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

Gerwen, O. Van; Craig-Kuhn, Megan Clare; Jones, AT; Schroeder, JA; Deaver, John; Buekens, Pierre; Kissinger, PJ; Muzny, CA

doi:10.1111/1471-0528.16774

Cited by 53 publications

(49 citation statements)

References 61 publications

(301 reference statements)

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“…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.…”

Section: Discussionmentioning

confidence: 60%

“…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).…”

Section: Discussionmentioning

confidence: 95%

“…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.…”

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confidence: 99%

“…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.…”

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confidence: 99%

“…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.…”

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confidence: 99%

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

et al. 2022

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Background: Trichomonas vaginalis (TV) is the most prevalent nonviral sexually transmitted infection globally, but routine screening is not recommended in HIV-negative individuals. There is a significant racial/ethnic health disparity in TV infection rates. Evidence regarding the association between TV and adverse perinatal outcomes is conflicting, but a recent large meta-analysis found a modest increased risk of preterm birth with TV infection (odds ratio, 1.27; 95% confidence interval, 1.08-1.50). The current study was undertaken to evaluate whether TV infection increases the risk of spontaneous preterm birth (sPTB) in a high-risk obstetric cohort in Atlanta, GA. Methods:We conducted a retrospective cohort study of women delivering at a safety-net hospital in Atlanta between July 2016 and June 2018. Women delivering a singleton live fetus at >20 weeks' gestation were included. The diagnosis of TV was by nucleic acid amplification testing. The outcome of interest was sPTB before 37 weeks' gestation. Multivariable Cox proportional hazards modeling was used to estimate the effect of TVon sPTB, controlling for confounding variables, including clinical and demographic characteristics. Several sensitivity analyses were undertaken.Results: There were 3723 deliveries during the study period, and approximately half (46%) were screened for TV with nucleic acid amplification testing. After exclusions, the analytic cohort included 1629 women. Median age was 26 years (interquartile range, 22-31 years), and 70% of participants were listed as non-Hispanic Black in the electronic medical record. The prevalence of TV was 16% (n = 257). The sPTB rate was 7% (n = 112). In multivariable Cox proportional hazards modeling, TV infection was not associated with a statistically significantly increased risk of sPTB (hazard ratio, 1.34; 95% confidence interval, 0.84-2.13; P = 0.22). Factors associated with sPTB included history of PTB, adequate plus or transfer of prenatal care (vs. adequate/intermediate prenatal care utilization using the Kotelchuck index), recreational substance use, and Chlamydia trachomatis diagnosed during the current pregnancy. Results were not substantively different in sensitivity analyses. Conclusions:The prevalence of TV was high in this cohort. Its infection was not associated with a statistically significantly increased risk of sPTB. Nevertheless, the magnitude of effect is consistent with prior meta-analyses.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 95%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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

et al. 2022

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Sexually transmitted infections in pregnancy and adverse pregnancy outcomes: A retrospective cohort study

Govender,

Moodley,

Naidoo

et al. 2024

Intl J Gynecology & Obste

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ObjectiveThere is a high prevalence and incidence rate of asymptomatic sexually transmitted infections (STIs) during pregnancy in adolescent girls and young women in Africa. The association between STIs and pregnancy outcomes in a hyperepidemic HIV setting has not been well described.MethodsPregnant women, HIV‐1 negative and <28 weeks' gestation at three primary health clinics in KwaZulu‐Natal, South Africa were enrolled from February 2017 to March 2018. Vaginal swabs collected at the first and later antenatal visits were stored and retrospectively tested for HSV‐2, Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae at the end of the study. The association between STIs detected at first and later antenatal visits and pregnancy outcome was assessed using multivariable logistic regression models adjusted for maternal age and treatment received for symptomatic STIs.ResultsTesting positive Mycoplasma genitalium at the first antenatal visit was significantly associated with low birth weight (odds ratio [OR] 5.22; 95% confidence interval [CI]: 1.10–15.98). Testing positive for T. vaginalis at the repeat visit was significantly associated with preterm births (OR 2.37; 95% CI: 1.11–5.03), low birth weight (OR 2.56; 1.16–5.63) and a composite adverse pregnancy outcome (OR 2.11; 95% CI: 1.09–4.08). Testing positive for HSV‐2 at the repeat visit was also likely associated with experiencing a preterm birth or any adverse pregnancy outcome (OR 3.39; 95% CI: 0.86–13.3) (P = 0.096).ConclusionsAmong predominantly asymptomatic STIs, M. genitalium detected at baseline visit was significantly associated with low birth weight, while T. vaginalis detected at the repeat visit in later pregnancy was significantly associated with preterm birth. Further research is warranted to study the impact of etiological testing of STIs at more than one antenatal visit and empirical treatment on pregnancy outcomes.

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Trichomoniasis

Kissinger

Gerwen

Muzny

2021

Neglected Tropical Diseases

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

Cited by 53 publications

References 61 publications

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

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

Sexually transmitted infections in pregnancy and adverse pregnancy outcomes: A retrospective cohort study

Trichomoniasis

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