Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa

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dc.contributor.authorNyemba, Dorothy C.
dc.contributor.authorPeters, Remco P H
dc.contributor.authorMedina-Marino, Andrew
dc.contributor.authorKlausner, Jeffrey D
dc.contributor.authorNgwepe, Phuti
dc.contributor.authorMyer, Landon
dc.contributor.authorJohnson, Leigh F
dc.contributor.authorJoseph Davey, Dvora L
dc.date.accessioned2022-04-12T09:01:06Z
dc.date.available2022-04-12T09:01:06Z
dc.date.issued2022-03-09
dc.date.updated2022-03-14T09:38:06Z
dc.description.abstractBackground Sexually transmitted infections (STIs) during pregnancy may increase the risk of adverse pregnancy outcomes. STI syndromic management is standard of care in South Africa but has its limitations. We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy and birth outcomes. Methods We combined data from two prospective studies of pregnant women attending public sector antenatal care (ANC) clinics in Tshwane District and Cape Town, South Africa. Pregnant women were enrolled, tested and treated for STIs. We evaluated the association between any STI at the first ANC visit and a composite adverse pregnancy outcome (miscarriage, stillbirth, preterm birth, early neonatal death, or low birthweight) using modified Poisson regression models, stratifying by HIV infection and adjusting for maternal characteristics. Results Among 619 women, 61% (n = 380) were from Tshwane District and 39% (n = 239) from Cape Town; 79% (n = 486) were women living with HIV. The prevalence of any STI was 37% (n = 228); C. trachomatis, 26% (n = 158), T. vaginalis, 18% (n = 120) and N. gonorrhoeae, 6% (n = 40). There were 93% (n = 574) singleton live births, 5% (n = 29) miscarriages and 2% (n = 16) stillbirths. Among the live births, there were 1% (n = 3) neonatal deaths, 7% (n = 35) low birthweight in full-term babies and 10% (n = 62) preterm delivery. There were 24% (n = 146) for the composite adverse pregnancy outcome. Overall, any STI diagnosis and treatment at first ANC visit was not associated with adverse outcomes in women living with HIV (adjusted relative risk (aRR); 1.43, 95% CI: 0.95–2.16) or women without HIV (aRR; 2.11, 95% CI: 0.89–5.01). However, C. trachomatis (aRR; 1.57, 95% CI: 1.04–2.39) and N. gonorrhoeae (aRR; 1.69, 95% CI: 1.09–3.08), were each independently associated with the composite adverse outcome in women living with HIV. Conclusion Treated STIs at the first ANC visit were not associated with adverse pregnancy outcome overall. In women living with HIV, C. trachomatis or N. gonorrhoeae at first ANC were each independently associated with adverse pregnancy outcome. Our results highlights complex interactions between the timing of STI detection and treatment, HIV infection and pregnancy outcomes, which warrants further investigation.en_US
dc.identifier.apacitationNyemba, Dorothy C., Peters, R. P. H., Medina-Marino, A., Klausner, J. D., Ngwepe, P., Myer, L., ... Joseph Davey, D. L. (2022). Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa. <i>BMC Pregnancy and Childbirth</i>, 22(1), 194. http://hdl.handle.net/11427/36343en_ZA
dc.identifier.chicagocitationNyemba, Dorothy C., Remco P H Peters, Andrew Medina-Marino, Jeffrey D Klausner, Phuti Ngwepe, Landon Myer, Leigh F Johnson, and Dvora L Joseph Davey "Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa." <i>BMC Pregnancy and Childbirth</i> 22, 1. (2022): 194. http://hdl.handle.net/11427/36343en_ZA
dc.identifier.citationNyemba, Dorothy C., Peters, R.P.H., Medina-Marino, A., Klausner, J.D., Ngwepe, P., Myer, L., Johnson, L.F. & Joseph Davey, D.L. et al. 2022. Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa. <i>BMC Pregnancy and Childbirth.</i> 22(1):194. http://hdl.handle.net/11427/36343en_ZA
dc.identifier.ris TY - Journal Article AU - Nyemba, Dorothy C. AU - Peters, Remco P H AU - Medina-Marino, Andrew AU - Klausner, Jeffrey D AU - Ngwepe, Phuti AU - Myer, Landon AU - Johnson, Leigh F AU - Joseph Davey, Dvora L AB - Background Sexually transmitted infections (STIs) during pregnancy may increase the risk of adverse pregnancy outcomes. STI syndromic management is standard of care in South Africa but has its limitations. We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy and birth outcomes. Methods We combined data from two prospective studies of pregnant women attending public sector antenatal care (ANC) clinics in Tshwane District and Cape Town, South Africa. Pregnant women were enrolled, tested and treated for STIs. We evaluated the association between any STI at the first ANC visit and a composite adverse pregnancy outcome (miscarriage, stillbirth, preterm birth, early neonatal death, or low birthweight) using modified Poisson regression models, stratifying by HIV infection and adjusting for maternal characteristics. Results Among 619 women, 61% (n = 380) were from Tshwane District and 39% (n = 239) from Cape Town; 79% (n = 486) were women living with HIV. The prevalence of any STI was 37% (n = 228); C. trachomatis, 26% (n = 158), T. vaginalis, 18% (n = 120) and N. gonorrhoeae, 6% (n = 40). There were 93% (n = 574) singleton live births, 5% (n = 29) miscarriages and 2% (n = 16) stillbirths. Among the live births, there were 1% (n = 3) neonatal deaths, 7% (n = 35) low birthweight in full-term babies and 10% (n = 62) preterm delivery. There were 24% (n = 146) for the composite adverse pregnancy outcome. Overall, any STI diagnosis and treatment at first ANC visit was not associated with adverse outcomes in women living with HIV (adjusted relative risk (aRR); 1.43, 95% CI: 0.95–2.16) or women without HIV (aRR; 2.11, 95% CI: 0.89–5.01). However, C. trachomatis (aRR; 1.57, 95% CI: 1.04–2.39) and N. gonorrhoeae (aRR; 1.69, 95% CI: 1.09–3.08), were each independently associated with the composite adverse outcome in women living with HIV. Conclusion Treated STIs at the first ANC visit were not associated with adverse pregnancy outcome overall. In women living with HIV, C. trachomatis or N. gonorrhoeae at first ANC were each independently associated with adverse pregnancy outcome. Our results highlights complex interactions between the timing of STI detection and treatment, HIV infection and pregnancy outcomes, which warrants further investigation. DA - 2022-03-09 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Pregnancy and Childbirth LK - https://open.uct.ac.za PY - 2022 T1 - Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa TI - Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa UR - http://hdl.handle.net/11427/36343 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12884-022-04520-6
dc.identifier.urihttp://hdl.handle.net/11427/36343
dc.identifier.vancouvercitationNyemba Dorothy C, Peters RPH, Medina-Marino A, Klausner JD, Ngwepe P, Myer L, et al. Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa. BMC Pregnancy and Childbirth. 2022;22(1):194. http://hdl.handle.net/11427/36343.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Pregnancy and Childbirthen_US
dc.source.journalissue1en_US
dc.source.journalvolume22en_US
dc.source.pagination194en_US
dc.source.urihttps://bmcpregnancychildbirth.biomedcentral.com/
dc.titleImpact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africaen_US
dc.typeJournal Articleen_US
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