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Sexually transmitted infections during pregnancy and subsequent risk of stillbirth and infant mortality in Kenya: a prospective study
  1. Alex J Warr1,
  2. Jillian Pintye2,
  3. John Kinuthia3,
  4. Alison L Drake2,
  5. Jennifer A Unger2,4,
  6. R Scott McClelland2,5,6,
  7. Daniel Matemo3,
  8. Lusi Osborn3,
  9. Grace John-Stewart2,5,6
  1. 1 Department of Pediatrics, University of Washington, Seattle, Washington, USA
  2. 2 Department of Global Health, University of Washington, Seattle, Washington, USA
  3. 3 Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
  4. 4 Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
  5. 5 Department of Epidemiology, University of Washington, Seattle, Washington, USA
  6. 6 Department of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Grace John-Stewart, Department of Global Health, University of Washington, Seattle, USA; gjohn{at}u.washington.edu

Abstract

Objectives We evaluated the relationship of sexually transmitted infections (STIs) and genital infections during pregnancy and subsequent risk for infant mortality and stillbirth.

Methods This was a nested longitudinal analysis using data from a study of peripartum HIV acquisition in Kenya. In the parent study, HIV-uninfected women were enrolled during pregnancy and followed until 9 months postpartum. For this analysis, women who tested positive for HIV at any point, had a non-singleton pregnancy or a spontaneous abortion <20 weeks were excluded. At enrolment, laboratory methods were used to screen for bacterial vaginosis (BV), vaginal yeast, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV). Syphilis was diagnosed using rapid plasma reagin testing and genital ulcer disease (GUD) identified by clinical examination. Treatment of laboratory-confirmed STIs and syndromic management was provided per Kenyan national guidelines. Predictors of stillbirth and infant mortality were determined using logistic regression and Cox proportional hazards models.

Results Overall, among 1221 women, 55% had STIs or genital infections detected: vaginal yeast (25%), BV (22%), TV (6%), CT (5%), NG (2%) and syphilis (1%). Among women with STIs/genital infections (n=592), 34% had symptoms. Overall, 19/1221 (2%) women experienced stillbirths. Among 1202 live births, 34 infant deaths occurred (incidence 4.0 deaths per 100 person-years, 95% CI 2.8 to 5.5). After adjustment for maternal age, education and study site, stillbirth was associated with maternal GUD (adjusted OR=9.19, 95% CI1.91 to 44.35, p=0.006). Maternal NG was associated with infant mortality (adjusted HR=3.83, 95% CI1.16 to 12.68, p=0.028); there was some evidence that maternal CT was associated with infant mortality. Stillbirth or infant mortality were not associated with other genital infections.

Conclusions STIs and genital infections were common, frequently asymptomatic and some associated with stillbirth or infant mortality. Expediting diagnosis and treatment of STIs in pregnancy may improve infant outcomes.

  • sexually transmitted diseases
  • Africa
  • neisseria gonorrhoeae
  • pregnancy
  • stillbirth
  • infant mortality

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Footnotes

  • AJW and JP contributed equally.

  • Handling editor Jackie A Cassell

  • Contributors AJW, JP and GJ-S conceived the question and designed the study. GJ-S obtained funding for the study. ALD, JK, JAU, DM, RSM and GJ-S participated in data collection. AJW, JP and GJ-S conducted the data analyses. All authors participated in preparation of the manuscript and approved the final draft for submission.

  • Funding Medical Student Research Training Program, University of Washington School of Medicine. This study was funded through National Institutes of Health grant (P01 HSD 064915; T32 T32AI07140 to JP; K01 AI116298 to ALD; K24 HD054314 to GJ-S) and received assistance from the University of Washington Center for AIDS Research (P30 AI27757). The Mama Salama Study Team was supported by the University of Washington’s Global Center for Integrated Health of Women Adolescents and Children (Global WACh).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All study procedures were approved by the Kenyatta National Hospital/University of Nairobi Ethical Research Committee (#P11/4/2010) and the University of Washington Institutional Review Board (#38472A) prior to study initiation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Detailed information on study data is available from GJ-S on request at gjohn@uw.edu.

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