期刊
JOURNAL OF INFECTIOUS DISEASES
卷 224, 期 12, 页码 2085-2093出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiab277
关键词
preterm birth; sexually transmitted infections; chlamydia; gonorrhea; HIV; STI
资金
- National Institutes of Health (NIH) [P01 HSD 064915]
- Center for AIDS Research (CFAR) [P30 AI27757]
- University of Washington Global Center for Integrated Health of Women, Adolescents, and Children
This study found that sexually transmitted infections and incident HIV during pregnancy are predictors of preterm birth in Kenya, suggesting the need for earlier treatment and interventions to decrease genital inflammation.
Background. Identifying predictors of preterm birth (PTB) in high-burden regions is important as PTB is the leading cause of global child mortality. Methods. This analysis was nested in a longitudinal study of human immunodeficiency virus (HIV) incidence in Kenya. HIV-seronegative women enrolled in pregnancy had nucleic acid amplification tests (chlamydia and gonorrhea), rapid plasma reagin (syphilis), wet mount microscopy (Trichomonas and yeast), and Gram stain (bacterial vaginosis); sexually transmitted infection (STI) treatment was provided. PTB predictors were determined using log-binomial regression. Results. Among 1244 mothers of liveborn infants, median gestational age at enrollment was 26 weeks (IQR, 22-31), and at delivery was 39.1 weeks (IQR, 37.1-40.9). PTB occurred in 302 women (24.3%). Chlamydia was associated with a 1.59-fold (P = .006), gonorrhea a 1.62-fold (P = .04), and incident HIV a 2.08-fold (P = .02) increased PTB prevalence. Vaginal discharge and cervical inflammation were associated with PTB, as were age <= 21 (prevalence ratio [PR] = 1.39, P = .001) and any STI (PR = 1.47, P = .001). Associations with chlamydia and incident HIV remained in multivariable models. Conclusions. STIs and incident HIV in pregnancy predicted PTB despite treatment, suggesting the need for earlier treatment and interventions to decrease genital inflammation.
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