目的:生殖道支原体感染与可产性降低相关吗?
结论:孕前生殖道支原体感染与可产性降低27%相关,尽管置信区间很宽,生殖支原体与生殖能力之间的关联可能取决于并发细菌性阴道病(BV)。
背景:M.生殖器与宫颈炎有关,盆腔炎,不孕症,和早产,但是生殖支原体与女性不良生殖后遗症的因果关系存在争议。
方法:参加前瞻性孕前队列的肯尼亚妇女提供了阴道液标本,每月接受妊娠试验。使用核酸扩增测试对407名试图怀孕≤6个月的女性的储存样品进行了生殖支原体测试。
方法:末次月经第一天的数据,性行为,怀孕状态,和阴道标本在孕前每月就诊时收集。使用离散时间比例概率模型估计在每次妊娠测试之前的访问中检测到的生殖支原体与可繁殖性之间的关联。次要分析探讨了同时发生的BV对生殖支原体和可育性之间关联的影响。
结果:407名参与者经历了1220个月经周期和213次怀孕。入组时生殖支原体的患病率为7.7%。调整后的年龄,在过去的4周内发生无套性生活的频率,和研究现场,生殖分枝杆菌与27%的可产性降低有关,但置信区间较宽(调整后的可产性比(aFR)0.73,95%CI0.44,1.23).在二级分析中,当与之前就诊时没有生殖分枝杆菌或BV的周期相比时,先前就诊时同时患有生殖支原体和BV的女性的可育性降低了51%(aFR=0.49,95%CI0.22,1.09),而单独与生殖支原体无关(aFR=0.98(95%CI0.54,1.76)),而仅患有BV的女性的可育性降低较小(aFR=0.80(95%CI0.60,1.07))。
结论:鉴于生殖支原体的患病率相对较低和置信区间较宽,应谨慎解释结果。
结论:在这群试图怀孕的肯尼亚妇女中,生殖支原体和生殖能力之间的关联受到并发BV状态的影响,提示生殖支原体和BV对可育性可能有协同作用。
背景:这项工作得到了美国国立卫生研究院的资助(NICHDR01HD087346-RSM)。R.S.M.获得了额外的指导支持(NICHDK24HD88229)。E.M.L.得到了前和博士后奖学金(NIAIDT32AI07140,NICHDF32HD100202)的支持。数据收集和管理是使用华盛顿大学转化健康科学研究所托管的REDCap电子数据捕获工具完成的,该工具得到了NCATS/NIH(UL1TR002319)的资助。本文的内容完全是作者的责任,不一定代表美国国立卫生研究院的官方观点。R.S.M.接受研究资助,付给华盛顿大学,来自Hologic公司和卢平制药公司的咨询费。L.E.M.接受研究经费和材料的研究研究,付给华盛顿大学,来自Hologic公司和Nabriva治疗,Hologic的旅行支持,和健康进步的咨询费。E.M.L.对这项研究的贡献主要发生在华盛顿大学的附属机构;在提交时,E.M.L.是AbbVie的雇员,并持有AbbVie的股票或股票赠款,其他作者没有利益冲突。
背景:不适用。
Is Mycoplasma genitalium-infection associated with reduced fecundability?
Preconception M. genitalium-infection was associated with 27% lower fecundability though confidence intervals were wide, and the association between M. genitalium and fecundability may be dependent on concurrent bacterial vaginosis (BV).
M. genitalium has been associated with cervicitis, pelvic inflammatory disease, infertility, and preterm birth, but the extent to which M. genitalium is causally related to adverse reproductive sequelae in women is debated.
Kenyan women enrolled in a prospective preconception cohort provided vaginal fluid specimens and underwent monthly pregnancy testing. Stored samples from 407 women who had been trying to conceive for ≤6 months were tested for M. genitalium using a nucleic acid amplification test.
Data on first day of last menstrual period, sexual behavior, pregnancy status, and vaginal specimens were collected at monthly preconception visits. The association between M. genitalium detected at the visit prior to each pregnancy test and fecundability was estimated using discrete time proportional probabilities models. Secondary analyses explored the influence of concurrent BV on the association between M. genitalium and fecundability.
The 407 participants experienced 1220 menstrual cycles and 213 pregnancies. The prevalence of M. genitalium at enrollment was 7.7%. After adjustment for age, frequency of condomless sex in the last 4 weeks, and study site, M. genitalium was associated with a 27% lower fecundability, but confidence intervals were wide (adjusted fecundability ratio (aFR) 0.73, 95% CI 0.44, 1.23). In secondary analyses, when compared to cycles without M. genitalium or BV at the visit prior, women with both M. genitalium and BV at the visit prior had a 51% lower fecundability (aFR = 0.49, 95% CI 0.22, 1.09) whereas there was no association of M. genitalium alone (aFR = 0.98 (95% CI 0.54, 1.76)), and a smaller reduction in fecundability for women with BV only (aFR = 0.80 (95% CI 0.60, 1.07)).
Results should be interpreted cautiously given the relatively low prevalence of M. genitalium and wide confidence intervals.
In this cohort of Kenyan women trying to conceive, the association between M. genitalium and fecundability was influenced by concurrent BV status, suggesting there may be a synergistic effect of M. genitalium and BV on fecundability.
This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-RSM). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were completed using REDCap electronic data capture tools hosted at the University of Washington\'s Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation and consulting fees from Lupin Pharmaceuticals. L.E.M. receives research funding and material for research studies, paid to the University of Washington, from Hologic Corporation and Nabriva Therapeutics, travel support from Hologic, and consulting fees from Health Advances. E.M.L.\'s contributions to this study primarily occurred while affiliated with the University of Washington; at the time of submission, E.M.L. was an employee of and holds stock or stock grants for AbbVie, Inc. The other authors have no conflicts of interest.
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