Chlamydia trachomatis infection and pregnancy outcome

doi:10.1016/0002-9378(87)90338-3

American Journal of Obstetrics and Gynecology

Volume 156, Issue 4, April 1987, Pages 824-833

https://doi.org/10.1016/0002-9378(87)90338-3 Get rights and content

Abstract

Chlamydia trachomatis is now recognized as the most common sexually transmitted disease organism in the United States. Although the potential for vertical transmission of C. trachomatis from pregnant women to their infants is well established, the extent to which infection adversely affects pregnancy and causes perinatal complications remains controversial. We report herein the results of a prospective study of 270 pregnant women with endocervical C. trachomatis compared with 270 matched control subjects (age ± 1 year, race, and socioeconomic status). Among the entire group (n = 540), the rates of pregnancy complications were: premature rupture of the membranes, 54/270 (10%); preterm delivery, 55 (11%); amnionitis, 20 (4%); intrapartum fever, 23 (4.3%); small for gestational age, 76 (14.5%); postpartum endometritis, 31 (6%); and neonatal sepsis, 10 (1.8%). No statistically significant differences were noted between cases and controls for any of these variables. In the subset of women with recent or invasive chlamydial infection, indicated by the presence of IgM antibody against C. trachomatis, preterm delivery occurred in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03) cases. Premature rupture of the membranes was present in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03).

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Cited by (185)

