Top

Published in:

Open Access 01-06-2011 | INFECTIOUS DISEASES

Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study

Authors: G. Ingrid J. G. Rours, Liesbeth Duijts, Henriette A. Moll, Lidia R. Arends, Ronald de Groot, Vincent W. Jaddoe, Albert Hofman, Eric A. P. Steegers, Johan P. Mackenbach, Alewijn Ott, Hendrina F. M. Willemse, Elizabeth A. E. van der Zwaan, Roel P. Verkooijen, Henri A. Verbrugh

Published in: European Journal of Epidemiology | Issue 6/2011

Abstract

Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted infection and may influence pregnancy outcome. This study was conducted to assess the effect of chlamydial infection during pregnancy on premature delivery and birthweight. Pregnant women attending a participating midwifery practice or antenatal clinic between February 2003 and January 2005 were eligible for the study. From 4,055 women self-administered questionnaires and urine samples, tested by PCR, were analysed for C. trachomatis infection. Pregnancy outcomes were obtained from midwives and hospital registries. Gestational ages and birthweights were analysed for 3,913 newborns. The C. trachomatis prevalence was 3.9%, but varied by age and socio-economic background. Chlamydial infection was, after adjustment for potential confounders, associated with preterm delivery before 32 weeks (OR 4.35 [95% CI 1.3, 15.2]) and 35 weeks gestation (OR 2.66 [95% CI 1.1, 6.5]), but not with low birthweight. Of all deliveries before 32 weeks and 35 weeks gestation 14.9% [95% CI 4.5, 39.5] and 7.4% [95% CI 2.5, 20.1] was attributable to C. trachomatis infection. Chlamydia trachomatis infection contributes significantly to early premature delivery and should be considered a public health problem, especially in young women and others at increased risk of C. trachomatis infection.

Mardh PA. Influence of infection with Chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring. Best Pract Res Clin Obstet Gynaecol. 2002;16(6):847–64.PubMedCrossRef

Wiesenfeld HC, Hillier SL, Krohn MA, Amortegui AJ, Heine RP, Landers DV, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol. 2002;100(3):456–63.PubMedCrossRef

Peipert JF. Clinical practice. Genital chlamydial infections. N Engl J Med. 2003;349(25):2424–30.PubMedCrossRef

Manavi K. A review on infection with Chlamydia trachomatis. Best Pract Res Clin Obstet Gynaecol. 2006;20(6):941–51.PubMedCrossRef

Darville T. Chlamydia trachomatis infections in neonates and young children. Semin Pediatr Infect Dis. 2005;16(4):235–44.PubMedCrossRef

Rours GIJG, Hammerschlag MR, Ott A, De Faber TJ, Verbrugh HA, de Groot R, et al. Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants. Pediatrics. 2008;121(2):e321–6.PubMedCrossRef

Rours GIJG, Hammerschlag MR, Van Doornum GJ, Hop WC, de Groot R, Willemse HF, et al. Chlamydia trachomatis respiratory infection in Dutch infants. Arch Dis Child. 2009;94(9):705–7.PubMedCrossRef

Martin DH, Koutsky L, Eschenbach DA, Daling JR, Alexander ER, Benedetti JK, et al. Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydia trachomatis infections. JAMA. 1982;247(11):1585–8.PubMedCrossRef

Harrison HR, Alexander ER, Weinstein L, Lewis M, Nash M, Sim DA. Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy. Epidemiology and outcomes. JAMA. 1983;250(13):1721–7.PubMedCrossRef

10.

Gravett MG, Nelson HP, DeRouen T, Critchlow C, Eschenbach DA, Holmes KK. Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. JAMA. 1986;256(14):1899–903.PubMedCrossRef

11.

Sweet RL, Landers DV, Walker C, Schachter J. Chlamydia trachomatis infection and pregnancy outcome. Am J Obstet Gynecol. 1987;156(4):824–33.PubMed

12.

Alger LS, Lovchik JC, Hebel JR, Blackmon LR, Crenshaw MC. The association of Chlamydia trachomatis, Neisseria gonorrhoeae, and group B streptococci with preterm rupture of the membranes and pregnancy outcome. Am J Obstet Gynecol. 1988;159(2):397–404.PubMed

13.

