Article Text

Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae: systematic review and meta-analysis
  1. Lisa M Vallely1,
  2. Dianne Egli-Gany2,
  3. Handan Wand3,
  4. William S Pomat4,
  5. Caroline S E Homer5,
  6. Rebecca Guy6,
  7. Bronwyn Silver7,
  8. Alice R Rumbold8,
  9. John M Kaldor1,
  10. Andrew J Vallely1,9,
  11. Nicola Low2
  1. 1Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
  2. 2Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
  3. 3Biostatistics and Databases program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
  4. 4Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
  5. 5Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
  6. 6Surveillance and Evaluation Research, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
  7. 7Public Health Division, Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
  8. 8Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
  9. 9Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
  1. Correspondence to Dr Lisa M Vallely, Kirby Institute, UNSW, Sydney, NSW 2052, Australia; lvallely{at}


Objective To examine associations between Neisseria gonorrhoeae (NG) infection during pregnancy and the risk of preterm birth, spontaneous abortion, premature rupture of membranes, perinatal mortality, low birth weight and ophthalmia neonatorum.

Data sources We searched Medline, EMBASE, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature for studies published between 1948 and 14 January 2020.

Methods Studies were included if they reported testing for NG during pregnancy and compared pregnancy, perinatal and/or neonatal outcomes between women with and without NG. Two reviewers independently assessed papers for inclusion and extracted data. Risk of bias was assessed using established checklists for each study design. Summary ORs with 95% CIs were generated using random effects models for both crude and, where available, adjusted associations.

Results We identified 2593 records and included 30 in meta-analyses. Women with NG were more likely to experience preterm birth (OR 1.55, 95% CI 1.21 to 1.99, n=18 studies); premature rupture of membranes (OR 1.41, 95% CI 1.02 to 1.92, n=9); perinatal mortality (OR 2.16, 95% CI 1.35 to 3.46, n=9); low birth weight (OR 1.66, 95% CI 1.12 to 2.48, n=8) and ophthalmia neonatorum (OR 4.21, 95% CI 1.36 to 13.04, n=6). Summary adjusted ORs were, for preterm birth 1.90 (95% CI 1.14 to 3.19, n=5) and for low birth weight 1.48 (95% CI 0.79 to 2.77, n=4). In studies with a multivariable analysis, age was the variable most commonly adjusted for. NG was more strongly associated with preterm birth in low-income and middle-income countries (OR 2.21, 95% CI 1.40 to 3.48, n=7) than in high-income countries (OR 1.38, 95% CI 1.04 to 1.83, n=11).

Conclusions NG is associated with a number of adverse pregnancy and newborn outcomes. Further research should be done to determine the role of NG in different perinatal mortality outcomes because interventions that reduce mortality will have the greatest impact on reducing the burden of disease in low-income and middle-income countries.

PROSPERO registration number CRD42016050962.

  • Neisseria gonorrhoeae
  • premature birth
  • meta-analysis
  • pregnancy
  • systematic review

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  • Handling editor Alec Miners

  • Twitter @lisa_vallely, @nicolamlow

  • LMV and DE-G contributed equally.

  • Contributors LV is the guarantor of the manuscript. AV, NL, JK and conceived the study. LV and DE-G led the study, including screening and data extraction; NL supported data extraction. HW undertook all data analysis, along with NL, DE-G. LV, DE-G and NL wrote the first draft of the manuscript, CSEH and AV reviewed the first draft. NL, AV, WSP, RG, HW, CSEH, BS, AR and JK contributed to various drafts of the manuscript. All authors read, provided feedback and approved the final manuscript.

  • Funding LV receives salary support from the Australian National Health and Medical Research Council (NHMRC), through an early career fellowship. DE-G received salary support from r4d programme (Swiss Programme for Research on Global Issues for Development), grant number IZ07Z0-160909. AV receives salary support from the Australian NHMRC, through a Career Development Fellowship and CH through an NHMRC Research Fellowship.

  • Disclaimer The funders played no role in the development of the protocol or the analyses conducted.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Not required.

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