 1.41, 95% CI 1.13, 1.76). Conclusions An increased prevalence was of preterm birth and low APGAR scores were associated with syphilis infection. Increased prevalence of GH among those with STIs warrants further investigation into the relationships and corresponding mechanisms of STIs in pregnancy on adverse maternal outcomes.

Importance of considering infection during pregnancy: An underappreciated and preventable perinatal concern

“…The authors show that in many cases, universal screening results in unnecessary antibiotic use for the prevention of GBS—important for tailoring our screening measures. Despite longstanding screening guidelines in the United States for sexually transmitted infections, Felske and colleagues 13 show that 2% of live births in 2019 occurred to pregnant persons with a chlamydia, gonorrhoea or syphilis infection and 0.2% were a combination of these infections (co‐infection). The resurgence of congenital syphilis over the past decade in the United States and increasing state‐wide outbreaks calls for enhanced preventive efforts and broader screening measures to better support maternal, foetal and neonatal health.…”

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

“…A recent meta-analysis [ 13 ] suggests a moderate association between gonorrhea and preterm birth, preterm premature rupture of membranes (pPROM), and perinatal mortality, but most of these studies did not include multivariable analyses, and they were limited by low screening rates in the target population. In recent studies, chlamydia and syphilis have been linked to hypertensive disorders of pregnancy (HDP) [ 14–17 ], which include a spectrum of disorders (gestational hypertension, preeclampsia, and superimposed preeclampsia) [ 18 ]. Preeclampsia, the new onset of hypertension and systemic organ dysfunction, is an HDP that imposes a great risk of maternal mortality and morbidity [ 19 ].…”

“…Preeclampsia is distinguishable from superimposed preeclampsia, which occurs among individuals entering pregnancy with chronic hypertension, and gestational hypertension, which does not result in multiple organ dysfunction. 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.…”

“…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.…”

“…Immune dysfunction very early in pregnancy is one pathway leading to placental-mediated diseases such as HDP [ 22 ]. In a recent, large study of US natality files, researchers found that chlamydia and gonorrhea coinfections with syphilis are associated with gestational hypertension [ 14 ]. However, the researchers were unable to examine other HDP.…”