Association of Chlamydia trachomatis and Mycoplasma hominis with intrauterine growth retardation and preterm delivery. The John Hopkins Study of Cervicitis and Adverse Pregnancy Outcome. Am J Epidemiol. 1989;129(6):1247–57.

14.

Ngassa PC, Egbe JA. Maternal genital Chlamydia trachomatis infection and the risk of preterm labor. Int J Gynaecol Obstet. 1994;47(3):241–6.PubMedCrossRef

15.

Claman P, Toye B, Peeling RW, Jessamine P, Belcher J. Serologic evidence of Chlamydia trachomatis infection and risk of preterm birth. CMAJ. 1995;153(3):259–62.PubMed

16.

Nadisauskiene R, Bergstrom S, Stankeviciene I, Spukaite T. Endocervical pathogens in women with preterm and term labour. Gynecol Obstet Invest. 1995;40(3):179–82.PubMedCrossRef

17.

Martin DH, Eschenbach DA, Cotch MF, Nugent RP, Rao AV, Klebanoff MA, et al. Double-blind placebo-controlled treatment trial of Chlamydia trachomatis endocervical infections in pregnant women. Infect Dis Obstet Gynecol. 1997;5(1):10–7.PubMedCrossRef

18.

Kovacs L, Nagy E, Berbik I, Meszaros G, Deak J, Nyari T. The frequency and the role of Chlamydia trachomatis infection in premature labor. Int J Gynaecol Obstet. 1998;62(1):47–54.PubMedCrossRef

19.

Rastogi S, Kapur S, Salhan S, Mittal A. Chlamydia trachomatis infection in pregnancy: risk factor for an adverse outcome. Br J Biomed Sci. 1999;56(2):94–8.PubMed

20.

Gencay M, Koskiniemi M, Ammala P, Fellman V, Narvanen A, Wahlstrom T, et al. Chlamydia trachomatis seropositivity is associated both with stillbirth and preterm delivery. APMIS. 2000;108(9):584–8.PubMedCrossRef

21.

Andrews WW, Goldenberg RL, Mercer B, Iams J, Meis P, Moawad A, et al. The preterm prediction study: association of second-trimester genitourinary chlamydia infection with subsequent spontaneous preterm birth. Am J Obstet Gynecol. 2000;183(3):662–8.PubMedCrossRef

22.

Odendaal HJ, Schoeman J. The association between Chlamydia trachomatis genital infection and spontaneous preterm labour. S. Afr J Obstet Gynaecol. 2006;12(3):146–9.

23.

Andrews WW, Klebanoff MA, Thom EA, Hauth JC, Carey JC, Meis PJ, et al. Midpregnancy genitourinary tract infection with Chlamydia trachomatis: association with subsequent preterm delivery in women with bacterial vaginosis and Trichomonas vaginalis. Am J Obstet Gynecol. 2006;194(2):493–500.PubMedCrossRef

24.

Blas MM, Canchihuaman FA, Alva IE, Hawes SE. Pregnancy outcomes in women infected with Chlamydia trachomatis: a population-based cohort study in Washington State. Sex Transm Infect. 2007;83(4):314–8.PubMedCrossRef

25.

Wilson JS, Honey E, Templeton A, Paavonen J, Mardh PA, Stray-Pedersen B. A systematic review of the prevalence of Chlamydia trachomatis among European women. Hum Reprod Update. 2002;8(4):385–94.PubMedCrossRef

26.

Smith JR, Taylor-Robinson D. Infection due to Chlamydia trachomatis in pregnancy and the newborn. Baillieres Clin Obstet Gynaecol. 1993;7(1):237–55.PubMedCrossRef

27.

Adams EJ, Charlett A, Edmunds WJ, Hughes G. Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies. Sex Transm Infect. 2004;80(5):354–62.PubMedCrossRef

28.

van Bergen J, Gotz HM, Richardus JH, Hoebe CJ, Broer J, Coenen AJ. Prevalence of urogenital Chlamydia trachomatis increases significantly with level of urbanisation and suggests targeted screening approaches: results from the first national population based study in the Netherlands. Sex Transm Infect. 2005;81(1):17–23.PubMedCrossRef

29.

Jaddoe VW, Bakker R, van Duijn CM, van der Heijden AJ, Lindemans J, Mackenbach JP, et al. The generation r study biobank: a resource for epidemiological studies in children and their parents. Eur J Epidemiol. 2007;22(12):917–23.PubMedCrossRef

30.