Pregnancy, infection, and epigenetic regulation: A complex scenario
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A unique immunological condition, pregnancy ensures fetus from maternal rejection, allows adequate fetal development, and protects against microorganisms. Infections during pregnancy may lead to devastating consequences for pregnant women and fetuses, resulting in the mother's death, miscarriage, premature childbirth, or neonate with congenital infection and severe diseases and defects. Epigenetic (heritable changes in gene expression) mechanisms like DNA methylation, chromatin modification, and gene expression modulation during gestation are linked with the number of defects in the fetus and adolescents. The feto-maternal crosstalk for fetal survival during the entire gestational stages are tightly regulated by various cellular pathways, including epigenetic mechanisms that respond to both internal as well outer environmental factors, which can influence the fetal development across the gestational stages.
Due to the intense physiological, endocrinological, and immunological changes, pregnant women are more susceptible to bacterial, viral, parasitic, and fungal infections than the general population. Microbial infections with viruses (LCMV, SARS-CoV, MERS-CoV, and SARS-CoV-2) and bacteria (Clostridium perfringens, Coxiella burnetii, Listeria monocytogenes, Salmonella enteritidis) further increase the risk to maternal and fetal life and developmental outcome.
If the infections remain untreated, the possibility of maternal and fetal death exists. This article focused on the severity and susceptibility to infections caused by Salmonella, Listeria, LCMV, and SARS-CoV-2 during pregnancy and their impact on maternal health and the fetus. How epigenetic regulation during pregnancy plays a vital role in deciding the fetus's developmental outcome under various conditions, including infection and other stress. A better understanding of the host-pathogen interaction, the characterization of the maternal immune system, and the epigenetic regulations during pregnancy may help protect the mother and fetus from infection-mediated outcomes.
Associations of Chlamydia trachomatis serology with fertility-related and pregnancy adverse outcomes in women: a systematic review and meta-analysis of observational studies
2023, eBioMedicine
Chlamydia trachomatis (CT) infection has an increased risk for fertility-related and pregnancy adverse outcomes partly due to mechanisms related to a pro-inflammatory response to CT-, or cHSP60-induced delayed hypersensitivity. This study aimed to assess the evidence on the association between CT serology and adverse outcomes.
PubMed/Medline, Embase and Web of Science databases were searched for observational studies on the association of CT-specific antibodies (e. g. IgG, IgA, IgM, etc.) with infertility, tubal factor infertility (TFIF), ectopic pregnancy (EP), spontaneous abortion (SA), or preterm labor (PL) that were published from database inception to 31 August 2022. Pooled adjusted odds ratios or relative risks with corresponding 95% confidence intervals were calculated using a random effects model. This study was registered with PROSPERO (CRD42022368366).
We identified 128 studies that met the inclusion criteria, comprising 87 case–control, 34 cross-sectional and 7 cohort studies, for a total of 167 records involving 128,625 women participants included into the meta-analyses. Based on the adjusted estimates, it was found that CT-specific IgG was significantly associated with TFIF (pooled adjusted OR = 2.09, 95% CI 1.33–3.27, I² = 63.8%) or EP (pooled adjusted OR = 3.00, 95% CI 1.66–5.40, I² = 93.0%). Analyses of the unadjusted estimates indicated significant associations between CT-specific IgG and infertility, TFIF, EP or SA (four pooled unadjusted ORs ranging between 1.60 and 5.14, I² ranging between 40% and 83%); IgA and infertility, TFIF, EP (three pooled unadjusted ORs ranging between 3.64 and 4.91, I² ranging between 0% and 74%); IgM and TFIF (pooled unadjusted OR = 5.70, 95% CI 1.58–20.56, I² = 56%); or cHSP60 and TFIF (pooled unadjusted OR = 7.83, 95% CI 5.42–11.31, I² = 49%).
A broad range of CT-specific antibodies have been studied in association with fertility-related and pregnancy adverse outcomes. However, our study identified a low- or moderate-quality evidence for an association of CT serology with the outcomes. There are substantial research gaps in relation to the clinical implications of CT serological biomarkers.
The work was supported by the Chinese Academy of Medical Sciences Initiative for Innovative Medicine (2016-I2M-3-021).
Maternal and Perinatal Infection: Chlamydia, Gonorrhea, and Syphilis in Pregnancy
2016, Obstetrics: Normal and Problem Pregnancies
Genital infections and pregnancy
2014, Revista Medica Clinica Las Condes
La flora vaginal normal, conformada por múltiples microorganismos, juega un rol fundamental en la mantención de un ambiente adecuado de defensa contra ciertas infecciones durante el embarazo. Cuando se altera puede dar origen a Vaginosis Bacteriana, caracterizada por la presencia de múltiples bacterias en número mayor a lo habitual y que en el embarazo pueden potencialmente desencadenar efectos adversos, tanto en la madre como en el feto. Lo mismo ocurre con otro tipo de infecciones vaginales, como Clamydia y Gonorrea, que además de tener un impacto por ser las principales ETS, sus consecuencias en el feto pueden implicar secuelas de por vida. Si bien Estreptococo grupo B en la vagina no corresponde a una infección propiamente tal, su oportuna identificación y tratamiento durante el embarazo y parto, ha mostrado ser útil en la prevención de secuelas del recién nacido. El siguiente artículo aborda las principales infecciones cérvico vaginales, sus características y potenciales daños tanto para la madre como para su hijo.
The normal vaginal flora, made of multiple microorganisms, plays a main role in the maintenance of a suitable environment for defense against certain infections during pregnancy. When altered, can lead to Bacterial Vaginosis, characterized by the presence of multiple bacteria in greater numbers than usual, and during pregnancy can trigger potentially adverse effects on the mother and the fetus. The same goes for other vaginal infections such as Chlamydia and Gonorrhea, which besides having an impact for being the main STDs, its consequences in the fetus may carry lifelong threats. While Group B Streptococcus located in the| vaginal area does not imply an infection, its early Identification and treatment during pregnancy and childbirth has proved to be useful in preventing neonatal damages. The following article addresses the main cervix vaginal infections, their characteristics and potential harm to both the mother and her child.
Ovarian steroid hormones: Effects on immune responses and Chlamydia trachomatis infections of the female genital tract
2013, Mucosal Immunology
Female sex hormones are known to regulate the adaptive and innate immune functions of the female reproductive tract. This review aims to update our current knowledge of the effects of the sex hormones estradiol and progesterone in the female reproductive tract on innate immunity, antigen presentation, specific immune responses, antibody secretion, genital tract infections caused by Chlamydia trachomatis, and vaccine-induced immunity.
Ectodermal markers of early developmental impairment in very preterm individuals
2012, Psychiatry Research
Citation Excerpt :
It is commonly recognized, that there are maternal, foetal and genetic factors involved in the determination of birth weight (Goldenberg et al., 2008). These include poor gestational nutrition, low pre-pregnancy maternal weight, several maternal infections and high levels of psychological or social maternal stress (Sweet et al., 1987; Lobel et al., 1992; Copper et al., 1996; Cotch et al., 1997). Maternal smoking during pregnancy also has adverse effects on reproductive outcomes, including low birth weight and preterm delivery (Kramer, 1987; Suzuki et al., 2008).
Individuals born very preterm (before 33 weeks' gestation; VPT) are at risk of life-long, neurological impairments, behavioural and other health problems. It is not clear whether these neurodevelomental abnormalities originate prenatally, postnatally or a combination of both. Dermatoglyphics are stable ectodermal markers of neurodevelopmental disruption in the early prenatal period, as it has previously been reported in neuropsychiatric disorders such as schizophrenia or bipolar disorder. We have analyzed the dermatoglyphic variable total a–b ridge count (TABRC), which is a sensitive marker of ectodermal disruption during the first 24 weeks of foetal development, in 142 very preterm (VPT) individuals and 64 term born young adults. The VPT group showed significantly lower TABRC than the term group, especially those individuals presenting very low birth weight (VLBW), considered a proxy for more extreme prenatal stress, as shown by a two-way Anova analysis. These individuals, at risk of brain abnormalities and behavioural impairments, may have undergone disturbances before preterm birth occurs and prior to the 24th week of gestation. Our results support that dermatoglyphics represent a suitable marker to detect ectodermal alterations which have occurred very early in the course of development, and point out the vulnerability of the immature brain during the first half of gestation which may have adverse health consequences later in life.

