Abstract：
OBJECTIVE: There is a high prevalence and incidence rate of asymptomatic sexually transmitted infections (STIs) during pregnancy in adolescent girls and young women in Africa. The association between STIs and pregnancy outcomes in a hyperepidemic HIV setting has not been well described.
METHODS: Pregnant women, HIV-1 negative and <28 weeks\' gestation at three primary health clinics in KwaZulu-Natal, South Africa were enrolled from February 2017 to March 2018. Vaginal swabs collected at the first and later antenatal visits were stored and retrospectively tested for HSV-2, Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae at the end of the study. The association between STIs detected at first and later antenatal visits and pregnancy outcome was assessed using multivariable logistic regression models adjusted for maternal age and treatment received for symptomatic STIs.
RESULTS: Testing positive Mycoplasma genitalium at the first antenatal visit was significantly associated with low birth weight (odds ratio [OR] 5.22; 95% confidence interval [CI]: 1.10-15.98). Testing positive for T. vaginalis at the repeat visit was significantly associated with preterm births (OR 2.37; 95% CI: 1.11-5.03), low birth weight (OR 2.56; 1.16-5.63) and a composite adverse pregnancy outcome (OR 2.11; 95% CI: 1.09-4.08). Testing positive for HSV-2 at the repeat visit was also likely associated with experiencing a preterm birth or any adverse pregnancy outcome (OR 3.39; 95% CI: 0.86-13.3) (P = 0.096).
CONCLUSIONS: Among predominantly asymptomatic STIs, M. genitalium detected at baseline visit was significantly associated with low birth weight, while T. vaginalis detected at the repeat visit in later pregnancy was significantly associated with preterm birth. Further research is warranted to study the impact of etiological testing of STIs at more than one antenatal visit and empirical treatment on pregnancy outcomes.
METHODS: Pregnant women, HIV-1 negative and <28 weeks\' gestation at three primary health clinics in KwaZulu-Natal, South Africa were enrolled from February 2017 to March 2018. Vaginal swabs collected at the first and later antenatal visits were stored and retrospectively tested for HSV-2, Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae at the end of the study. The association between STIs detected at first and later antenatal visits and pregnancy outcome was assessed using multivariable logistic regression models adjusted for maternal age and treatment received for symptomatic STIs.
RESULTS: Testing positive Mycoplasma genitalium at the first antenatal visit was significantly associated with low birth weight (odds ratio [OR] 5.22; 95% confidence interval [CI]: 1.10-15.98). Testing positive for T. vaginalis at the repeat visit was significantly associated with preterm births (OR 2.37; 95% CI: 1.11-5.03), low birth weight (OR 2.56; 1.16-5.63) and a composite adverse pregnancy outcome (OR 2.11; 95% CI: 1.09-4.08). Testing positive for HSV-2 at the repeat visit was also likely associated with experiencing a preterm birth or any adverse pregnancy outcome (OR 3.39; 95% CI: 0.86-13.3) (P = 0.096).
CONCLUSIONS: Among predominantly asymptomatic STIs, M. genitalium detected at baseline visit was significantly associated with low birth weight, while T. vaginalis detected at the repeat visit in later pregnancy was significantly associated with preterm birth. Further research is warranted to study the impact of etiological testing of STIs at more than one antenatal visit and empirical treatment on pregnancy outcomes.
摘要：
目的：在非洲的少女和年轻女性中，怀孕期间无症状性传播感染（STIs）的患病率和发病率很高。在高血脂的HIV环境中，性传播感染与妊娠结局之间的关联尚未得到很好的描述。
方法：孕妇，在夸祖鲁-纳塔尔省的三个初级保健诊所，HIV-1阴性和<28周妊娠，南非于2017年2月至2018年3月注册。在第一次和以后的产前检查中收集的阴道拭子被储存并回顾性地检测HSV-2，阴道毛滴虫，研究结束时的沙眼衣原体和淋病奈瑟菌。使用多变量逻辑回归模型对产妇年龄和接受有症状性传播感染的治疗进行校正，评估了首次和后期产前检查时检测到的性传播感染与妊娠结局之间的关联。
结果：第一次产前检查时，生殖道支原体检测阳性与低出生体重显著相关（比值比[OR]5.22；95%置信区间[CI]：1.10-15.98）。再次访视时阴道毛囊试验阳性与早产显著相关(OR2.37;95%CI:1.11-5.03),低出生体重(OR2.56;1.16-5.63)和复合不良妊娠结局(OR2.11;95%CI:1.09-4.08).再次就诊时HSV-2检测阳性也可能与早产或任何不良妊娠结局相关（OR3.39;95％CI：0.86-13.3）（P=0.096）。
结论：在主要无症状性性传播感染中，在基线访视时检测到的生殖支原体与低出生体重显著相关，而在妊娠后期再次访视时检测到的阴道毛虫与早产显著相关。有必要进行进一步的研究，以研究在一次以上的产前访视和经验性治疗中性传播感染的病因检测对妊娠结局的影响。
方法：孕妇，在夸祖鲁-纳塔尔省的三个初级保健诊所，HIV-1阴性和<28周妊娠，南非于2017年2月至2018年3月注册。在第一次和以后的产前检查中收集的阴道拭子被储存并回顾性地检测HSV-2，阴道毛滴虫，研究结束时的沙眼衣原体和淋病奈瑟菌。使用多变量逻辑回归模型对产妇年龄和接受有症状性传播感染的治疗进行校正，评估了首次和后期产前检查时检测到的性传播感染与妊娠结局之间的关联。
结果：第一次产前检查时，生殖道支原体检测阳性与低出生体重显著相关（比值比[OR]5.22；95%置信区间[CI]：1.10-15.98）。再次访视时阴道毛囊试验阳性与早产显著相关(OR2.37;95%CI:1.11-5.03),低出生体重(OR2.56;1.16-5.63)和复合不良妊娠结局(OR2.11;95%CI:1.09-4.08).再次就诊时HSV-2检测阳性也可能与早产或任何不良妊娠结局相关（OR3.39;95％CI：0.86-13.3）（P=0.096）。
结论：在主要无症状性性传播感染中，在基线访视时检测到的生殖支原体与低出生体重显著相关，而在妊娠后期再次访视时检测到的阴道毛虫与早产显著相关。有必要进行进一步的研究，以研究在一次以上的产前访视和经验性治疗中性传播感染的病因检测对妊娠结局的影响。
