The preterm prediction study: association of mid-trimester genital chlamydia infection and subsequent spontaneous preterm birth (SPTB)

Academic Article

Abstract

  • OBJECTIVE: To determine the association of genitourinary (GLT) tract Chlamydia trachomatis (CT) infection with SPTB. STUDY DESIGN: Among women enrolled in the NICHD MFMU Preterm Prediction Study, urine collected at 24 (22 -24 ) and 28 (27 -28 ) weeks gestational age (wks) was available for analysis in 195 of 206 cases who had a SPTD <37 wks and 201 of 206 controls who delivered at >S7 wks (matched for race, parity, and center). GU infection with CT was determined in these samples with a ligase chain reaction (LCR) assay. RESULTS: Overall, 10.9% of women were LCR+ at 24 wks and 11.3% at 2H wks. CT infection was significantly more common in the cases vs controls at 24 wks (15% vs 6%, p = .004) but not at 28 wks (14 vs 9%, p = .2). I.CR( + ) women were more likelv than LCR(-) women to have BV (24 wks; 58 s 33%, p = .001 and 28 wks; 50 vs 26%, p = .003) and a short cervix [<25 mm] (24 wks; 33 vs 18%, p = .02 and 28 wks; 4.3 vs 26%, p - .03) but were not more likely to have a positive cervicovaginal fetal fihronectin [FFN] (24 wks; 7 vs 'l<)%, p = .8 and 28 wks; 3 vs 9%, p = .5) or a low maternal BMI [<19.8] (24 wks; 37 vs 23%, p = .07 and 28 wks; 25 vs 24%, p = .9). Alter adjusting for risk factors found to be predictive of SPTB (including low socioeconomic status, prior SPTB, vaginal bleeding in the 1st or 2nd trimester, urinary tract infections, BMI < 19.8, short cervix, and a positive FFN), neither CT infection at 24 wks (OR 2.1, 95% CI 0.97-4.6) not√Ęt 28 wks (OR 1.4, 95% CI 0.6-3.1) was significantly associated with subsequent SPTB. CONCLUSION: CT infection at 24 wks was significantly more common among women who subsequently had a SPTB. CT infection was also associated with BV and a short cervix. After adjusting for these and other risk factors, the independent association of CT infection with subsequent SPTB was not conclusive. Whether the relationship between CT infection and SPTB is mediated through its association with BV or a short cervix will require additional study. 0 6 0 6
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  • Andrews WW
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  • 176
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  • 1 PART II