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^☆: This work was supported in part by Public Health Service Grant HD 13453 from the National Institute of Child Health and Human Development.

^☆☆: Presented at the Fifth Annual Meeting of the American Gynecological and Obstetrical Society, Hot Springs, Virginia, September 4–6, 1986.

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American Journal of Obstetrics and Gynecology

Abstract

References (16)

Prevalence of six sexually transmitted disease agents among pregnant inner-city adolescents and pregnancy outcome

Lancet

Prospective study of perinatal transmission of Chlamydia trachomatis

JAMA

Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydia trachomatis infections

JAMA

Chlamydia trachomatis infections: policy guidelines for prevention and control

MMWR

Chlamydial infections

N Engl J Med

Chlamydial infections

N Engl J Med

Chlamydial infections

N Engl J Med

Mucopurulent cervicitis: the ignored counterpart in women of urethritis in men

N Engl J Med

Chlamydial salpingitis and infertility

Fertil Steril

Ectopic pregnancy and antibodies to Chlamydia trachomatis

Fertil Steril

Cited by (185)

Pregnancy, infection, and epigenetic regulation: A complex scenario

Associations of Chlamydia trachomatis serology with fertility-related and pregnancy adverse outcomes in women: a systematic review and meta-analysis of observational studies

Maternal and Perinatal Infection: Chlamydia, Gonorrhea, and Syphilis in Pregnancy

Genital infections and pregnancy

Ovarian steroid hormones: Effects on immune responses and Chlamydia trachomatis infections of the female genital tract

Ectodermal markers of early developmental impairment in very preterm individuals

Chlamydia trachomatis infection and pregnancy outcome☆,☆☆

Abstract

Lancet

JAMA

JAMA

Chlamydia trachomatis infections: policy guidelines for prevention and control

MMWR

Chlamydial infections

N Engl J Med

Chlamydial infections

N Engl J Med

Chlamydial infections

N Engl J Med

Mucopurulent cervicitis: the ignored counterpart in women of urethritis in men

N Engl J Med

Chlamydial salpingitis and infertility

Fertil Steril

Ectopic pregnancy and antibodies to Chlamydia trachomatis

Fertil Steril