Chlamydia trachomatis and Adverse Pregnancy Outcomes: Meta-analysis of Patients With and Without Infection
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Chlamydia trachomatis and Adverse Pregnancy Outcomes: Metaanalysis of Patients With and Without Infection Courtney Olson‑Chen1 · Kripa Balaram2 · David N. Hackney3
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Objectives We conducted a meta-analysis to determine the association between Chlamydia trachomatis and adverse perinatal outcomes. Methods Electronic databases were searched between 1970 and 2013. Included studies reported perinatal outcomes in women with and without chlamydia. Summary odds ratios were calculated using fixed- and random-effects models. Study bias was assessed using a Funnel Plot and Begg’s test. Results Of 129 articles identified, 56 studies met the inclusion criteria encompassing 614,892 subjects. Chlamydia infection in pregnancy was associated with preterm birth (OR = 1.27, 95% CI 1.05, 1.54) with a large quantity of heterogeneity (I2 = 61%). This association lost significance when limiting the analysis to high-quality studies based on the Newcastle–Ottawa Scale. Chlamydia infection in pregnancy was also associated with preterm premature rupture of membranes (OR = 1.81, 95% CI 1.0, 3.29), endometritis (OR 1.69, 95% CI 1.20, 2.38), low birthweight (OR 1.34, 95% CI 1.21, 1.48), small for gestational age (OR 1.14, 95% CI 1.05, 1.25) and intrauterine fetal demise (OR 1.44, 95% CI 1.06, 1.94). Conclusions This review provides evidence that chlamydia in pregnancy is associated with a small increase in the odds of multiple adverse pregnancy outcomes. The literature is complicated by heterogeneity and the fact that the association may not hold in higher quality and prospective studies or those that use more contemporary nucleic acid testing. Keywords Chlamydia trachomatis · Perinatal infection · Pregnancy outcomes · Preterm birth
Significance Chlamydia trachomatis is the most common sexually transmitted infection in the US. There have been conflicting reports regarding the impact of this infection during pregnancy. A comprehensive meta-analysis of 56 studies was conducted to determine the association between C.
trachomatis and adverse pregnancy outcomes with a focus on preterm birth. This study found that pregnancies affected by chlamydia are more likely to be complicated by multiple adverse outcomes including preterm birth, preterm premature rupture of membrane (PPROM), endometritis, low birth weight, small for gestational age and intrauterine fetal demise.
* Courtney Olson‑Chen Courtney_Olson‑[email protected]
Introduction
1
Division of Maternal‑Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Strong Memorial Hospital, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY 14642, USA
2
Northeast Ohio Medical University, 4209 OH‑44, Rootstown, OH 44272, USA
3
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
Chlamyd
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