Jaddoe VW, van Duijn CM, van der Heijden AJ, Mackenbach JP, Moll HA, Steegers EA, et al. The generation R study: design and cohort update 2010. Eur J Epidemiol. 2010;25(11):823–41.PubMedCrossRef

31.

Rours GIJG, Verkooyen RP, Willemse HF, van der Zwaan EA, van Belkum A, de Groot R, et al. Use of pooled urine samples and automated DNA isolation to achieve improved sensitivity and cost-effectiveness of large-scale testing for Chlamydia trachomatis in pregnant women. J Clin Microbiol. 2005;43(9):4684–90.PubMedCrossRef

32.

Niklasson AEA, Fryer JG, Karlberg J, Lawrence C, Karlberg P. An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977–1981). Acta Paediatr Scand. 1991;80(8–9):756–62.PubMedCrossRef

33.

Rothman K.J. GS. Modern epidemiology. second ed: Lippincott-Raven 1998.

34.

Kataoka S, Yamada T, Chou K, Nishida R, Morikawa M, Minami M, et al. Association between preterm birth and vaginal colonization by mycoplasmas in early pregnancy. J Clin Microbiol. 2006;44(1):51–5.PubMedCrossRef

35.

Silveira MF, Ghanem KG, Erbelding EJ, Burke AE, Johnson HL, Singh RH, et al. Chlamydia trachomatis infection during pregnancy and the risk of preterm birth: a case-control study. Int J STD AIDS. 2009;20(7):465–9.PubMedCrossRef

36.

Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, et al. Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG. 2005;112(4):430–7.PubMedCrossRef

37.

The Netherlands Perinatal Registry. Perinatal Care in the Netherlands 2003. Bilthoven: Stichting Perinatale Registratie; 2006.

38.

Thomas AG, Brodine SK, Shaffer R, Shafer MA, Boyer CB, Putnam S, et al. Chlamydial infection and unplanned pregnancy in women with ready access to health care. Obstet Gynecol. 2001;98(6):1117–23.PubMedCrossRef

39.

Chen MY, Fairley CK, De Guingand D, Hocking JS, Tabrizi S, Wallace EM, et al. Screening pregnant women for chlamydia: what are the predictors of infection? Sex Transm Infect. 2008;85(1):31–5.PubMedCrossRef

40.

Gotz HM, van Bergen JE, Veldhuijzen IK, Broer J, Hoebe CJ, Steyerberg EW, et al. A prediction rule for selective screening of Chlamydia trachomatis infection. Sex Transm Infect. 2005;81(1):24–30.PubMedCrossRef

41.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2006;55(RR-11):1–94.

42.

U.S. Preventive Services Task Force. Screening for Chlamydial infection: U.S. preventive services task force recommendation statement. Ann Intern Med. 2007;147(2):128–34.

43.

Bernloehr A, Smith P, Vydelingum V. Antenatal care in the European Union: a survey on guidelines in all 25 member states of the Community. Eur J Obstet Gynecol Reprod Biol. 2005;122(1):22–32.PubMedCrossRef

44.

Health Council of the Netherlands. Screening for Chlamydia, nr 2004/07. 2004:1–106.

Title: Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study
Authors: G. Ingrid J. G. Rours
Liesbeth Duijts
Henriette A. Moll
Lidia R. Arends
Ronald de Groot
Vincent W. Jaddoe
Albert Hofman
Eric A. P. Steegers
Johan P. Mackenbach
Alewijn Ott
Hendrina F. M. Willemse
Elizabeth A. E. van der Zwaan
Roel P. Verkooijen
Henri A. Verbrugh
Publication date: 01-06-2011
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 6/2011
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-011-9586-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2011

Influence of common variants in FTO and near INSIG2 and MC4R on growth curves for adiposity in African– and European–American youth

The Mayo Lung Project lung cancer mortality findings are unlikely to be biased by a volunteer effect

Rebuilding bridges: what is the real role of social class in disease occurrence?

Maternal smoking during pregnancy and risks of suicidal acts in young offspring

Informativeness of indices of blood pressure, obesity and serum lipids in relation to ischaemic heart disease mortality: the HUNT-II study

Estimating measures of interaction on an additive scale for preventive exposures